Recognizing the pattern
Consider inflammatory back pain in patients whose symptoms:

• Began before age 45
• Have lasted for three months or longer
• Improve with movement or exercise rather than rest
• Include prolonged morning stiffness or pain that wakes them at night

Other clues can include heel pain, swollen joints or digits, and a personal or family history of psoriasis, inflammatory bowel disease or uveitis.

When several of these features occur together, spondyloarthritis should be considered.

Remember: symptoms can look different in women
Women can experience longer delays in receiving an axSpA diagnosis. Symptoms may not always follow the pattern clinicians expect and may extend beyond the lower back.

The practical takeaway: persistent symptoms that suggest inflammatory pain deserve a closer look, even when initial findings are inconclusive.

What can primary care clinicians do?
Depending on the patient’s presentation, initial evaluation may include inflammatory markers and imaging. Normal test results do not necessarily rule out axSpA, so continued clinical suspicion may warrant rheumatology referral.

A rheumatologist can determine whether additional imaging, testing or specialist treatment is appropriate.

Supporting patients while they’re being evaluated
Exercise and physical therapy play important roles in managing spondyloarthritis and maintaining mobility. NSAIDs are also commonly used to help manage pain and stiffness.

Patients whose symptoms persist despite initial treatment may need specialist assessment for additional treatment options.

For primary care clinicians, the important point is not to let persistent inflammatory-type back pain linger without further evaluation.

A quick reminder for your next patient
When you see a younger patient with persistent back pain, ask:

"When did it begin? How long has it lasted? Does movement make it better or worse?"

Those few questions can help distinguish everyday mechanical back pain from symptoms that deserve a closer look, and potentially help a patient reach the right diagnosis sooner.

Every year, the Healthcare Immersion Program (HIP) is made possible by an incredible group of healthcare professionals who generously open their practices, share their expertise, and give students an authentic look at life in healthcare. We can't thank our preceptors enough for the time, encouragement, and mentorship they provide.

For many students, HIP is their first opportunity to experience healthcare beyond the classroom. It's an experience that often shapes future career decisions, and we're proud that many former HIP students have gone on to become clinicians themselves.

We're delighted to recognize and thank our 2026 preceptors:

Golden State Orthopedics & Spine:

• Michael Sacco, MD – Orthopedic Surgery, Upper Extremity
• Charles Preston, MD – Orthopedic Surgery, General / Sports Medicine
• Louay Toma, MD – Orthopedic Surgery, Total Hip & Knee / General
• Alexander Bradley, MD – Orthopedic Surgery, Total Joint
• Connor Byrne, MD – Total Joint – Hip & Knee
• Special thanks to site coordinator Maggie Stroud

Touro University:

• Victor A. Nuño, DO
• Angela M. Abuda

Webster Outpatient Surgery Center:

• J. Theodore Schwartz Jr., MD
• Dorothy DeMartini
• Sandy Luong

Stanford Health Care:

• Nina Ramos, MSN, RN, ONC
• Aaron Salyapongse, MD
• Kathryn Segura; Krystal Dimaya
• Robin Mercer, PA-C
• Victoria Redmond

To each of our preceptors, thank you for investing in the next generation of healthcare professionals. Your generosity makes a lasting difference.

We’re delighted to welcome the 2026 cohort of Jackson Orthopedic Foundation’s Healthcare Immersion Program (HIP): Jaylene Banaag, Danica Bagayna, Megan Truong, and William Anderson.

Over the course of the four-week program, our students will shadow experienced healthcare professionals in a variety of clinical settings, gaining first-hand insight into different healthcare careers and the many roles involved in delivering high-quality musculoskeletal care.

Alongside their clinical experiences, students will attend weekly clinical conferences, connect with healthcare professionals, and learn more about the education, skills, and experiences that can shape a career in healthcare.

This change supports our ongoing commitment to making our courses more affordable, accessible, and convenient for busy clinicians. JOF's new platform will offer a more user-friendly experience for both students and instructors, making it easier to navigate content, track progress, and engage with course materials.

This move also allows us to streamline how we deliver and support our courses, so we can focus more of our time and resources on what matters most: expanding access to high-quality MSK education.

We will continue to offer the same high-quality, nationally accredited online and hybrid courses our students rely on. 

If you are currently one of our students who has been using Canvas LMS, you will be contacted shortly with details about your transition to our new platform. We’re taking steps to ensure this process is smooth and is minimally disruptive.

We’re looking forward to delivering an even better learning experience in the months ahead, as we continue our mission to close the MSK education gap and support confident, high-quality care in primary settings.

Questions? Read our FAQ or get in touch.

We’re inviting a small group of clinicians to test our new platform ahead of the June transition. We'd love your help.

Just click the button below and watch our Orthopedic Primary Care Foundations video. Then share your feedback and we’ll thank you with 1 free CE.

We’re excited to welcome three outstanding clinicians and educators to the Jackson Orthopedic Foundation faculty. Tom Bush, Matt Jacinto, and Matthew Scroggy will be teaching our nationally certified, in-person Orthopalooza workshops.

Combined, they bring a great mix of experience, perspectives, and a shared commitment to improving musculoskeletal (MSK) care in primary care settings. As we continue to grow, their experience will help us reach and support more clinicians across the country.

Tom has served as educator, and clinician at the University of North Carolina at Chapel Hill for over 30 years. His clinical experience ranges from critical care to primary care and he has maintained an active clinical practice at the UNC Department of Orthopedic Surgery for more than two decades.

He has developed, implemented and evaluated multiple experiential clinical training programs through the UNC Schools of Nursing and Medicine. His research focus is on postgraduate APP education directed toward improving access to high quality musculoskeletal care. 

Matt is a board-certified Family Nurse Practitioner with over five years of experience in neurosurgery and physical medicine and rehabilitation. His clinical practice has centered on the evaluation and management of spine and musculoskeletal conditions across acute, outpatient, and rehabilitation settings.

He has developed expertise in neurosurgical spine assessments and the musculoskeletal physical exam, with an emphasis on accurate diagnosis, clinical reasoning, and practical bedside application. Matt is passionate about teaching efficient, high-yield examination techniques that enhance provider confidence and improve patient care.

Through his work, he aims to bridge the gap between clinical examination and real-world decision-making in spine and musculoskeletal medicine.

Matthew is a Nurse Practitioner, surgical first assistant, and works in a team specializing in orthopedic sports medicine and the treatment of shoulder, elbow and knee injury.  He also performs injection therapies and conservative management of non-operative interventions of minor musculoskeletal injuries.

He has a strong background in human movement and sports science with a BS degree in Kinesiology. He worked as a physical therapy aide for several years before returning to school to earn his Master of Science in Nursing from Samuel Merritt University.

Matthew’s passion for building meaningful relationships, combined with a strong interest in sports medicine and kinesiology led him to pursue a career as a nurse practitioner with an emphasis on sports medicine and orthopedics.

We’re proud to welcome Tom, Matt, and Matthew to the JOF instructor team. Their combined expertise strengthens our ability to deliver practical, evidence-based MSK education that helps clinicians feel more confident in diagnosing and treating common conditions.

As our programs continue to expand, we’re always looking for experienced clinicians who are passionate about teaching and improving care.

If you’d like to help other clinicians build their MSK skills and confidence, we’d love to hear from you. Get in touch to learn more about joining our instructor community.  Here's a link to the position description.

Juvenile arthritis is a diagnosis primary care clinicians, including nurse practitioners, may encounter in children and adolescents with joint pain, swelling, stiffness, limp, fatigue, or unexplained fever or rash. Early recognition matters, because timely treatment can reduce pain, preserve function, and help prevent long-term joint damage.

Juvenile idiopathic arthritis is the most common form of arthritis in kids and teens, and symptoms can be subtle early on. Common features include morning stiffness, swollen or warm joints, limp, fatigue, rash, and sometimes eye symptoms or systemic features such as fever.

Current CDC data estimate that about 220,000 U.S. children and adolescents under 18 had diagnosed arthritis during 2017–2021, with the highest prevalence in ages 12–17.

These patients may also need school accommodations and multidisciplinary follow-up depending on subtype and severity.

Parents may come across misleading information online, so it can help to gently correct a few common myths. Juvenile arthritis is not just “growing pains,” it does not always cause obvious swelling right away, and a child can look well even when the disease is active.

It is also not true that every child simply grows out of it; some children improve, but others need longer-term follow-up and treatment.

• It’s not just growing pains.
• It may not always look dramatic at first.
• A child can appear well and still have active disease.
• Not every child simply “outgrows” juvenile arthritis.

Treatment for juvenile arthritis usually focuses on reducing inflammation, relieving pain, preserving joint function, and helping the child stay active and engaged in daily life.

The Mayo Clinic notes that treatment may include medicines such as NSAIDs, disease-modifying antirheumatic drugs, and biologic therapies, along with physical therapy, occupational therapy, and sometimes corticosteroid injections or other supportive care depending on the subtype and severity.

In practice, care is often individualized and may also involve ophthalmology monitoring and other specialist input when eye involvement or systemic features are a concern.

When a child with juvenile arthritis is still in pain or not responding well to treatment, families often explore complementary and alternative therapies, but these should be used alongside, not instead of, medical care. Some approaches such as exercise, massage, yoga, and acupuncture may help with symptoms, while supplements and CBD require extra caution because the evidence is limited and safety, dosing, and medication interactions are not always clear.

Clinicians who want to review current information on juvenile arthritis can visit:

• CDC: Arthritis Among Children and Adolescents Aged <18 Years — United States, 2017–2021
• Mayo Clinic: Juvenile idiopathic arthritis — Symptoms and causes
• Mayo Clinic: Juvenile idiopathic arthritis — Diagnosis and treatment
• Cincinnati Children’s: 8 Misconceptions about Juvenile Idiopathic Arthritis (JIA)
• Blue Cross and Blue Shield of Alabama: 6 Myths (and Facts) about Juvenile Arthritis
• Allergy Institute: Myths and Facts About Juvenile Arthritis
• HealthCentral: (Video) Fake or Fact? Juvenile Idiopathic Arthritis Edition
• Arthritis Foundation: CAM Therapies to Try for Juvenile Arthritis
• Arthritis Foundation: Federal Laws That Support Kids With JA in School
  

If you know a college student with an interest in healthcare, now is a good time to encourage them to apply for the 2026 Healthcare Immersion Program (HIP).

Our 2026 program runs from July 7 to July 31, and applications are now open. The deadline to apply is Monday, June 8, 2026.

Many students are interested in careers such as nursing, medicine, physician assistant studies, physical therapy, or occupational therapy, but have limited opportunities to see what those paths actually look like in day-to-day practice. The Healthcare Immersion Program helps bridge that gap through structured shadowing, mentorship, and guided reflection.

HIP is a four-week summer program that allows participants to learn directly from licensed clinicians in real care settings, observe a range of clinical roles, and gain greater clarity and confidence about their future direction.

HIP is not a classroom simulation. It is real clinical exposure in real care settings.

Students in the program have the opportunity to:

• Shadow licensed clinicians (preceptors) as they care for patients
  
• Observe different healthcare roles, not just one pathway
• Learn directly from professionals who enjoy mentoring students
• Build clarity and confidence about their future direction
• Reflect on what they are seeing through weekly clinical conferences

Many students describe HIP as the moment when healthcare stops feeling abstract and starts to feel possible.

HIP is designed to provide substantial clinical exposure while remaining flexible enough to fit around summer work, classes, and other commitments.

During the four-week program, students typically:

• Complete shadowing in 4-hour blocks during standard weekday hours
  
• Participate in at least two shadowing sessions per week, with opportunities to do more
• Join weekly clinical conferences for guided reflection and learning
• Take part in surgery observation later in the program
• Log approximately 80 to 100 total hours

Students share their availability at the start of the program, and schedules are coordinated accordingly.

HIP is open to college students who:

• Have completed at least one year of college
  
• Are interested in exploring a healthcare career
• Are curious, reliable, and ready to learn
  

This program is ideal for students who want more than general advice or online research. It is for students who are ready to gain firsthand exposure to healthcare settings and begin making more informed decisions about their future.

Students applying to HIP will need to submit:

• High school transcripts
• College or university transcripts to date
• Letter or letters of recommendation
• A personal statement
• A copy of photo ID
• Vaccination record

If selected for the program, students may also be required to receive additional vaccinations as required by Jackson Orthopedic Foundation’s clinical partners.

Program fee and scholarships
The program fee for HIP is $500. Scholarships are available for students with financial need. 

By supporting the Healthcare Immersion Program, you help more students access early clinical learning, mentorship, and the kind of real-world experience that can shape a future in healthcare. Your gift helps build a stronger, more prepared healthcare workforce.

We are relaunching the Orthopalooza series with Musculoskeletal Fundamentals, our most popular course, built specifically for primary care clinicians who want practical, real-world confidence managing common muscle, bone, and joint conditions.

You will strengthen your ability to:

•  Perform focused MSK exams
•  Improve diagnostic reasoning
•  Interpret imaging
•  Make safe, scope-appropriate treatment decisions
•  Build procedural confidence

Orthopalooza is ideal for:

• Nurse practitioners, clinical nurse specialists, and APRNs
• Physicians and other advanced practice providers
• Clinicians in primary care, urgent care, and outpatient settings
• Providers early in their MSK journey or looking to refresh and refine existing skills
  

Have a colleague who would benefit from stronger MSK confidence in primary care? Please feel free to share this with them. We would love to welcome them too!

Primary care is often the best place to treat common muscle, bone, and joint problems, and winter makes that role especially clear. As colder temperatures, seasonal storms, and disrupted routines affect how people move and work, musculoskeletal (MSK) complaints become a frequent reason for primary care and urgent care visits. 

During the current Arctic blast, for example, many nurse practitioners and other advanced practice providers are likely seeing how slippery surfaces, heavy lifting, cold-related stiffness, deconditioning, and winter sports contribute to predictable injury patterns. 

Following are common winter MSK injury patterns, how they typically present, and practical insights intended to support primary care clinicians in delivering confident, nonsurgical care.

In regions with snow, ice, or freezing rain, falls remain a leading cause of winter MSK injury, especially among older adults.

Common presentations

• Wrist fractures from falls on an outstretched hand
• Ankle sprains or fractures
• Hip fractures or contusions
• Shoulder contusions, dislocations, or rotator cuff injuries

Primary care approach

• Pay close attention to mechanism, particularly in older patients
• Obtain plain radiographs when fracture is suspected
• Manage stable injuries with immobilization, analgesia, and early physical therapy
• Use winter visits to address fall risk, footwear, balance, and home safety

Even seemingly minor winter falls can result in significant injury, especially in patients with osteoporosis or balance issues. Careful history, exam, and first-line imaging often determine whether these patients can be managed safely in primary care or require escalation.

Snow shoveling or any seasonal heavy lifting frequently leads to acute MSK complaints.

Common presentations

• Acute low back strain
• Cervical or thoracic paraspinal muscle strain
• Shoulder and rotator cuff flares

Primary care approach

• Screen for neurologic deficits or red flags
• Avoid early imaging unless trauma or neurologic symptoms are present
• Emphasize conservative care:
  • Activity modification
  • NSAIDs or acetaminophen
  • Early mobility and gradual return to activity

These injuries often result from poor biomechanics combined with sudden, unaccustomed load, and are frequently seen in patients who are otherwise inactive for much of the year.

Learn more about shoulder injuries in our Online Mini Course The Painful Shoulder (10 hours)

Winter sports contribute a steady stream of MSK injuries, many of which can be managed nonsurgically.

Common presentations

• Knee ligament injuries (ACL, MCL)
  
• Shoulder dislocations or AC joint injuries
• “Skier’s thumb” (ulnar collateral ligament injury)
• Wrist sprains or occult fractures
  

Primary care approach

• Start with X-rays to rule out fracture
  
• Use bracing and activity modification early
• Reserve MRI for suspected significant ligament or meniscal injury when results will change management
• Most patients improve with structured rehabilitation rather than surgery

Only a small proportion of winter sports injuries ultimately require operative care.

For many patients, reassurance and a clear recovery plan are just as important as imaging. Setting expectations early around healing time, activity modification, and rehabilitation can reduce unnecessary follow-up visits and referrals.

Even without snow or ice, winter increases MSK injury risk due to colder temperatures and changes in activity patterns.

Common presentations

• Hamstring, calf, or quadriceps strains
• Achilles or patellar tendinopathy flares
• Plantar fasciitis
• Shin splints or early stress reactions

Primary care approach

• Recognize sudden changes in activity, footwear, or training surface
• Emphasize warm-up, load management, and gradual progression
• Imaging is usually unnecessary early unless stress fracture is suspected

Cold muscles and tendons are less compliant, increasing injury risk without adequate preparation. These presentations often test diagnostic confidence, especially when deciding whether imaging is necessary or conservative care is appropriate.

Knee injuries are common in winter. Learn more about how to diagnose and treat them in our 10-Hour Painful Knee Mini-Course (10 hours)

Indoor exercise and home-related injuries
As more people move workouts indoors during winter, injury patterns shift.

Common presentations

• Shoulder impingement or rotator cuff irritation
• Wrist and elbow overuse injuries
• Low back strain from poor ergonomics or floor exercises

Primary care approach

• Ask where and how patients are exercising
• Address technique, volume, and recovery rather than default imaging
• Early physical therapy can prevent progression to chronic pain
• Simple questions about equipment, technique, and recent changes in routine often reveal the underlying cause.

Winter often worsens symptoms of chronic MSK conditions, even in the absence of injury.

Common presentations

• Knee, hip, hand, and spine osteoarthritis flares
• Increased stiffness and reduced morning mobility

Primary care approach

• Encourage movement rather than prolonged rest
• Adjust analgesic strategies seasonally
• Reinforce strengthening and joint-protective activity

Clear guidance on movement and pain management can help prevent unnecessary imaging or escalation during seasonal symptom flares.

Primary care is often the best place to treat common muscle, bone, and joint problems. Urgent referral is warranted for:

• Inability to bear weight
• Neurovascular compromise
• Obvious deformity or unstable fracture
• Red-flag spine symptoms

Most winter MSK injuries, however, can be managed confidently in primary care with conservative treatment and close follow-up. Clear referral thresholds help clinicians reassure patients while ensuring timely escalation when it truly matters.

Winter looks different depending on where you practice, and the musculoskeletal patterns you see may vary by region and patient population. If you’re noticing winter-related MSK patterns in your clinic – whether tied to cold weather, activity changes, or recovery challenges – we’d love to hear what you’re seeing.

Feel free to join the conversation on our social channels and share what winter looks like in your practice.

We understand how full your schedule is. That’s why Jackson Orthopedic Foundation’s online Orthopedic Primary Care (OPC) courses are designed to work around your life, not add to your stress. Learn MSK diagnosis, imaging, nonsurgical treatment options, injections, and more:

• 100% online and self-paced, so you can learn when it works for you
• 10–65 CE hours per course, from MSK fundamentals to deeper clinical dives
• Online mini-courses: $65 / 10 hours
• Full online courses: $300 / 65 hours
• Discount bundles available if you want to go deeper
• Designed to help you manage muscle, bone, and joint conditions with confidence and reduce unnecessary referrals
• Nationally accredited, so CEs are accepted in all 50 states
• Apply what you learn right away in your practice
  

Every course you take helps close the musculoskeletal education gap and improves care for the patients and communities you serve.

Warmest thanks for all you do, and for considering Jackson Orthopedic Foundation as your MSK education partner in the year ahead.

Yours in good health,
The JOF team