USA Rugby National Team Physician Marc Kowalsky, MD: Injury Prevention Strategy

Kowalsky MD World Rugby 2015 Pacific Nations CupONS Orthopedic Surgeon, Marc Kowalsky, MD, USA Rugby National Team physician returned from the Pacific Nations Cup this week.

“The USA Rugby National Team lost to Samoa in the first round of the Pacific Nations Cup, 21-16 at Avaya Stadium in San Jose, California. This match was a preview of the match-up between these two teams in pool play for the Rugby World Cup this fall. While the Samoans, ranked 9th in the world they jumped out to an early lead in the first half. The Eagles battled valiantly in the second half, but fell short of victory by only five points.” (more about the game)

Dr. Kowalsky traveled with the team during their week of preparation, and served as team physician for the match. The Eagles contended with a tough Samoan team, known for their physical style of play. Fortunately, neither team sustained catastrophic injuries during the match.

Now back in Connecticut, Dr. Kowalsky looks forward to the fall season of high school, collegiate, and men’s rugby, passing along to athletes these tips for injury prevention strategy:

  1. Adequate nutrition and hydration are imperative not only to optimize performance, but also to avoid overuse injuries during training and competition.
  2. A supervised strength and conditioning program is essential.
  3. Athletes must respond early to symptoms of impending injury when possible, and seek the care of their training staff and team physician.

Dr. Kowalsky is not only team physician for USA Rugby National Team but also for Iona College Rugby Football club and White Plains Rugby Football Club.

ONS Stamford: Off to a Great Start

ONS_Stamford
5 High Ridge Park, 3rd floor, Stamford, CT 06905

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/.

An Arthritic Reality Check

Arthritis affects more than 52 million adults in the United States and is the most common cause of disability,” according to the CDC. The pain from arthritis can set the stage for a decline in physical activity and make it difficult to prevent chronic health problems. Unfortunately, some who suffer from this ailment stop their activity and become depressed from thoughts of the mobility they once had.

Solutions for Knee Pain ArticleJane E. Brody, author of the “Keep  Moving to Stay a Step Ahead of Arthritis” article in The New York Times recently attempted to relate to those suffering from arthritis by speaking of her own battle with having to put down the tennis racket after decades of enjoying the sport, and her story did not end there. Two years after that, she had joint replacement surgery, picked up an assortment of other activities that successfully replaced tennis as a main source of activity. Therefore, encouraging others to do the same and not succumb to the depression that can sometimes come in hand with arthritis.

The reality is that the majority of people dealing with arthritis do not fully understand what they are capable of. Less than 10% of participants with arthritic knees in a 10-year study met the national guidelines of doing two and a half hours of moderate physical activity a week. Yes, you read that correctly, a week! It gets better though. Participants did notice a significant improvement of function when the amount of activity per week was increased. Additional weight on the body creates unnecessary stress on the major joints as well, leaving a 10% decrease in weight able to make a noticeable difference. With this fact a recommendation of starter exercises were mentioned, including walking laps in a swimming pool and then increasing activity as the muscles gain strength.

For more insightful tips, come to Dr. Delos’ talk about “Solutions for Knee Pain in Active Patients with Arthritis” tonight! The program is free and open to the public! Registration Requested. Aside from the talk, please consult your physician if this article has hit home and/or your quality of life is not what it once was; ONS provides excellent service and care for those in need, proudly keeping up-to-date with developments in the field.

“Maximizing Your Child’s Athletic Potential” Success

Delos_Houston_
Dr. Delos with Allan Houston

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.

Delos_Group_2
Photography credit goes to the Delos family, thank you!

Overuse Injuries: Recovery Time (Part II)

Elbow_Pain_WebRemember last week’s post? Dr.Cohen’s knowledge of “overuse injuries” does not stop at what causes the condition; she has valuable insight on the treatment and prevention as well.

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.

Overuse Injuries: Cause and Effect (Part I)

Cohen headshot for letterGloria Cohen, MD is a specialist in non-operative sports medicine who 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. Aside from her impressive medical career, Dr. Cohen is a successful competitive runner who has qualified twice for the New York Marathon and is also an off-road and road cyclist. Her academic insights are a combination of both research and real-world experience, the following article is her most recent commentary on the topic of “overuse injuries”:

What is an “overuse injury”?
An “overuse injury” is an injury that results when excessive stress is applied over a period of time to bones, muscles, tendons, and other supporting soft tissue structures of a particular body part.  This differs from an acute injury which happens quickly and is traumatic in nature. Too much stress to a body part will cause the tissues to break down faster than healing can occur, thereby resulting in an injury. A good analogy would be to consider what happens to a credit card or a piece of metal when you bend it back and forth repetitively – first you see the stress reaction, and then with continued stress the item breaks in two.  As you can appreciate, we want to avoid the latter situation when it comes to the body.

What are some common examples of “overuse injuries”?
Every body part can be affected by an overuse injury.  Some common examples you might be familiar with are: rotator cuff injuries of the shoulder; epicondylitis or tennis elbow; patellofemoral pain syndrome of the knee; and tibial stress syndrome or “shin splints” for the lower leg.  Here are a few case examples of classic overuse syndromes:

Jogging injury.

  1. A 40 year old male has recently increased the intensity and frequency of his swimming activity over the summer months. He now complains of pain in the front of his shoulder with overhead and rotation motion. Diagnosis: Rotator cuff tendinitis
  2. A 30 year old female has been playing tennis daily, now competing in matches at a more difficult level. She complains of increasing soreness in the outside aspect of her elbow. She had tried to play through the pain, but had to stop. She says that she can barely lift a coffee cup now because of the elbow pain. Diagnosis: Tennis Elbow /Lateral epicondylitis
  3. A 20 year college student takes up running during her summer break from school. When she returns to school, she decides to train for a half marathon. As she increases her mileage, and adds speed work to her training program, she develops pain in the inside aspect of one shin. She now complains of pain with just walking. Diagnosis: Shin splints/Medial Tibial Stress Syndrome

What are some of the specific causes of these “overuse injuries”?
As a primary care sports medicine physician I recognize that there are sport specific issues which may contribute to the resulting injury; but there are common “intrinsic” and “extrinsic” factors which play a major role in the development of these types of injuries. “Intrinsic” factors refer to the elements that we cannot control but that we can modify.  These include biomechanical alignment, such as knock knees, bowl legs, flat feet or high arched feet; leg length difference; muscle imbalance; muscle weakness; and lack of flexibility.  These factors can be modified to maximize the individual’s performance, and thereby treat or prevent injury.  An example would be a conditioning program and sport specific training. The “extrinsic factors” include training errors, such as doing “too much too soon”; training surfaces – running on too hard a surface, or playing on an uneven surface; shoes – it is important to wear the appropriate type of shoe for your foot mechanics and the sport; equipment; and environmental conditions. Paying attention to the “extrinsic factors” will help you modify the “intrinsic” ones.

… to be continued in the next segment, Overuse Injuries: Recovery (Part II)

Getting Ready for the Slopes: Ski Conditioning

chalonChalon Lefebvre is the Clinical Manager and Coordinator for Education at ONS Physical Therapy. Chalon is from Vermont where she was a ski racer and continues to lecture on ski injury prevention, the following is her expert advice for the season:

Certain exercises come to mind when I think about growing up as a ski racer in Vermont. Wall sits, crunches, push-ups, lateral bounds and lots and lots of box jumps got me into shape but were they really the best exercises for ski conditioning? Not necessarily, but they were on the right track. As a physical therapist, I now understand skiing and the biomechanics that go along with the sport. I understand the appropriate exercises that help to prevent injury while conditioning people so they are ready to enjoy the season.

Skiing can be broken down into concentric (muscles shorten/lifting portion of the movement against gravity) and eccentric (lowering portion while lengthening) movements. Skiing starts at the top of the mountain, as you ski down, you perform eccentric movements the entire way, resisting gravity’s pull by controlling your body’s movements. EMG studies have shown that throughout the ski turn, the prime movers and stabilizers change at different points in the turn and therefore it is important to work your muscles in functional patterns consistent with the sport.

1) Lunges are an amazing exercise for skiers. Lunges work the quadriceps, glutes and hamstrings. Both your legs are working independently of one another in concentric and eccentric motions. To perform a good lunch, stand with both feet positioned shoulder width apart and step forward with one foot making sure to step far enough so that your knee does not extend past your toes and your shin is nearly vertical, and then step back into the start position. This exercise can progress to walking lunges or by lunging while holding dumbbells in your hands. Once you are proficient, you can make these a plyometric exercise by jumping in between each lunge.

2) Squats, whether one footed and two footed, work your quadriceps and glutes. Start with your feet shoulder width apart with your back slightly arched. Initiate the squat by sitting back and down keeping your weight through your heels. Lower yourself so that your thighs are parallel to the floor (or as low as you can) being careful not to let your knees fall in front of your toes. This exercise should be done at high repetitions for endurance.

Ski_Web_II

3) The Romanian deadlift is one of the best and most functional hamstring exercises. ACL tears often occur because people have a strength imbalance between their quadriceps and hamstrings. Stand holding a barbell or a dumbbell in each hand with your feet shoulder width apart. Maintain the lordosis in your lower back and keep a slight bend in your knees, lower the weight towards the floor until you feel a slight stretch in your hamstrings. Reverse the movement by contracting your hamstrings and glutes and push your hips forward as you return to the starting position. This exercise can also be done on one.

4) Planks and side planks work your abdominals, erector spinae, and glutes. Both of these exercises will provide you with the core strength that you need to be able to hold yourself upright while skiing. Lie on your stomach; place your hands at either side of your chest and tuck your elbows in at your sides. Keep your back flat, and push up onto your toes and elbows so that your body is off the floor. Pull your abdominals into your spine and try to maintain this position for 10 seconds to two minutes. If this is too challenging, this can also be down on your knees. A side plank is done using one arm and on one side at a time.

5) Lateral bounds work on agility and reaction time and when done consecutively will carry over to your ski turns. They can be done one footed or two footed. Create a line on the floor and jump sideways across the line, when your feet land, immediately jump back to the other side. This can be done for time as well as number of repetitions.

Although this is just a taste of what I would include in a ski conditioning program but are some of my favorite exercises for keeping my clients injury free and having fun on the mountain.

The Fragile Feet: A Ballerina Story (Part I)

Ballerina
Ballerina in en pointe position

Dr. Peden 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 handsthey 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)

Want to learn even more? Dr. Peden will be giving a seminar on “Solutions for Foot and Ankle Pain: Beyond a Foot Massage.”  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

ONS Physiatrist, Christopher Sahler, MD presents “Exercise as Treatment for Chronic Pain”

Christopher Sahler, MD
Christopher Sahler, MD

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

The program is free and open to the public. Registration Requested.
Call (203) 863-4277 or register online at www.greenhosp.org.

ONS Physiatrist, Christopher Sahler, MD on post New York City Marathon Tips for Runners

Christopher Sahler, MD
Christopher Sahler, MD

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.

Congratulations again on the race!”

Dr. Sahler will present “Exercise as Treatment for Chronic Pain.” Learn how exercise can be used as a safe and effective treatment for chronic pain conditions. This free health seminar will be in the Noble Conference room at Greenwich Hospital Tuesday, December 2 at 6:00 p.m.  To register call 203-863-4277 or register online at https://www.greenhosp.org/CREG/ClassDetails.aspx?sid=1&ClassID=5348