ONS PAIN MANAGEMENT SPECIALIST, CHRISTOPHER SAHLER, MD, WILL DISCUSS THE BENEFITS OF REGENERATIVE MEDICINE AT GREENWICH HOSPITAL TALK.
Does your own blood hold the key to healing your medical condition? The evolving field of regenerative medicine uses biomedical materials, often from your own body, to regenerate cells and rebuild diseased and damaged tissues. Join Dr. Christopher Sahler to learn about this exciting new medical field that uses therapies from blood, platelets and stem cells to treat pain and cure complex, often chronic conditions of the musculoskeletal system. Healing Yourself: The Promise of Regenerative Medicine for Chronic Pain and Orthopaedic Care will take place on Thursday, March 10 at Greenwich Hospital’s Noble Auditorium. 6 – 7:30 pm. Free. To register, call 203-863-4277 or go to greenwichhospital.org.
Exercise can help people with chronic pain return to daily activities with ease and comfort, writes Dr. Christopher Sahler, interventional pain management specialist at ONS in this week’s issue of the Greenwich Sentinel. Slowing down is wise advice if pain is caused by an injury, he said, but a growing body of research suggests people suffering from chronic pain may feel better if they keep moving.
You can learn about the early days of ONS and the philosophy that made us the most comprehensive and advanced practice the region. The writer, Sara Poirier Correa, did an excellent job explaining that with 22 top sub-specialty trained physicians, ONS is able to provide personalized services to patients. The article also highlights the Women’s Sports Medicine Center and the ONS Foundation for Clinical Research and Education, which has published internationally and competes among researchers at larger universities such as Harvard, Yale, and Johns Hopkins. http://bit.ly/1PNTkfh
On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit https://onsmd.com/ons-stamford/.
We are excited to announce that ONS will open an expanded, state-of-the-art office and physical therapy facility at 5 High Ridge Park in North Stamford in June. Construction began in January and is expected to be completed by the end of May.
The Stamford location will offer a team of physicians and clinical staff dedicated to that office. Some of our other surgeons from Greenwich will also maintain a schedule to see patients in Stamford on a weekly basis. In addition to the doctors’ office, the site will feature a state-of-the-art physical therapy facility outfitted with the latest equipment in an aesthetically comfortable and healing environment.
The new facility is being added in order to accommodate ONS’s growing patient population in the Stamford, New Canaan, Darien and surrounding communities. “Many of our patients come from the Stamford area. Now they can receive the excellent level of orthopedic and neurosurgical care they count on without having to drive to Greenwich,” explained Dr. Seth Miller. In house x-ray and a fully integrated electronic medical records system will make the ONS Stamford office a convenient choice for patients in that area.
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.
If golf or racket sports are in your plans for the spring you will want to hear tips from fellowship trained orthopedic foot and ankle specialist Mark Yakavonis, MD, MMS and fellowship trained hand/wrist/elbow specialist Mark Vitale, MD, MPH who will discuss common injuries seen in golf and racket sports. Special guest and local tennis pro Patrick Hirscht will also speak. Learn about common injuries, and how to choose footwear, braces and exercises to prevent injury and play your best; whether it’s the foot, hand, wrist or elbow, they’re all at risk for injury when you’re active. Dr. Yakavonis and Dr. Vitale will discuss nonsurgical and surgical treatments, along with ailments particular to racket sports. 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.
Remember last week’s post?Surprisingly enough, gymnasts share a lot in common with ballerinas, especially in terms of injuries of the feet.
Both gymnasts and dancers place a tremendous amount of stress on their feet for a significant amount of time per week – often greater than 10 hours a day. Because of this combination of stress and time, stress fractures are common. Stress fractures can occur almost anywhere in the foot or ankle, but the most common locations are the metatarsals, navicular, tibia, calcaneus, and fibula. A key to avoiding stress fractures is proper nutrition, avoiding disturbances in the menstrual cycle, and proper technique and amount of training. A gymnast who trains 4 hours a week that increases the workload to 10 hours a week in preparation for a performance without any ramp up is a setup for stress fractures. A better way to ramp up training would be to increase the workload by approximately 25% per week, or going from 4 hours a week to 5 hours a week and so forth. The treatment of stress fractures varies depending on the location and character of the fractures. It also depends on the patients demands and expectations. In most situations a period of immobilization and rest is all that is necessary.
Young gymnasts often complain of various painful lumps and bumps on the feet. Some of these are calluses, which are the bodies response to repetitive force on areas of weight bearing. Another extra bone in the foot – the accessory navicular, also thought to exist in about 10% of all people – can be a troublemaker for gymnasts in particular. It is a tender prominence on the inside of the ankle. Flatfooted patients will sprain or strain the ligaments that attach to the accessory navicular. Continued activity worsens the symptoms and the first line treatment is a period of immobilization to allow it to heal. When that fails, the extra bone is excised, and the damaged tendons and ligaments on the inside of the ankle are repaired or reconstructed.
Many of the problems in both ballet and gymnastics results from the nature of the sports – long hours and repetition in little to no footwear. These patients are predisposed to develop certain problems based on the alignment or posture of the feet. Feet come in two general shapes – flat and high arched. In reality it is a spectrum. So many problems can be treated simply by accommodating or adjusting a patient’s flat or high arch with a specific type of shoe or insert (orthotic). Unfortunately, the competitive gymnast and dancer cannot wear athletic shoes or orthotics. Some may be able to train in orthotics or custom shoes and that is important to keep in mind.
Dr. Yakavonis, MD, MMS,of ONS and Greenwich Hospital is an orthopedic surgeon specializing in foot and ankle surgery and treatments for adult foot conditions as well as youth sports injuries in field athletes, gymnasts and ballet dancers. He shares a two-part blog about conditions to be aware of for ballet dancers and gymnasts.
Ballet dancers feet are much like a musician’s hands – they earn a living with them. In addition to putting an amazing amount of stress on their feet, they also are often well below an ideal body weight – either because of the stress of an enormous amount of training or because of unrealistic expectations placed on them by the ballet community. This leads to several different and often unique foot and ankle conditions.
One fairly unique foot and ankle condition in ballet is caused by the en pointe position. In this position an enormous amount of strain is put on the dancer’s great toe, as it is essentially holding up the entire body weight through a small joint. The main flexor tendon of the toe, called the flexor hallicus longus – normally quite small, takes over the job of the largest tendon in the body, the Achilles. The flexor hallicus longus hypertrophies well in compensation for its new job, but unfortunately this tendon is forced through a tight tunnel in the back of the ankle. When it gets too large it will get pinched in the posterior ankle joint. Patients develop painful irritation of the bones and soft tissues in the posterior ankle. An extra bone in the posterior ankle called the os trigonum, which present in about 10% of all people, can be become very painful and irritated in many ballerinas. This constellation of problems is called posterior impingement of the ankle, and it is noticed by the patient as a vague deep pain in the posterior part of the ankle, in front of the Achilles, that is felt with plantarflexion, the position of pointing the foot and toes downward.
Ballet dancers suffer from numerous other problems of the foot & ankle, many of which are not unique. One of the less glamorous problems they deal with are corns, calluses, and blisters. These are necessary adaptations to allow a high level dancer to compete.
Similar to posterior impingement, which arises from dancers spending an inordinate amount of time and stress in an extreme position at the ankle, ballet dancers will develop anterior impingement at the ankle. This comes from repetitive forceful dorsiflexion – pulling the foot and toes upward, toward the shin. Landing from jumps and deep knee bends exacerbate this problem. Pain is felt in the anterior ankle.
Treatment for the above condition is customized to the patient. Often a minor activity modification, or period of rest, can dramatically improve the symptoms. Unfortunately, rest is not easy to come by in the competitive living of a gymnast. Many dancers will treat the symptoms with a combination of anti-inflammatory medications and occasional steroid injections in the region of maximal tenderness. Surgery is a last resort option for any ballerina – when symptoms persist for many months and are limiting, despite all other efforts. Surgery is typically very successful in these patients and can be done with arthroscopic or minimally invasive techniques.
The most common orthopaedic injury of all is also very common amongst ballet dancers: the lateral (traditional) ankle sprain. The mainstay of treatment for ankle sprains is rest, ice, compression, and elevation – mnemonic RICE. A short period of rest and immobilization (1-2 weeks) is followed by aggressive physical therapy, with strengthening of the muscles that stabilize the ankle. Recent research has pointed to improved short and long-term outcomes when early motion and weight bearing is initiated. There is promising early research on the role of stem cell injections – harvested from the patient’s own blood or bone marrow – in the setting of an acute ankle sprain. This is a technique we will offer for the highest level athletes and dancers in certain situations, understanding that the research data on this intervention is still in development.
… to be continued in the next segment, The Fragile Feet: A Gymnast Story (Part II)
Christopher Sahler, MD of ONS and Greenwich Hospital, is an interventional physiatrist specializing in sports medicine. His focus is non-operative treatment of musculoskeletal injuries, restoring proper function, reducing pain and promoting active lifestyles.
If you are suffering from chronic pain, you are not alone. It is estimated that 100 million Americans are currently living with chronic pain. The pain may make it difficult just to get out of bed or do household chores, let alone be active and exercise. Studies have shown this inactivity can actually cause you to experience a worsened level of pain and for a longer period of time. Exercise actually improves your pain threshold. Even simple exercises such as walking can provide some benefit.
Join Dr. Sahler as he presents his first health Seminar “Exercise as Treatment for Chronic Pain” at Greenwich Hospital. Come learn how staying active and performing exercise may help treat an array of chronic pain conditions.
When: December 2nd, 2014 Time: 6:00 p.m. Place: Noble Auditorium at Greenwich Hospital
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.
Team USA’s scrimmage this past Friday night was definitely one to remember; and not in a good way. ONS Orthopedic Surgeon and fellowship trained Sports Medicine Specialist, Timothy Greene, MD, gives us some insight on NBA Super Star, Paul George’s gruesome injury that caused jaws to drop and made an entire arena become strikingly silent.
“NBA star Paul George sustained a gruesome leg injury during Friday night’s Team USA basketball game in Las Vegas. While trying to contest a layup, George’s leg hit the basketball stanchion causing an open tibia/fibular fracture. The injury consists of a complete break of the shin bone and small bone in the lowerleg that penetrates through the skin. When the bone penetrates the skin, there is an increased risk of infection and thus an urgent surgery was preformed the night of the incident to clean and repair the ends of the bone and skin and place a rod in the shin bone.
The road to recovery will most likely be a long one for the NBA superstar. When the bone penetrates the skin, it increases the time for healing. Studies examining these types of injury show that it can take up to 6 months to get complete healing of the bone. Although we often see our professional athlete’s recover and return to a high level of play in a surprisingly rapid timeframe, it is not unreasonable to expect that Paul George may take an entire year to return to elite level basketball.”
Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.
14 Specialists from ONS included in New York Area Medical Guide Book top primary care and specialty care doctors in the tri-state metropolitan New York area.
Fourteen physicians from Orthopaedic and Neurosurgery Specialists (ONS) on Valley Drive are included in the latest edition of Castle Connolly Top Doctors, New York Metro Area guidebook. The resource directory, which is in its seventeenth edition, is a guide to finding the top primary care and specialty care doctors in the tri-state metropolitan New York area. It details information on over 6,400 physicians in 65 specialties. Physicians profiled in the guide were nominated by their peers and screened by a research team at Castle Connolly.
Castle Connolly Top Doctors® are nominated by their peers including physicians and hospital executives throughout the New York metropolitan region in an online survey process. Nominations are open to all board certified MDs and DOs. Nominated physicians are selected by the Castle Connolly physician-led research team based on criteria including medical education, training, hospital appointments, disciplinary histories and much more.
“We congratulate our physicians who have been recognized as ‘Top Doctors’ by Castle Connolly,” said hand and wrist specialist Dr. John Crowe. “Having fourteen of our fine doctors included in this authoritative guide is a reflection of the commitment and quality of excellence of all our physicians and entire staff at ONS. The multidisciplinary nature of ONS makes it possible to provide patients with access to the most advanced care available in orthopedics, neurosurgery and physiatry.”
Survey recipients are asked to nominate those doctors who, in their judgment, are the best in their field and related fields– especially those to whom they would refer their own patients and family members.
Orthopaedic and Neurosurgery SpecialistsPC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.
Like all activities engaged in regularly, cycling has its share of common ailments and injuries. Many of the overuse injuries result from attempting to do too much, too soon. Poor riding technique, and improper frame fit for the individual may also cause injuries. Riding too many miles or tackling too many hills in too high a gear will stress the musculoskeletal system, especially at the start of the cycling season.
Knee pain is the most common complaint and is usually related to the tracking of the kneecap, or “patella” in the mid-groove of the thigh bone or “femur.” The symptoms of “biker’s knee,” also known as “patellofemoral pain syndrome,” usually result from a combination of malalignment of the extensor mechanism of the knee, muscle imbalance, and improper set-up on the bike. Each cyclist presents with differences in biomechanics (flat pronated feet, bow legs, etc.) and muscle conditioning (strength and flexibility) that can predispose to this condition. It is important to avoid riding with high pedal resistance at a low cadence as this puts excessive pressure across the knee joint. The rule of the road is “if the knees hurt gear down.”
Some common riding errors are riding with the saddle too low or too far forward and poor foot position or improper cleat adjustment. This can lead to other musculoskeletal injuries such as neck problems, or Achilles tendinitis.
We must not forget that traumatic injuries can occur when we least expect it. Wear an approved bicycle helmet at all times while cycling. Remember to replace your helmet if you are involved in a bike crash while wearing it. It will likely not perform for you the second time.
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 and 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.
Dr. Cohen believes in taking an integrative approach to medical management by considering a patients’ bio-mechanics, cardio-vascular and pulmonary function as it relates to athletic performance. Dr. Cohen is a successful competitive runner who has qualified twice for the New York Marathon. She is also an off-road and road cyclist and will be a featured speaker at Cycle Strong! A Sports Conditioning and Injury Prevention Workshop for Cycling Enthusiasts!This event is presented by ONS Foundation for Clinical Research, Inc. and sponsored by the North Castle Library, Armonk. For more information visit the ONS Foundation website.
Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit https://onsmd.com/ or call 203.869.1145.
On Tuesday, June 4th, Physiatrist Dr. Jeffrey Heftler gave an informative talk at Greenwich Hospital on how some sports injuries may be effectively treated with therapeutic injections. If you missed the talk, here is a link to his powerpoint presentation: