Dr. Greene completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado under the direction of Dr. Marc Philippon. While there, he served as associate team physician for the U.S. Ski Team.

What are the most common ski injuries?

Orthopedic Surgeon and skier Dr. Tim Greene, has served as team physician to the US Ski Team.

Although skiing might appear to be a high risk sport, the incidence of ski injuries has actually been declining for the past 20 years. This is partially attributed to better boot and binding technology and may partially be due to the raising awareness of common ski injuries and what can be done to prevent them. The risk of sustaining a fracture is now minimal since the advent of breakaway bindings.

Today, the knee is the most vulnerable body part for a skier. The most common injury is a tear to the MCL, the Medial Collateral Ligament that supports the inside of the knee, and in second place is a tear to the ACL (Anterior Crutiate Ligament), which runs through the center of the knee and is important for stability. In skiing, the knees serve as shock absorbers. They undergo a lot of stress, absorbing the bumps and turns as you navigate the mountain. Beginning skiers may be susceptible to a torn MCL due to the mechanics of the “snowplow” technique, ironically often the first method taught. When in the snowplow position with the skis forming an arrow and the knees bent inward, there is a lot of stress put on the inside of the knee. Falling in this position can result in a sprain or strain of the MCL.

The ACL is at greater risk during skiing because the ankle is locked into position by the boot and the knee is absorbing much of the turning motion. If a skier is thrown off balance and leans back, his skis will sometimes shoot out in front of him or her creating extra torque on the knees that may rupture the ACL. The ACL can also be torn by impact to the knee or severe stress from bouncing down hard on a bump.  This can also happen when turning hard and “catching an edge”. A quick jolt and rotation can also cause an injury. 

Do you see the same kinds of injuries with snowboarders?

Generally the injuries are different. You don’t have the twisting motions in snowboarding that you have in skiing, so we don’t see nearly as many knee injuries as we see in skiing. Snowboarders do however tend suffer more upper extremity injuries like the shoulder or hand, which occur when they try to catch themselves during a fall.

Who is most susceptible to these injuries?

There are two sets of people who tend to get ski injuries; very beginning skiers who are not supervised on the slopes, and very experienced skiers who tend to take more risks with speed and terrain.

Why do they happen?

Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. If the conditions are difficult, ski down a level. In other words, In poor visibility or icy conditions, a beginner trail becomes an intermediate, an intermediate slope becomes advanced and on and on.

Another reason injuries occur is fatigue. Most people only take one or two ski vacations a year, so they try to cram the most into each day. Their bodies aren’t accustomed to exercising of 6-8 straight hours and they get tired and weak. Most injuries happen at the end of the day and that’s because the light is poor and skiers are fatigued. The combination can be very bad.

What is the best way to prevent those kinds of injuries before hitting the slopes?

Starting a conditioning and strengthening program a few months before your first trip up the mountain is a very good way to help prevent injuries. By developing good core strength your body will be in better shape to handle the stress and strength needed in skiing. Leg strengthening and balance should also be central to a conditioning program. Aerobic training will help build stamina which will help prevent fatigue which is the cause of many injuries.  

Are there any other precautions to take, once on the slopes?

Ski in control. Loss of control can lead to a crash, which is the cause of the most serious accidents.

Recognize the condition of the terrain you’re on and of your own condition. Pay vigilant attention to your own level of fatigue and rest when you feel tired or weak. Weakened muscles can lead to a loss of control that can lead to a fall or a crash into another skier or stationary object like a tree or lift tower. If you are tired, take a break, if it’s icy or the snow is extra heavy, ski down a level and if you are inexperienced, take a lesson. You’ll have more fun, and the instructor will help you avoid mistakes that can lead to injury.

In addition to your own mindfulness, pay attention to weather conditions. When I was in Vail working at the Steadman Hawkins Clinic, we could tell from the weather what kinds of injuries we would see that day. If the snow was soft and powdery, you would typically see more ligament injuries from skis getting stuck in a bank. If the snow conditions were harder, you would have more fractures.

If someone is injured, what kind of treatment is involved?

Treatment depends greatly on what type of injury you sustain. Unless an injury requires emergency treatment, if you think you’ve been injured, have it evaluated by the ski patrol.  Many sprains and strains can be addressed by applying the RICE principle; Rest, Ice, Compress the area and Elevate. It is always best to follow up with an orthopedic surgeon once you get back home, who will most likely access your injury by physical exam and sometimes x-rays or an MRI. Your doctor will make a determination of the best course of treatment depending upon the severity of the injury and your general physical condition. In the case of a ligament tear, surgery may be an option but that depends on how bad the tear is, your general health and your normal level of activity.

Primary Care Sports Medicine Physician Dr. Gloria Cohen

On August 3rd, Primary Care Sports Medicine Physician Dr. Gloria Cohen will speak on pediatric and adolescent sports medicine at the 55th Annual Family Medicine Seminar in Taos, New Mexico. The conference attracts family medicine physicians, nurse practitioners, physician assistants, and nurses from New Mexico and surrounding states.

On August 25th, Dr. Cohen will be the featured speaker at the 3^rd Annual University of California, San Francisco School of Medicine (UCSF) CME conference, Medicine of Cycling Conference and Research Symposium in Colorado Springs, CO. This program is presented by the UCSF School of Medicine and Medicine of Cycling in collaboration with USA Cycling for physicians and other medical professionals working with cyclists, cycling teams and race events. The conference will feature presentations on nutrition, orthopedic injuries, concussion, cardiology, rehabilitation, bike fit, and more.

Gloria Cohen, MD is a specialist in non-operative sports medicine. She is a primary care team physician for the Columbia University varsity athletic teams and lecturer in the Department of Orthopaedics at Columbia University.

A graduate of University of Ottawa School of Medicine, Dr. Cohen has lived in Montreal and Vancouver, Canada. She served as team physician to the Canadian National Olympic Cycling Team for 14 years and was a member of the Canadian Medical Team for the Olympic Games in Seoul, Atlanta, and Sydney. She travels regularly with the Columbia University varsity football team, the Lions and is recognized as an authority in sports medicine in the United States and Canada.

Most athletic injuries are not the result of accidents but are due to poor preparation for sports activity, overuse of joints or muscles, and missing the early warning signs of injury- according to sports medicine specialist Tim Greene, MD.

Sports Medicine specialist and orthopedic surgeon Tim Greene, MD

“Most sports injuries are preventable and can be traced to a lack of core body strength.  Core strength refers to the strength of the muscles of the torso that keep your stomach strong and support your back. Think in terms of a tree that has strong branches but a weak trunk. The imbalance of strength can cause strain, cracking and even collapse the trunk.  If your core is not strong and you engage in a running or jumping activity, you’re risk for injury is increased.”

When you play golf or tennis, swim, or cycle, Dr. Greene recommends varying your activities so your body doesn’t become unevenly strengthened and conditioned. “Incorporating programs like yoga, Pilates, and strength training can be very effective for developing your core and reducing the risk for injury.”

As you go about your summer sports activities, keep these injury prevention tips in mind:

• Prepare your body for sports activity with sport-specific conditioning and muscle strengthening.
• Strengthen opposing muscle groups to maintain balance of muscle strength.
• Maintain proper hydration and give your body adequate nutrition.
• At the beginning of your sport or workout, activate your body with a dynamic warm up- Begin at an easy pace to slowly increase heart rate, respiratory rate and blood flow to muscles.
• Warm up both upper and lower extremities.
• Know when to rest or stop. Many injuries occur from over-fatigued muscles.
• Use properly fitting protective gear when appropriate, like helmets and wrist and shin guards.
• Use properly fitting sports clothing and supportive sport-specific foot gear.
• Vary your fitness routine. Repetitive use of muscles and joints can cause strain and injury.
• If you feel persistent pain in your muscles or joints, stop exercising and have the pain evaluated.

This summer the ONS Blog will present a series on preventing summer sports injuries.  Check back regularly for valuable tips from our sports medicine experts that may just keep you out of the doctor’s office.

Because dance training involves repetitive movements done in classes, rehearsals, and performances, a lot of stress is put on dancers’ ligaments and muscles. Over time, this repetitive activity can lead to a number of overuse injuries.

The program, which is hosted by The Ballet School of Stamford at 175 Atlantic Street, will highlight the importance of understanding the signs and symptoms of the most common dance injuries including tendinitis, snapping hip, foot stress injuries, sprained ankles, and low back pain. “The panel will discuss the physical and emotional challenges for the young dancer,” said Dr. Cohen. “We will talk about the importance of proper technique and of identifying any muscle imbalances in the young dancer that might lead to an injury. There will also be discussion on proper strengthening and stretching exercises that can prevent injuries, basic rehabilitation exercises for dancers recovering from an injury, and how to know when to see a professional about a condition.” The FREE workshop will be conducted in an open forum. The public is invited, however advance registration is requested. For information, or to register, please send an email to info@Balletschoolofstamford.org, or call 203-358-8853. For directions go to www.balletschoolofstamford.org.

The Ballet School of Stamford is a not-for-profit school that provides professional dance training for children and adults from Fairfield and Westchester counties. The school is entering its thirteenth year and has moved into its new home at Old Town Hall. Through its relationship with Stamford Center for the Arts, the Ballet School is able to provide unique performance opportunities for its students, with a varied repertoire of original productions and classical ballets.

Six physicians from Orthopaedic and Neurosurgery Specialists (ONS) on Valley Drive

Connecticut Top Doc neurosurgeon Mark Camel, MD

are included in the latest edition of Connecticut Magazine Top Docs issue. The resource directory provides information on over 800 doctors in 29 medical specialties. To compile the list, the magazine sends out questionnaires to Connecticut-licensed doctors, asking them to recommend two fellow physicians that they would send a loved one for expert medical care. The doctors who received the most votes were awarded Top Doc status and added to the list that has been compiled since 2007.

ONS physicians included in the Connecticut Magazine list are neurosurgeons Paul Apostolides, MD; Mark Camel, MD and Scott Simon, MD; and orthopedic surgeons Brian Kavanagh, MD; Seth Miller, MD; and Paul Sethi, MD.

“It is an honor to be recognized by your peers as among the region’s most trusted physicians,” said shoulder and sports medicine specialist Dr. Seth Miller. “ONS is proud to work with a team that is committed to providing excellent care for its patients. The multidisciplinary nature of ONS makes it possible to provide patients with access to the most advanced techniques and treatments available in orthopedics, neurosurgery and physiatry.”

ACCORDING TO TIM GREENE, MD, SPORTS MEDICINE SPECIALIST AT ONS (Orthopaedic and Neurosurgery Specialists), most athletic injuries are not the result of accidents but are due to inadequate preparation for a sports activity, overuse of joints or muscles and missing the early warning signs of injury. “Most sports injuries are preventable,” he says.  “Many sports-related injuries can be traced to a lack of core body strength– which is the strength of the muscles of the torso that keep your stomach strong and support your back. Think of the body as a tree that has strong branches but a weak trunk. That imbalance of strength can cause strain, cracking and even collapse the trunk.  If your core is not strong and you engage in a running or jumping activity, you’re risk for injury is increased.” Dr. Greene recommends varying your activities so your body doesn’t become unevenly strengthened and conditioned. “Incorporating programs like yoga, Pilates, and strength training can be very effective for developing the body core and reducing the risk for injury.”

“Many people are more active in the summer than during the rest of the year,” says Dr. Greene.  “When returning to a sports activity after taking time off, moderation is the key to avoiding injury.  Your body is conditioned to do what it does most, so if you work seated in an office and take regular walks on weekends, the muscles you use in those activities are most conditioned.  Whether you play tennis, golf, go bicycling or running, when you first return to a sport that you haven’t done for some time, you need to retrain those unconditioned muscles.  Sports-specific muscle groups have to become stronger in order to support the balance and flexibility that are required for that activity. By gradually working into a new activity, you condition your muscles without damaging them and your body will adjust to the new demands.”

Injury may also occur when people think they can “push through pain”. But pain may be a symptom of inflammation in the muscle, bone or even a hairline fracture.  If you experience pain, it is safest to consult your physician or a sports medicine specialist to make sure you’re not over stressing a muscle or bone, which could develop into a more serious injury like a muscle tear or bone fracture. “If you listen to your body, don’t ignore early warning signs of overuse and develop your core strength, you’ll have a great summer of outdoor exercise and fun,” says Dr. Greene.

Tips for Preventing Injuries

• Listen to your body and know your risks.
• Warm-up and stretch at the start of every workout or sports activity.
• Women should be sure they are getting adequate calcium in their diet.
• Wear appropriate footgear and don’t wear worn out running or tennis shoes. Find a store where knowledgeable salespeople can advise you on appropriate footgear designed for women.
• If you feel persistent pain in your muscles or joints, stop exercising and have the pain evaluated.
• When beginning a new sport or fitness program, start slowly and build up over time.
• Avoid sudden changes in intensity or type of exercise.
• Vary your fitness routine.

The program will offer practical tips on how to stay in the game- and out of the doctor’s office and will feature presentations by orthopedic surgeon James Cunningham, MD and physiatrist Halina Snowball, MD as well as Round Hill Club Head PGA Professional, Tom Henderson. The physicians will discuss the most common injuries to the back, elbow, knee and shoulder. They will offer tips for staying injury free, information on the best techniques for treating common injuries and will suggest goals for physical conditioning, off the course, to optimize strength and flexibility.  Mr. Henderson will focus on the importance of proper equipment and how poorly fitting equipment may prompt compensating movements that can be injurious to joints and muscles.

In addition to his practice as an orthopedic surgeon who specializes in sports injuries and the knee and shoulder, James Cunningham, MD is an avid golfer. Dr. Halina Snowball specializes in pain management and uses acupuncture to treat a number of conditions particularly relating to the spine. Tom Henderson is the head professional at Round Hill Club. He is also co-chair of the National Instruction Committee for PGA America and is the Honorary President of the Metropolitan Section of the PGA.

Of course, I wouldn’t be doing my blogging duties if I did not comment on the USA/Canada men’s hockey game from last night.  Looks like this newspaper cover said it all for the Canadian fans.  But it’s not over yet…  Yes, the Canadian team will have to work a little harder to get to the finals, but a Gold medal is still within reach.  I wonder which goalie will play for Canda for the next game?  But… it is a team effort!

Here is a peek into the Athlete Medical clinic, the treatment cubicles. There are cubicles designated for suturing as well as trauma and life support. Even the experienced skaters can sustain lacerations. Speed skate blades are so sharp that you might cut yourself on the skate and not realize it until you notice you’re bleeding.   Skate guards are an essential item in our emergency packs for treatment on the ice.  The skate blades average 39 to 46 cm in length (15″ to 18″ if you are not metric savy) so regular skate guards tend to fall a bit short and are not protective.

Here is a speed skating quiz: What is different about this Dutch speed skater?

He is skating in a clockwise direction.  All speed skating races as you may have notice are in a counter clockwise direction.  I am told they do this for muscle balance.

- Dr. Gloria Cohen

I was assigned to the Field of Play and three skaters fell in three different races at the corner where I was stationed. The corners tend to be the areas where skaters crash and fall. Fortunately, none of the injuries were serious. Needless to say, these skaters were very disappointed. …a prime example of the agony and ecstasy of sport that exists at all levels.

As for the ecstasy, check out the beautiful wooden podium behind me in the photo. It is in the shape of Vancouver Island, British Columbia.

I have still not caught site of Stephen Colbert around the venue yet, but I did meet Barry, a tech manager from NBC. I introduced him to our medical team, including our resuscitation model!

Well, at least I found a copy of his book. He must be here somewhere.

-Dr. Gloria Cohen