Give Young Athletes a Break

ConcussionFor many of today’s young athletes, summer break includes a sports camp providing concentrated training in their specialized sport. But according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky, early sports specialization is the last thing they should be doing with their free time.

“There is an increasing body of evidence indicating that early sports specialization does more harm than good. In fact, it seems that it actually decreases the potential for success in the sport in the long term,” he said.

Dr. Kowalsky said children who specialize in a single sport before the age of 13 don’t develop the protective neuromuscular patterns that help prevent stress to a single area of the body.  Because young athletes are less likely to perform technical repetitive skills properly, these children are more prone to overuse injuries that can sideline them later in life.

“The risk of injury doubles for children involved in excessive organized play at early ages over children who participate in an appropriate amount of free play,” Dr. Kowalsky noted.

Children who undergo early sports specialization are also at an increased risk for psychological burnout. Overtime it can manifest as mood disturbances, social isolation, and eating disorders. “These kids often drop out of the sport altogether as they get older,” he said.

Despite popular belief, early specialization does not guarantee elite performance later in life. A study of elite adult athletes at amateur and pro levels revealed that elite success did not require exclusive participation in a single sport until their high school years. Instead, top players participated in multiple sports in the preceding years, developing important movement patterns that made them stronger over time.

“Sports diversification actually increases overall athleticism, and the chance of a young athlete achieving elite status,” Dr. Kowalsky said.

The trend toward early youth sports specialization is relatively new. Twenty years ago, young athletes typically played a particular sport only during a given season (i.e. football in the fall, baseball in the spring, swimming in the summer), and most kids rested from competitive sports for a season or during the summer.

The surge in throwing injuries, stress fractures, and other overuse injuries in younger athletes reflects the physical pressures affecting today’s young athletic bodies.  A recent study found that high school athletes who had trained in one sport for more than 8 months in a year were more likely to report a history of overuse knee and hip injuries, than those who played a variety of sports throughout the year or played sports at less intense levels.

The vast majority of injuries associated with excessive specialization and training are overuse injuries. Overuse injuries develop slowly over time, starting perhaps as a mild twinge before progressing into relentless, often debilitating pain.

Thankfully, these injuries are relatively easy to treat when recognized early, with a period rest and activity modification.  All too often, however, players, their coaches and, sadly, parents, are often reluctant to have the athlete sit out a few practices and games.

Left untreated, overuse injuries can lead to more significant structural damage to an affected area. Therefore, it can require lengthier rehabilitation and sometimes surgery.

What’s more, repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. For instance, significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

“The musculature and bones of the developing thrower are not prepared for the excessive numbers of pitches they throw in a game,” said Dr. Kowalsky. This in part has contributed to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, which sometimes requires the so-called Tommy John Surgery.

The solution is simple but that doesn’t mean it is easy.  Dr. Kowalsky recommends the following practices for kids younger than 13 years:

  • Make time for unstructured play

  • Keep the ratio of weekly hours of organized sport to free play below 2:1.

  • Weekly hours of sports participation should not exceed a child’s age, or total of 16 hours in teen players.

  • Athletes of all ages should participate in some sort of supervised strength and conditioning program.

But he admits, in today’s competitive environment implementation of these steps can be easier said than done.  Parents and coaches should keep in mind that the ultimate goal is to make sure their children remain injury-free so they can maximize enjoyment and success in their sport of choice.

 

Biceps and Shoulder Pain

People with shoulder pain often assume they’ve injured their rotator cuff, but sometimes that is not the only culprit. Shoulder specialist and orthopedic surgeon Dr. Marc Kowalsky of ONS notes that an injury to the tendon of the biceps, the prominent muscle in the upper arm that made Popeye and spinach famous, can cause shoulder pain and other uncomfortable symptoms such as clicking or popping.

“The biceps tendon is an often-misunderstood structure of the shoulder and arm,” said Dr. Kowalsky. “We now know that damage to that tendon is often the primary cause of shoulder pain in active people.”

Anatomically, the biceps muscle has two tendons, called heads, that attach it from the elbow to the shoulder. The tendon of the short head attaches to a bone on the shoulder blade outside of the joint. The long head, usually the source of the pain, takes a circuitous path into the shoulder joint. It then attaches to the top of the socket and the glenoid labrum.

As with any other tendon in the shoulder, the biceps can develop tendonitis and tears. It can be a result of repetitive, strenuous overhead activities. Pain from biceps tendonitis or partial tearing typically occurs over the front of the shoulder. It radiates toward the biceps muscle. If the biceps tendon fully tears or ruptures, patients may notice bruising and a cosmetic deformity as the muscle descends and becomes more prominent, in what is known as a “Popeye sign”. Lastly, you can affect the biceps tendon by instability, particularly in certain overhead athletes including swimmers. Biceps instability can also occur in association with a particular tear of the rotator cuff tendon in the front of the shoulder. When this happens, pain is caused because the biceps has slipped from its bony groove of the upper humerus (head of the arm bone).

Moreover, most patients with tendonitis, a partial, or complete rupture of the long head of biceps can be treated conservatively. You can use a combination of ice, anti-inflammatory medication, physical therapy, and corticosteroid injection, said Dr. Kowalsky. Although the cosmetic deformity from a complete rupture will persist, once the pain from the acute rupture improves, strength and overall function of the shoulder should return to normal. If conservative measures fail to relieve symptoms from biceps problems, surgery may be recommended.  If you experience shoulder pain, consult with a fellowship-trained shoulder  specialist at ONS. 

ONS Dr. Seth Miller is Featured in WAG

Top shoulder surgeon Dr. Seth Miller is featured in an article titled “A (Medical) Shoulder to Lean On” in the October issue of  the Westchester magazine, WAG. The piece, written by Jane Dove, was released online on September 26, 2017.  Ms. Dove delivers a comprehensive view of Dr. Miller’s distinguished career and founding prinicple of ONS, one of the region’s premier orthopedic and neurosurgical practices.  She is also able to capture the unique formula that sets ONS apart from the competition:  the highest standard of care, the collaborative approach among specialists in the practice and patients, and the compassion for patients’ individual conditions and treatment goals.

The entire article is copied below:

A (MEDICAL) SHOULDER TO LEAN ON  by Jane Dove

“I am personally very proud of our practice — Orthopaedic & Neurosurgery Specialists (ONS) and the way we treat each patient as an individual,” says Seth R. Miller, an orthopedic surgeon who specializes in arthroscopic shoulder surgery and shoulder replacement.

With offices in Greenwich and Stamford and now Harrison, ONS takes a conservative approach to patient care. “We recommend surgery to only about 10 percent of our patients,” says Miller, who is also a clinical assistant professor of orthopedic surgery at the Hospital for Joint Diseases; a staff orthopedic physician at Greenwich Hospital and an assistant attending physician in orthopedic surgery at New York-Presbyterian Hospital. “We want to make sure it is really needed, because we realize that surgery in any of our subspecialties is a traumatic event for our patients. If it can be avoided, so much the better.”

A leading specialist in shoulder replacement surgery with 1,000 total shoulder and reverse shoulder replacements to his credit, Miller helped found ONS in 1998. There he remains committed to providing excellent orthopedic and neurosurgical care through professional cooperation while showing compassion for patients. By setting the highest of standards, ONS can offer patients a wide range of choices that leads to the best possible outcomes.

“For example, if needed, we will have two surgeons involved in a complicated procedure,” he says. “We do everything we can to ensure the results our patients get are the very best possible. And we deliver those results with compassion and understanding along the way.”

SPOTLIGHT ON SHOULDERS

After graduating from Harvard University in 1978, Miller went on to get his M.D. at the Mount Sinai School of Medicine, followed by a residency in general surgery and then a sought-after one-year residency in shoulder surgery at Columbia-Presbyterian Medical Center.

“I studied under the renowned Dr. Charles S. Neer, who offered me this wonderful opportunity,” he says. “I was always interested in the shoulder and had a great year with him, from l988 to 1989. At about the same time, I met another shoulder specialist who invited me to join him at Greenwich Hospital.”

Miller says Greenwich had many orthopedic surgeons on staff but most practiced in the general area. “I did my share of general orthopedic surgery but really wanted to do as much shoulder surgery as possible. I spoke with several other subspecialists who, like me, wanted to improve patient care by combining several of our doctor’s groups into one entity.”

In 1998, the group took the plunge and founded ONS, starting with only eight physicians.

EXPANSION

ONS now has 22 subspecialty physicians trained in orthopedic surgery, sports medicine, physical medicine and rehabilitation.

“Things really took off when patients realized they could get specialty care of the highest quality right in Greenwich. We now have two specialists for every part of the body.”

The successful reception ONS earned from the local patient community there led to its expansion, first to Stamford and then to a new facility in Harrison.

Miller says he believed one of the keys to the success of ONS has been the one-stop approach the practice offers.

“Our patients just love that we can provide so much under one roof,” he says. “Everything is right here and there is no need to trek from outside office to outside office for tests, scans and blood work. We function as a team of doctors and other medical professionals, working closely and seamlessly together.”

If a question about care or a procedure that can best be answered by another specialist comes up, Miller says, “All we have to do is walk down the hall. Patients find this very comforting and we pride ourselves as working as a collaborative team. At ONS you get the best possible care all under one roof. While our practice is large, it is very effective and attuned to the patient, what he or she really needs.”

SATISFIED PATIENTS

He believes ONS is well-served, as are its patients, by not being a part of a larger patient care “network system.” The proof is in the response. “We get positive feedback in the 96 to 97 percent range,” he says.

“As a result, we are not controlled so much by cost-cutting to enhance the bottom line of the network. As a private practice, we control our own destiny and even have our own foundation. We are free and now big enough to control our financial destiny on our own.”

Shoulder and Elbow Throwing Injuries Rise for Young Athletes

SURGE IN ELBOW AND SHOULDER INJURIES FOR YOUTH INVOLVED IN THROWING ACTIVITIES. 

Young male baseball player

For youth involved in repetitive throwing activities, there is an epidemic of elbow and shoulder injuries, usually due to overuse, poor training, improper throwing mechanics, and fatigue, according to sports medicine physician, Demetris Delos, MD, who specializes in shoulder and knee conditions.

The dreaded injury to the ulnar collateral ligament (UCL)  is usually caused by excessive pitching. If the UCL is injured, it can sometimes be difficult to repair or rehabilitate and may require the so-called Tommy John procedure in order to return to competitive pitching. The surgery is named after Tommy John, the first baseball pitcher to undergo successful UCL reconstruction surgery in the 1970’s.

Other common throwing-related injuries include Little League shoulder, which occurs when the growth plate of the humerus (arm bone) becomes inflamed by the excessive forces produced by repetitive throwing. Similarly, Little League elbow involves injury to the growth plate along the inner portion of the elbow.

In addition to acute injuries, repetitive activities such as throwing can lead to physical changes in the development of growing bones and joints. Significant amounts of pitching during adolescence can change the rotation and shape of the shoulder which may leave the player vulnerable to shoulder injury and arthritis in adulthood.

Studies show that children and adolescents who pitch competitively for more than 8 months in a year are the most prone to injury. Throwing more than 80 pitches per game, a fastball that consistently exceeds 85 mph, or pitching while fatigued are also risk factors for injury.

According to one study, pitchers who pitched more than 100 innings in a calendar year were 3.5 times more likely to sustain serious injuries requiring elbow or shoulder surgery or retire due to the injury. This is why USA Baseball and Major League Baseball now recommend that youth pitchers of all ages and abilities take a minimum four month break from overhead throwing, with at least two months off consecutively.

However, athletes and their parents should be reassured that numerous studies have shown that kids who are exposed to a range of sports that utilize different muscle groups and mechanical skills have greater overall success in athletics than those who specialize early on. In addition, they are less prone to injury and burnout than those who focus on a single sport exclusively.

Double Shoulder Replacement Restores Mobility

SHOULDER REPLACEMENT REGAINS HIS ACTIVE LIFESTYLE JUST MONTHS FOLLOWING SURGERY. 

Arthritis had taken its toll on Dave’s shoulders. He was in constant pain. Sleeping was difficult and it was nearly impossible for him to take part in activities that he loves.  Then, two friends with similar shoulder issuesD.Hapke in Kayak referred Dave to shoulder surgeon, Dr. Seth Miller at ONS.  “When I met him, I immediately knew he was the doctor I wanted to care for me. He was thorough, thoughtful and patient. He has a great bedside manner and took the time to completely answer all my questions,” he recalled. 

Dave had his first shoulder replacement in January, 2013; the second one was done a year later. In both instances, the therapists had him doing exercises the day after surgery, which he continued at home within the week. Through a physical therapy program over the next few months, Dave was able to build muscle mass to help support his new shoulders.

Just 16 weeks after surgery, Dave was back on the water kayaking pain free. These days, he goes to the gym 2- 3 times a week and kayaks quite a bit on ponds, lakes and streams. He can even carry his  kayak.

“I am so grateful to have my active life back, thanks to ONS!” he said.

Shoulder replacement surgery and reverse shoulder replacement surgery is not for everyone. In many cases, treatment such as icing, anti-inflammatory medication and physical therapy can help get shoulder pain from arthritis under control. However, if pain persists, as it did with Dave, it may be time to consider a surgical option, notes Dr. Miller.

With arthritis and some fractures and injuries, the cartilage of the shoulder gradually wears away, creating a situation where bone is rubbing against bone. The resulting inflammation is extremely painful and makes shoulder mobility progressively more difficult. This condition typically develops later in life and gets worse over time.

The shoulder replacement procedure replaces the damaged joint with a highly-polished metal ball attached to a stem and a plastic socket. As long as a patient has an intact functioning rotator cuff, it can be an extremely successful procedure.

However, there is a group of patients that not only have significant cartilage damage in their shoulder, but also have a torn rotator cuff that is beyond repair. The rotator cuff is a group of muscles that run from the shoulder blade to the upper arm and allows patient to elevate their arm. Twenty years ago, treatment options were limited. In 2004, the FDA approved a reverse shoulder replacement procedure that was being used successfully overseas.

The surgery takes about two hours and involves a small incision, usually about three to four inches in length. Patients can expect to stay in the hospital somewhere from one to three days. Further, patients will be released with their arm in a sling, and undergo exercises to reestablish range of motion with the joint.

Between four and eight weeks after surgery, patients should be able to raise their arms above their heads without pain. Three to four months after surgery, patients are gradually resuming the activities of daily living. Many patients remark after recovery that they feel like they’ve been given their life back.

ONS’ Dr. Seth Miller was one of the first in the metropolitan area to perform reverse shoulder replacement surgery. He will take part in a Joint Replacement Symposium at Greenwich Hospital with ONS colleagues and joint replacement surgeons Drs. Frank Ennis and Brian Kavanagh.

The event will be held on Wed. May 11 starting at 6 p.m.  To register, call 203-863-4277 or online.

ONS Surgeon Demetris Delos, MD Speaks about Knee and Shoulder Conditions on Health IQ

Demetris Delos, MD
Demetris Delos, MD

ONS orthopaedic surgeon Demetris Delos, MD, was a featured guest on Pleasantville Community Television’s series, Health IQ, hosted by Dr. Alan Siegel of ProClinix. During the fascinating thirty-minute interview, Dr. Delos, a specialist in knee and shoulder conditions, spoke in detail about common cartilage, ligament and tendon injuries. Age, gender and type of activity can play a role in a person’s susceptibility to orthopedic problems, he said. Using models and computer generated images, Dr. Delos described the non-surgical and surgical options to repair or replace damaged tissue and joints.  Functional and strength training, he stressed, are key for injury prevention and rehabilitation. Dr. Delos also provided a glimpse into future treatments including the development of synthetic tissue products and the advances in biologic medicine which uses biomedical materials such as blood, platelets and stem cells to treat pain and complex, often chronic conditions of the musculoskeletal system.