ONS specialists are on a mission to spread the word about health! Gloria Cohen, MD participated in the first Collaborative Solutions for Safety in Sport Meeting at the NFL Headquarters in New York City on March 26-27 with more than 20 other members of the AMSSM (American Medical Society for Sports Medicine); an organization of sports medicine physicians in multiple fields dedicated to education, research, and advocacy.
The meeting was strongly influenced by the “2013 Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletic Programs: Best Practice Recommendations” giving it a focus on safety and health issues at the secondary sports level. Speakers encouraged best practices and protocols and this fit perfectly with Cohen’s belief in a comprehensive approach to prevention and treatment of injury. They concerned the establishment with heat-related illnesses, cardiac conditions (use of AEDs), head and neck injuries and the overarching need for emergency action plans in all high schools. ONS would like to thank the participants for understanding how important preventative care is.
Aside from the talk Dr. Cohen is not only a recognized authority in sports medicine, she is a successful competitive runner who has qualified twice for the New York Marathon. She has also held the title as head team physician for the Canadian National Olympic Cycling Team for 14 years while still enjoying off-road and road cycling herself. All in all, we are incredibly proud to have her on our team.
On Wednesday, April 22nd, at 6:00 p.m., orthopedic surgeon/ joint replacement specialists from ONS and Greenwich Hospital will present a joint replacement symposium in the Noble Conference Center at Greenwich Hospital located at 5 Perryridge Road. Knee and hip specialists Frank Ennis, MD and Brian Kavanagh, MD; and shoulder specialist Seth Miller, MD will present information about the latest advances in joint replacement, including computer-assisted and minimal incision, muscle sparing techniques. Information about preparing for joint replacement, pain management and what to expect from the recovery process will be addressed by hospital anesthesiology, nursing and physical therapy department staff.
Many people suffer from severe pain caused by arthritis, a fracture or other conditions that make common activities such as walking, putting on shoes and socks or getting in and out of a car, extremely difficult. Today, over 900,000 hip and knee replacement surgeries are performed each year in the United States. An additional 53,000 shoulder replacements are performed. Deciding if and when it’s time to consider joint replacement surgery are important decisions. This educational symposium is designed to provide anyone who is considering joint replacement with pertinent information to assist them in making the right decision for them.
Frank Ennis, MD specializes in hip and knee replacement and is fellowship trained in adult reconstructive surgery. Dr. Ennis is among the first orthopedic surgeons in the New York area to perform computer-assisted joint replacement. He completed undergraduate studies at Yale University and post-baccalaureate pre-medical studies at Harvard University. He graduated from Duke University School of Medicine and completed a residency at Yale University Department of Orthopaedic Surgery. He received his fellowship training at New England Baptist Hospital in Boston.
Brian Kavanagh, MD has performed over 6500 joint replacement surgeries in the past 25 years. He graduated Princeton University and earned a medical degree at University of Connecticut School of Medicine. He did his internship and residency at the Mayo Clinic, Mayo Graduate School of Medicine in Rochester, Minnesota, and served on the faculty at the Mayo Graduate School of Medicine for seven years. Dr. Kavanagh was on the teaching staff at Yale University School of Medicine in New Haven for five years. Dr. Kavanagh was also an instructor in the hip and knee total joint fellowship program.
Seth Miller, MD is a graduate of Mount Sinai School of Medicine in New York. After his residency at New York Columbia-Presbyterian Medical Center, he completed a research fellowship at the Hospital for Special Surgery in New York and a shoulder surgery fellowship at Columbia-Presbyterian Medical Center. He served as an orthopaedic consultant to the New York Mets for more than eight years. He is the current President of ONS.
All three surgeons are on staff at Greenwich Hospital, a recipient of The Joint Commission’s “Gold Seal of Approval™” for total hip and knee replacement surgery and spinal fusion. The certification for hip and knee replacement procedures recognizes the hospital’s commitment to maintain clinical excellence and patient satisfaction, while continuously working to improve patient care. Greenwich Hospital’s total joint replacement program offers a level of continuity that sets it apart from other facilities. A clinical resource nurse helps patients every step of the way – before, during and after surgery and throughout rehabilitation and recovery. Patients receive the practical information, emotional support and follow-up care they need to guide them through the entire process.
You will have the opportunity to ask questions at the conclusion of the talk. The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.
Last Thursday’s talk on “Maximizing Your Child’s Athletic Potential” was a success. A big thank you goes out to the Junior League of Greenwich for making it possible with their focus on improving the community and empowering others to further health and education! Ultimately they brought together the perfect combination of experts to inform the public about the youth and the sports they love.
Dr. Delos, of ONS and Greenwich Hospital, was a panel speaker at this event. He specializes in sports medicine and arthroscopic treatment of knee and shoulder disorders. Before ONS, Dr. Delos was the Assistant NFL Team Physician for the New York Giants and was team physician for a number of local high school and college athletes.
Other panel members consisted of Andy Barr, Director of Performance and Rehab for the New York Knicks, Mubarak “Bar” Malik, Head of Strength and Conditioning for the New York Knicks, and Allan Houston, one of NBA’s all-time greatest long range shooters and Olympic gold medalist, as the moderator. Each participant reinforced the importance of parents taking interest in the development of their young athlete and properly guiding them to the path of success. Parents attending this event were very attentive, and came prepared with questions.
Conversations covered the fundamental topics, like proper sleep habits and nutrition. For example, a young athlete’s nutrition should increase in relation to the amount of activity they experience daily. This may be common knowledge to an adult but for an adolescent, proper amounts of sleep and good nutrition that balances the amount of activity should be added to their routine.
Aside from the basic topics of discussion, there was a myth to be busted as well; to find out the details of the myth and for more information about the questions that were asked at the event, please read the article written by the Greenwich Freepress.
The Mystery is in the History
Careful history taking and examination helps the sports medicine physician diagnose the condition. It is helpful to know what maneuver produces the pain; or when the pain occurs. Many times with an overuse the injury the symptoms will first occur after the activity; then earlier and earlier into the activity until you become symptomatic at rest. It is important to seek medical attention long before that occurs. It is not normal to have pain with the activity. It is important to consult a physician regarding your symptoms, and to find the cause of the injury so that re-injury does not occur once the present injury is treated.
What are the treatment principles for Overuse Injuries?
Management of the condition depends on the severity. Relative rest, which is stopping the aggravating activity while maintaining cardiovascular activity with another activity is one aspect of the treatment program. For example, use of a stationary bicycle or elliptical, or swimming, which are nonimpact activities, might be an alternate activity for a runner while the injury is healing. One needs to individualize the modified activity for the patient and their injury. Other aspects of the treatment plan are pain management with nonsteroidal anti-inflammatory medication as indicated if no contraindication; physical therapy to include instruction in stretching and strengthening exercises; use of an appropriate brace or support for the injured body part; correction of predisposing factors; and modification of biomechanics.
Are there some injury prevention guidelines?
We would all like to prevent an injury from occurring and to maximize our athletic endeavors. Some key points to remember to help get you there are: appropriate training and conditioning for the sport; check your biomechanics for the sport; allow for adequate recovery and do not engage in your sport when you are tired or in pain. Engage in a variety of sports and activities so that you are not always using the same muscles in the same way. Many elite level athletes complement their specialized sport training with another sport. For example, a cyclist might skate or play hockey in the off season to maintain muscle balance of the quadriceps and hamstring muscles of the thigh. It is best to be proactive and prevent the injury from happening.
Dr.Cohen will be discussing Stress Fractures and Biomechanical assessment in future blogs.
Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes. His practice will also focus on youth athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.
Achilles tendon ruptures will often not be discovered for months after the injury. In the months between injury and showing up at the doctor’s office, the torn tendon develops scar tissue which decreased the quality and elasticity of the tissue. Because of this, directly repairing the torn tendon, as is done in an acute injury, becomes is less than ideal. In this situation, we will supplement the tendon repair with a tendon transfer. Essentially, we borrow a tendon that bends the big toe (there is another tendon that compensates when it is borrowed), reroute it, and reattach it to the heel bone. This does two very important things:
1. It supplements the strength of the torn Achilles, allowing a quicker and better recovery.
2. It provides improved blood supply to the Achilles repair, providing healing factors to the area of diseased tendon.
In summary, ruptures of the Achilles tendon are increasingly common in our aging yet increasingly active population. In cases where an Achilles rupture is missed or the rupture cannot be repaired directly under normal tension, adding the flexor hallicus longus tendon transfer allows for significantly improved results with a shorter recovery.
If you suffer from foot and ankle pain and would like to attend a free seminar, Dr. Yakavonis of ONS is an orthopedic surgeon specializing in foot and ankle surgery, and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage . He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.
“Bunions are a common deformity encountered in the foot where the big toe is out of alignment. This creates pain in that toe and often in the lesser toes as well. The deformity makes it difficult to find shoes that fit comfortably. Ill-fitting shoes can contribute to the situation but the underlying deformity is genetic. This is why most patients can recall a parent or grandparent that had the problem.
In consultation, I often tell patients that the options are to accommodate the foot with wider shoes, gentle arch supports and sometimes padding or I encourage them to consider surgery. The decision to proceed with surgery should be based on the overall level of discomfort and deformity. This will differ from patient to patient. It is rare that the patient that must have bunion surgery. Most people will choose surgery due to the accumulation of annoyances, discomfort, pain and deformity in other toes.
It is very important, from my point of view, to communicate realistic expectations for the procedure and the ultimate result. I try hard to be very specific about the time involved in recovery and give every patient a written “expected surgical recovery.” It is obviously difficult to remember everything when you as the patient are given a great deal of information so it’s helpful to have a summary to refer to.
Not all bunions are the same. Routinely, I perform about six different surgical procedures. The goal is to do the most appropriate operation for your particular foot and circumstance. With careful communication and a well thought-out plan it is highly likely that we should be able to get a great result for almost any foot.”
If you suffer from bunions and would like to attend a free seminar on foot pain Dr. Yakavonis of ONS and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage is an orthopedic surgeon specializing in foot and ankle surgery. He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.
Christopher S. Sahler, MD of ONS is an interventional physiatrists specializing in sports medicine. His focus is non-operative treatment of musculoskeletal injuries, restoring proper function, reducing pain and promoting active lifestyles.
“Each year 50,000 people participate in the NYC marathon. If you are in that group and completed the race this past weekend, congratulations! It is an exciting accomplishment that you will remember for the rest of your life.
Now that the race is over, there are a few key points to remember that will help to maximize your recovery and minimize pain. Many athletes experience worsening soreness over the following days after the race. This is known as delayed onset muscle soreness and typically is most painful 48-72 hours later. After the race, your body is in a depleted state so it is important to take in plenty of water and healthy food. A combination of complex carbohydrates and protein help the muscles to repair themselves and re-build their energy stores. It is also recommended that you perform light, short duration activities such as walking, gentle jogging, biking, swimming etc. This helps to increase blood flow to the muscles and tissues that need the nutrients the most and helps to wash away the built up metabolic byproducts such as lactic acid. Gentle stretching and soaking in a warm bath may also help loosen up the muscles. Depending on your previous activity level, it is important to give your body time off before re-starting any intense exercise routines. Most runners should take at least one month off.
According to The National Osteoporosis Foundation, as our population ages, even more men will be diagnosed with osteoporosis. As many as one in four men over the age of fifty are more likely to break a bone due to osteoporosis than they are to get prostate cancer. Approximately 2 million American men already have osteoporosis. About 12 million more are at risk. Many of the risk factors that put women at risk apply to men as well. For example family history, smoking, drinking too much alcohol, not exercising, taking steroid medicines, and having low testosterone levels are all risk factors for men. Visit the National Osteoporosis Foundation to learn more about men and osteoporosis.
There are things you can do to minimize your risk factors for osteoporosis. Speak to your physical therapist for recommendations on exercises and instructions in proper posture and body mechanics.
Most Americans spend too much time sitting and should take advantage of these tips to help keep good posture.
First, when sitting in a chair make sure your buttocks is all the way to the back of the chair. Using a lumbar roll in the small of your back will help to keep optimal alignment.
Second, if you sit at a computer, your monitor should be at eye level, feet firmly on floor, hands and wrists in a straight line, shoulders back and elbows at 90 degrees. A break from sitting every 30 minutes will relieve your back of stresses placed on it while sitting. For a more detailed guide to improve seated posture, download Work Station Ergonomics as a reference.
Posture is equally important when doing chores. While working, make sure your lower back is in a neutral position to avoid a forward curve in your spine. Watching your posture over the years will help avoid vertebral compression fractures due to osteoporosis.
Osteoporosis, or thinning bones, can result in painful fractures. Risk factors for osteoporosis include aging, being female, low body weight, low sex hormones or menopause, smoking, and some medications.
To learn more about osteoporosis, bone anatomy, fracture prevention exercises to promote bone health, updates on treatments, measures to promote strong bones and personal risk factors, register to attenda free health seminar on October 14, 2014 at Greenwich Hospital in the Noble Conference Room. The panel of speaker include ONS Orthopedic Surgeon Steven Hindman, MD, Greenwich Hospital Endocrinologist Renee Ileva, MD and ONS Physical Therapist Betsy Kreuter, PT, CLT . After the seminar you will be able to ask the doctors and therapist questions.