ONS Announces Strategic Partnership

Joining with Orthopedic Associates of Middletown Keeps Patients, Physicians at Center of Care

ONS today announced a strategic partnership with Orthopedic Associates of Middletown (OAM), a market leading integrated orthopedic practice based in Middletown, Connecticut. The partnership will facilitate the continued growth of OAM through capital resources provided by ONS, including additional locations and patient-centric care offerings, and marks a milestone on the path of regional growth plans for ONS.

“Our combined organization prides itself on the ability to provide the region with a patient-centered, integrated suite of musculoskeletal services including orthopedic surgery, neurosurgery, podiatry and ancillary support,” said Tim Corvino, M.D., who was appointed CEO of ONS in March of this year. “Financial pressure is increasing for patients and physicians, and we, along with our new colleagues at Orthopedic Associates of Middletown, understand that physician-led organizations like ours represent the best way to deliver outstanding patient care and leading clinical outcomes.”

With this partnership, the ONS network now includes 34 physicians, 350 employees, and seven locations throughout central and southern Connecticut, including ONS operations in Greenwich, Stamford and Harrison (New York), and OAM facilities in Marlborough, Middletown, North Haven and Westbrook.

“The communities we serve have always been supportive of us, and this partnership will allow us to continue providing them with the highest-quality of care,” said Terry Reardon, M.D., one of OAM’s founding physicians. “Orthopedic Associates of Middletown has a history of investing in and pursuing innovations that benefit our patients, physicians and team. Twelve years ago, we built a state-of-the-art clinic to provide our community with a home for care, and by securing this partnership, we are taking another proactive step to make sure we’re able to provide the physician-guided care our community needs for decades to come.”

As a leading provider of multi-specialty orthopedic and neurosurgery care in the Tri-state area, ONS is poised to continue expanding its model – built on best practices in clinical outcomes and patient experience – through partnerships with like-minded, physician-led practices such as OAM.

“This partnership will provide more opportunities for ONS and OAM to expand our services and geographic footprint,” said Seth Miller, M.D., co-founder of ONS. “Both practices share the same core values of providing the highest quality of care to our patients, ensuring their safety and supporting an organizational culture that puts patients first.”

As the healthcare environment adapts to the rapid change, challenges and innovations spurred by the COVID-19 pandemic, partnerships such as these help to preserve high-quality, cost-effective care for patients in the physician practice setting. With the backing of its capital partner Kohlberg & Company LLC (“Kohlberg”), ONS continues to pursue partnerships with leading organizations to ensure this type of care remains an option for patients.

“Kohlberg is honored to support the partnership of ONS and OAM. These organizations share a reputation for delivering the highest level of patient care provided by world-class physicians,” said Ahmed I. Wahla, Partner of Kohlberg and a member of the ONS Board of Directors. “This partnership will set the foundation for what we want to build together, and we look forward to the company’s continued growth and development.”


 About Orthopaedic & Neurosurgery Specialists (ONS)

ONS is an advanced multi-specialty orthopaedic and neurosurgery practice that has served patients throughout the New York Metropolitan area for more than 20 years. The 25 ONS fellowship-trained 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. ONS provides onsite digital imaging and state-of-the art physical therapy and MRI. ONS also operates an ambulatory surgery center (ASC) in Stamford, CT. For more information, please visit onsmd.com

 About Orthopedic Associates of Middletown (OAM)

Orthopedic Associates of Middletown was founded 30 years ago and provides integrated general and multispecialty orthopedic and podiatry care with five board-certified orthopedic surgeons, a board-certified physical medicine and rehabilitation physician and a fellowship trained foot and ankle podiatrist. OAM offers a broad spectrum of care including total joint replacement, sports medicine care and injuries, hand surgery, specialized foot and ankle care and non-surgical approaches to neck and back pain. OAM patients have the convenient choice of outpatient procedures in an ortho-specialized surgery center and four different hospitals, in Hartford, Middletown and Meriden. OAM’s Urgent Ortho™ walk in care provides a patient-friendly alternative to the emergency room for orthopedic injures including rapid worker compensation care. 

 About Kohlberg & Company

Kohlberg & Company, LLC (“Kohlberg”) is a leading private equity firm headquartered in New York. Since its inception in 1987, Kohlberg has organized nine private equity funds, through which it has raised over $10 billion of committed equity capital. Over its 33-year history, Kohlberg has completed 80 platform investments and nearly 200 add-on investments, with an aggregate transaction value in excess of $22 billion.  For more information, please visit kohlberg.com.

Dr. Sethi Published

Dr. Paul Sethi is the senior author of an important study that has been published in the the prestigious publication,  Journal of Shoulder and Elbow Surgery.  The article, “Perioperative pain management for shoulder surgery: evolving techniques,” details the evaluation of strategies to enhance patient satisfaction and outcomes, and provides guidelines for opiate utlization/minimization after surgery.

Dr. Sethi has been at the forefront of research into non-opioid options for post-operative pain and the development of the multi-modality strategies for surgical pain management.

“Although opioid medications have historically been mainstay of acute post surgical pain management, relying solely on them is not advisable given their many short- and long-term effects,” noted Dr. Sethi. “It is incumbent upon surgeons to understand the evidence behind the various modalities for controlling pain after shoulder surgery.”

Read the article 


ONS Appoints ASC Executive Director

ONS Appoints Edward W. Staunton as Executive Director of Stamford ASC

Greenwich, CT – August 24, 2020 – Orthopaedic & Neurosurgery Specialists (ONS), the leading provider of multi-specialty orthopedic and neurosurgery services in Connecticut and Westchester, announced today the appointment of Edward W. Staunton to the company’s management team as Executive Director of the Stamford ASC.

Mr. Staunton joins ONS with more than 25 years of management experience in the healthcare field, including executive-level hospital operations, strategic planning, and Ambulatory Surgery Center (ASC) development and administrative leadership. Most recently, he served as Site Director at Hospital for Special Surgery (HSS) Sports Medicine Institute in New York City. Prior to HSS, Mr. Staunton was the Executive Director of Western Connecticut Health Network (WCHN) in Norwalk, where he led the strategic growth, operations, and development of the Department of Surgery across the WCHN system. He previously served as Director of Cardiovascular Services at Norwalk Hospital, and was the Director of Business Development at Ambulatory Surgical Centers of America, in Norwell, MA.

“We are excited to have Ed take the helm at Stamford ASC at a time when the demand for outpatient surgical options is on the rise. Ed’s extensive expertise in healthcare management and strategic growth will heighten our ability to deliver same-day surgical procedures to more patients while maintaining the highest quality of clinical care,” stated James Cunningham, MD. Medical Director at Stamford ASC.

“Ed is an ideal fit for Stamford ASC leadership. His knowledge, experience, and management skills will enhance our efforts to expand our reputation as the premier full-service orthopedic practice in the region,” commented Tim Corvino, MD, Chief Executive Officer at ONS.

“I could not be more excited to join the ONS team at this pivotal period of growth for the practice,” said Mr. Staunton “By working closely alongside ONS’ physicians and management, I look forward to ensuring patients always receive the highest standard of care at the ambulatory surgery center.”

Exercise After Injury

“No pain, no gain” doesn’t apply to post-injury exercise.

Having an injury can be frustrating to fitness enthusiasts, but it does not mean you have to abandon all physical activities. There are ways to ensure safe participation in exercise following an Electrolyte Supplementsinjury, or while still battling with certain aches and pains without making matters worse, according to Alicia Hirscht, DPT, SCS, CSCS, director of physical therapy at ONS Stamford.

Whole Body Health

Following your physical therapist’s home exercise program or consulting with your physician is a vital first step to proceed in the right direction.  “It’s most important for you to start very slowly. Pay close attention to how your body and pain levels respond to the increased physical exertion. This will be your indicator of whether you need to scale back for a while, keep at your current exercise level, or increase you activity,” said Hirscht.  For example, if you have mild pain at the beginning of a run that goes away within 1-2 minutes, it’s probably okay to continue. However, if the pain worsens over time, or does not go away with rest, you are not ready to perform that exercise.  It is equally important to follow a modified conditioning program of strengthening exercises and stretches that promote whole-body health.

Knee, Shoulder, Back Exercise Advice

“Someone with chronic knee issues should be careful with high impact and weight bearing activities like running and contact sports. Biking, walking, and swimming are safer options,” said Hirscht, who recommends knee patients follow to a lower extremity strengthening and stretching program that targets the core and lower body. “Building up the core and lower extremities will help ease the stress on the joint and stabilize the knee.”

People with shoulder issues should be careful with overhead activities, such as racket sports and freestyle swimming, she said.  Opt instead for a strengthening program that emphasizes the rotator cuff and shoulder blade muscles, combined with a stretching program to open the chest and shoulder muscles.

With back pain, there’s a good chance your core muscles are weak (abdominals, back muscles, hips and hamstrings). “Swimming is an excellent activity to strengthen your back and maintain cardiovascular fitness,” Hirscht said. “Exercises that focus on the core and safely engaging multiple muscles, like planks, are extremely beneficial for the back, too.”

All in Good Time

Regaining your previous level of fitness after pain or injury can be discouraging because  healing does take time. “It helps to remember how far you’ve come rather than how much farther you have to go,” said Hirscht. “Taking a smart and steady approach that allows for one day of rest between outings, a nutritious diet, proper sleep, and stress management will all help you get better faster and back to doing the things you most enjoy,” she said.

ONS Ranked Best

Don’t just take our word for it. 

For the second time this month, ONS specialists have been ranked among the best in their areas of expertise, this time they have been named “Best Doctors in the New York Metropolitan Area” by New York Magazine.  Published in the June issue, the magazine’s annual list of best doctors is compiled by Castle Connolly, a nationally recognized medical rating agency that uses peer reviews as part of its identification process.

Earlier this month, Connecticut Magazine published its list of the state’s best doctors based on results provided by researchers at Best Doctors®, a global benefits provider and medical information services company that uses a peer-to-peer polling method and proprietary balloting software for the selection process.

ONS Doctors Recognized as Best in the New York metropolitan area by New York  Magazine

Michael Clain, MD

Amory Fiore, MD

Jeffrey Heftler, MD

Paul Sethi, MD

Katherine Vadasdi, MD

Mark Vitale, MD

ONS Doctors Recognized as Best in Connecticut by Connecticut Magazine

Paul Apostolides, MD

Mark Camel, MD

Michael Clain, MD

James Cunningham, MD

Frank Ennis, MD

Amory Fiore, MD

Seth Miller MD

Paul Sethi, MD

Scott Simon, MD

Katherine Vadasdi, MD

Mark Vitale, MD

Trend: Outpatient Joint Replacement

Faster recovery and fewer risks of infection when recovery begins at home.

As elective surgeries resume in Connecticut and throughout the Northeast, patients are thinking about their risk for infection as never before. This is one of the reasons surgical candidates are trending toward outpatient procedures at independent ambulatory surgery centers and recovery in the comfort of home. Demand for outpatient joint replacement surgery, in particular, is on the rise. By some estimates, the number of hip and knee replacements surgeries done as a same-day procedure will increase by 50 percent in the next five years.

Total joint replacement surgeons Jonathan Berliner, M.D., and Kevin Choo, M.D. at Orthopaedic & Neurosurgery Specialists (ONS), a leading provider of orthopedic and spine care, have noticed a significant uptick in patients opting for the hip and knee replacement procedures that don’t require a hospital stay.

“Innovations over the past several years in anesthesia, surgical techniques and therapeutic approaches have allowed joint replacement procedures to safely transition to the outpatient setting,” said Jonathan Berliner, director of the ONS Outpatient Joint Replacement Center. “Factor in the benefits of conducting joint replacements in facilities dedicated to the care of orthopedics and spine patients separate from those being relied on to treat COVID-19 and it may become a better decision for the patient’s overall health and the system as a whole.”

Years ago, patients would often remain in the hospital for 3-5 days after total hip or knee replacement surgery. Today, hip or knee replacement surgery for an otherwise healthy patient can be safely performed at an outpatient facility followed by at-home nursing and physical therapy.

“Advances in anesthetic techniques that allow for improved pain control and a more rapid functional recovery have been an important factor in reducing the amount of time a patient needs to stay in a healthcare facility following a joint replacement procedure,” said Dr. Berliner.

A successful and smooth outpatient joint replacement surgical experience relies on detailed preoperative planning of post-operative care.  At ONS all patients are provided a clinical team to support the process that along with the doctor includes a case manager and physical therapist who engage with patients at each step in the process. Good candidates for outpatient joint replacement are motivated to recover at home, have a reliable support network, and are otherwise in good health.

“Continually improving the recovery process for my patients has become one of my greatest interests,” said Dr. Berliner. “Joint replacements can be a life changing event. The ability to eliminate joint pain and restore a patient’s desired activity level and quality of life is what makes my job so enjoyable. These patients are our family, friends and neighbors who have been waiting for more than two months to address a serious health need.  I think it is important they understand that we will continue to address their needs as safely as we can.”

If you are a current ONS patient, or are in-need of an orthopaedic evaluation or consultation, please visit https://onsmd.com/joint-replacement/outpatient/for more information about your options.

CT Magazines Best Doctors

Eleven ONS Physicians Recognized.Best Doctors ONS

We already knew our doctors are among the best, but it’s nice to be formally recognized once in a while.  In the June issue, Connecticut Magazine published its annual list of Best Doctors in Connecticut. We were thrilled to see so many ONS specialists named.

Paul Apostolides, MD – Neurosurgery

Mark Camel, MD – Neurosurgery

Michael Clain, MD – Orthopedic Surgery

James Cunningham, MD – Orthopedic Surgery

Frank Ennis, MD – Orthopedic Surgery

Amory Fiore, MD – Neurosurgery

Seth Miller, MD – Orthopedic Surgery

Paul Sethi, MD – Orthopedic Surgery

Scott Simon, MD – Neurosurgery

Katherine Vadasdi, MD – Orthopedic Surgery

Mark Vitale, MD – Hand Surgery

ONS Webinar Series

New Live Speaker Events.

We are excited to kick off the ONS Live Webinar series, featuring ONS specialists’ discussions on interesting, health-related topics, followed by Q & A.. Click on the titles below at the appointed times to join any or all of our upcoming webinars, or copy to your calendar. Is there a topic of interest to you?  Send your suggestions to contact@onsmd.com and put Webinars in the subject line. Check the calendar on our website for future events. IOS users may need to download Microsoft Teams free app.


June 2    5:00 – 5:30 pm    

Treatments for Shoulder Pain
with Dr. Demetris Delos, sports medicine and shoulder specialist

June 3   5:00 – 5:30 pm    

The Healthy Student Athlete
with Dr. Marc Kowalsky, sports medicine specialist

June 4  9:30 – 10:00 am    

Is Outpatient Joint Replacement Right For You?
with Dr. Jonathan Berliner, total joint replacement specialist

June 9  5:00 – 5:30 pm    

Overcoming Neck Pain
with Dr. Heeren Makanji, orthopedic spine specialist


June 10  5:00 – 5:30 pm

Bunion Surgery: An Overview
with Dr. Michael Clain, foot and ankle specialist

June 11  12:00 – 1:00 pm
Understanding Knee Pain
with Dr. Kevin Choo, hip and knee replacement specialist

Honor for Dr. Berliner

Dr. Jonathan Berliner, director of the ONS Outpatient Joint Replacement Center, was named among the 2020 Rising Stars – 40 Under 40, by the Business Council of Westchester (BCW).

Dr. Berliner is a board certified orthopaedic surgeon and fellowship-trained specialist in hip and knee replacement. His expertise includes muscle sparing anterior hip replacement, minimally invasive total knee and partial knee replacement, complex revision total hip and total knee replacement, computer-assisted surgery, and trauma of the lower extremity.  Dr. Berliner joined ONS in 2017.

According to a statement released by the BCW, the Rising Stars program is modeled after the national business recognition program “40 under 40.” Rising Stars honorees were chosen based on professional and/or entrepreneurial accomplishments, professional and/or business affiliations, and demonstrated leadership skills.

“This year’s winners represent the very best and brightest of Westchester County’s up and coming young professionals from a tremendous cross-section of organizations and industries. We’re delighted to honor such an elite group,” said Rising Stars Chairman Joseph McCoy, Region Manager, Commercial Lending, SVP People’s United Bank.

The winners will be honored on September 2 at a location to be announced.


Back Pain Exercises


If you are among the millions of Americans who experience persistent back pain, you may bet some relief by following the exercises demonstrated by ONS Stamford Physical Therapist, Liz Catalano, DPT.

Tennis Exercises

With tennis courts opening for singles play, Alicia Hirscht, DPT, SCS, director of physical therapy at ONS Stamford, has put together this video demonstration of exercises to strengthen the main muscle groups required to play the sport and help prevent tennis-related injuries.


Beginning Monday, May 11, ONS will resume all office visits during regular business hours. Ambulatory surgeries  are scheduled to resume on Monday, May 18.

Throughout the past two months, ONS has maintained our commitment to patient and community health and safety. As our state leaders allow communities to reopen, ONS has strategically planned for the reinstatement of our elective office visits and ambulatory surgeries. 

We know this is a time of uncertainty. Our clinician-led team is acting purposefully and strategically to help you feel confident walking through our doors to receive the essential services you need, and to protect your safety before, during and after your visit.


ONS is taking a physician-led and phased approach to safely treat patients with time-sensitive needs. This careful effort began with the introduction of ONS TeleHealth to keep patient care plans on track during Shelter in Place orders and the service is now expanding.

While we do not and have not treated any COVID-19 patients within our facilities, we are nonetheless enhancing our Safety & Access Protocols to support your overall wellness.



·         Temperature & Symptom Screening – All patients and staff will be screened for potential COVID-19 symptoms prior to appointments and again upon arrival at any of our facilities.

·         Socially Distanced Waiting Room – Our waiting room will be open and will be rearranged to enforce social distancing measures for patients and staff.

·         Parking Lot Waiting – As an alternative to our waiting room, we are encouraging patients to wait in their car until their appointment begins.

·         Mask, Glove & PPE Use – We will use the proper PPE for all appointments in addition to following CDC reuse and preservation protocols.

·         Enhanced Cleaning & Sterilization – All common spaces, procedure rooms, equipment and more will undergo strict sanitization measures.


·         Pre-Visit Registration – You will have the opportunity to reduce time spent in our lobby and reception area by completing necessary registration documents prior to your visit.

·         ONS TeleHealth – Our new telehealth portal, ONS TeleHealth, continues to connect patients, physicians and therapists for virtual appointments and care sessions. Visit https://onsmd.com/telehealth/ for more information.

·         Online Self-Scheduling – ONS patients are now able to schedule TeleHealth appointments online through our self-scheduling program. You can handle your scheduling needs at any time of day that is convenient for you.

ONS Safety & Access Protocols are in place so that you can feel comfortable and confident returning to the providers you know and trust. We are here for you and can’t wait to see you … even if it will be from behind a face mask.

We also know you are going to have questions and that’s a good thing. We want to answer them. Call (203) 869-1145 or visit www.onsmed.com.

Golf Injury Prevention

Now that golf courses are starting to open, golfers may want to head out to the links to make up for time lost in quarantine.  Not so fast, writes ONS Physical Therapist, Matt Dunning, DPT, who advises golfers to make sure they are physically primed for the demands the sport takes on different parts of the body. 

He’s shared some insightful information detailing the physical exertion that occurs while playing golf and how to avoid common golf injuries.

Golf is a full body exercise for three hours or more.  During that time, the golf swing transfers energy from the feet through the legs, up the spine, through the arms and to the club.  Physical issues and pain can arise due to problems at any point along that kinetic chain.  Pre-existing physical issues can put limitations on the ability to swing soundly and play consistently and at the desired level.

A good golf training program must include leg and core strengthening and stretching as well as upper body work to ensure the entire body moves in correct alignment. 


A good golf training program must include leg and core strengthening and stretching as well as upper body work to ensure the entire body moves in correct alignment. 

Golf injuries occur if the body is not conditioned to go through the motions effortlessly.  A comprehensive training program should promote:

  • Ankle /calf flexibility
  • Knee bend and rapid straightening during swing
  • Hip and lower back rotation
  • Shoulder rotation, elbow bending and straightening
  • Neck flexibility, strength and stability


Any one of the following issues can and will impact your ability to swing a golf club properly and consistently.

  • Joint pain and stiffness  
  • Muscle tightness
  • Limited hip rotation
  • Decreased balance
  • Weakness and decreased stability


Neck and Back: Muscle strain, overuse, limited range of motion, weakness, disc dysfunction

Shoulder: Bursitis, rotator cuff tendonitis, biceps tendonitis

Elbow: Medial or  lateral epicondylitis (Golfer’s or Tennis elbow), forearm tightness

Wrist: Carpal Tunnel Syndrome

Knee:  Pain due to OA, meniscus injury

Ankle: Sprain, weakness


Back pain / injury

Most common area of injuries, affecting 15-34% of amateur golfers

Upper extremity pain

Affects 13-20% of amateur golfers

Knee pain

Affects about 3-18% of all golfers


Daily stretching and exercise will reduce the risk of repetitive motion injuries common to golfers. Stretching and staying mobile during the round of golf helps to maintain flexibility for safe play throughout the game. 

Download this Golf Stretching Program

These muscles, in particular, should not be tight.

  • Hamstring – back of the thigh
  • Piriformis – deep muscle of the buttocks
  • Quadriceps – front of the thigh
  • Quadratus Lumborum and Latissimus – along your side from the hip to the armpit
  • Wrist flexors/extensors – forearm
  • Pectoralis muscles – chest
  • Upper Trapezius /Levator scapula – neck muscles


  • Stretch or exercise at home before leaving for the course to save time and ensure proper ability to perform.  Fight the urge to bounce or stretch quickly, hold each stretch for 15-20 seconds at a comfortable position
  • At the course, a quick stretch with the club, prior to lining up the first tee
  • Stretch from time to time while other players playing through their shots
  • Give yourself opportunities to walk more if using a cart, to keep muscles loose and increase circulation
  • If sore after the round of golf, use ice to reduce inflammation at the elbow, shoulder, knee


Managing Back & Neck Pain

Amanda Rausch, PTA, offers advice for dealing with back and neck pain while at home.

pain in the backDuring this time of lock down, many people are finding themselves in a more sedentary lifestyle than they lived before the COVID-19 outbreak. After many weeks of confinement and immobility, they may start to experience restricted movement and stiffness that can easily lead to back and neck pain. That’s why it is so important to intersperse periods of movement throughout the day. The more you move, the better your body mechanics and posture, and the more control you will have over neck and back pain.


Eight out of ten people will suffer from some form of pain at some point in their life. Pain is the body’s way of protecting itself and alerting you to the fact that something is wrong. Back and neck pain can range from a mild, dull, annoying ache, to persistent, severe, disabling pain. Spine pain can restrict your mobility and interfere with your normal functioning and quality of life.

Pain in your back or neck area can be acute, meaning it comes on suddenly and intensely, lasting for a few days to a couple weeks. Chronic pain tends to increase over time, lasting for weeks, months, or even years. This type of pain can be continuous or intermittent. Consult with your healthcare provider or an ONS spine specialist if you experience persistent or increasing pain for more than few weeks.


Anatomy of the Spine

The spine has natural curves creating an “S” shape. These curves allow the spine to act like a coiled spring to absorb shock, maintain balance, and facilitate full range of motion through the spinal column.

The muscles that support and maintain the spinal column fall into two groups, lexors and extensors. The flexor muscles are on the front side of the spine and include the abdominals. The extensor muscles are in the back of the spine.

Both groups perform different functions for the spine. Flexors allow you to bend forward and flex. They also assist when you lift objects to stabilize the low back. Extensors allow you to stand up straight and they assist with lifting objects as well. When both muscle groups work together, they stabilize the spine.


Even with today’s technology, the exact cause of back and neck pain is difficult to determine. In most cases, the cause includes any of the following:

  • Overuse, strenuous activity, or improper use, such as repetitive or heavy lifting
  • Poor muscle tone
  • Muscle tension or spasm
  • Sprain or strain
  • Ligament or muscle tears
  • Trauma, injury, or fractures
  • Infection
  • Abnormal growth, such as a tumor or bone spur
  • Obesity, which places increased pressure on your spine, and discs
  • Joint problems, such as arthritis
  • Smoking
  • Dehydration
  • Protruding or herniated (slipped) disk and pinched nerve
  • Osteoporosis and compression fractures
  • Congenital (present at birth) abnormalities of your vertebrae and bones
  • Abdominal problems
  • Degeneration of vertebrae, often caused by stresses on the muscles and ligaments that support your spine, or the effects of aging
  • Emotions: Stress, Depression, Anxiety, etc.


Symptoms associated with back pain may include:

  • Dull, burning, or sharp pain in the back.  The pain can be confined to a single spot or cover a large area
  • Leg numbness or tingling above or below your knee from any side
  • Stiffness or achiness that occurs anywhere along your spine (from your neck to your tailbone)
  • Sharp, shooting pain that radiates from your low back to your buttocks, down the back of your thigh, and into your calf and toes
  • Consistent ache in the middle or lower part of your back, especially after standing or sitting for an extended period

Loss of bladder and bowel control, with weakness in both legs, are symptoms of a serious condition that requires immediate medical attention.


  • Headaches, Migraines
  • Shoulder pain
  • Arm numbness or tingling than can radiate part way down the arm or all the way to the finger tips
  • Sharp shooting pains or a dull ache in your neck that can radiate the length of the neck or down the upper back


If you experience acute back or neck pain, it may simply improve with some rest. Over-the-counter medicines can also help with the discomfort. It may seem counter intuitive, but you should try to move gently during this time to avoid stiffness and lose mobility. It becomes more difficult to decrease pain when you stop moving for too long.

If you have acute or chronic pain of your back and neck, there are several remedies you can try that may help. These include:

  • Hot or cold packs; for better results it’s best to alternate hot and cold. However, wait for the affected area to return to your normal body temperature before alternating packs
  • Specific exercises to strengthen muscles and ease pain, such as stretching, extending and flexing
  • Mild aerobic exercise such as walking at a normal pace
  • Certain anti-inflammatory medications or muscle relaxants may be used, with your Doctor’s supervision


Acute back pain usually resolves on its own. Acetaminophen, such as Tylenol®, or ibuprofen, such as Aleve®,will decrease the pain and help you rest. Surgery and special exercises are generally not used with acute pain.

For severe, disabling, or chronic back and neck pain, a physical therapist can develop a program designed specifically to meet your needs and lifestyle goals. The type of program will depend on the type and severity of your pain, injury, or disease.

The goal of back and neck rehabilitation is to help you manage the pain, return to your highest level of functioning and independence possible, while improving your overall quality of life. The focus of physical therapy is to relieve pain and improve mobility (movement). Surgery is always the last option for treatment of pain relief.

To help reach these goals, back and neck rehabilitation programs can include the following:

  • Exercise programs to improve range of motion, increase muscle strength, improve flexibility and mobility, and increase endurance
  • Help with obtaining assistive devices that promote independence
  • Patient and family education
  • Pain management techniques (breathing exercises and mindful awareness)
  • Gait (walking) and movement retraining
  • Stress management
  • Ergonomic assessments and work-related injury prevention programs
  • Body Mechanics and Posture training
  • Proper lifting techniques: avoid heavy lifting; when you do lift something, bend your legs, keep your back straight, and then slowly lift your body and the object
  • Ergonomics for telephone and computer use and other equipment
  • Correct posture while sitting, standing, and sleeping


back pain exerciseIt’s always important to remember to breath when doing exercises especially when having pain. I always suggest starting with breathing exercises before doing any other physical exercises. It will help you build a better tolerance when going for a walk or doing the neck or back exercises. You can do these exercises laying down or sitting. It’s important to have your back be fully supported while seated or your spine  straight when laying down.

You may be self-conscious if you are new to these types of exercises, but it’s important to be fully relaxed.  Allow your stomach to expand and contract without resistance for best results. Try to visualize your breathing cycle and how it affects your body while completing these exercises.


When first starting to work on breathing exercises, you can either place one hand on your chest and one on your stomach or you can place both hands on your stomach, whichever is most comfortable for you.

With any exercise, if you start to feel pain going down the arm or leg stop immediately and rest.

Posture and Transfers

If you have increased pain in the back or neck, supporting the spine is very important with transfers and with posture.

Getting out of Bed: The proper transfer is the log roll. Turn to the side without rotating or twisting the spine then put legs over the edge before pushing yourself up.

Bed positioning– If you sleep on your back, support your neck with a neck pillow and place a second pillow under your knees to support your low back.  If you tend to sleep on your side, use a neck pillow to support your neck and place a second pillow between your knees. This helps to relieve the pressure from your hips and low back.

Proper workstation postureSitting posture: Working or reading while sitting. You want your computer screen at comfortable eye level and keyboard lowered to comfortable level using an extra keyboard if needed to keep straight neutral posture. When reading, don’t slouch and hold the book higher to eye level.

When looking at your phone, keep in mind that for every inch that your head flexes forward, you add 10 lbs of pressure to your neck. The pressure from the head going forward leads to compression on the nerves in the back of the neck and can start causing pain down the neck and into the arms and upper back.  Looking at your phone for long periods can also contribute to disc degeneration and neck arthritis.


Avoiding Shoulder Pain

Peter Falla, ATC/L, of ONS Physical Therapy in Greenwich, shares tips to avoid shoulder pain during the COVID-19  lock down.

Many of us have recently set goals to take advantage of downtime during isolation from coronavirus.  We have pledged to improve eating habits, get on track with our exercise routines, and even check off some household projects that have been hanging over our heads.  Additionally, stay-at-home orders have many of us working and schooling from home, presenting a whole new set of challenges including less than optimal workstation setups. Any and all of these situations can put you at risk for a shoulder injury.

Outlined below are steps you can take to help prevent or perhaps improve, pain in and around the shoulder.

Watch Your Posture!Poor work posture

Pay attention to your posture while using your laptop to work from home.  Fight the urge to sit cross-legged on the couch during long bouts of keyboarding, reading, or video conferencing.  Sitting in this position promotes a slouched thoracic spine and a forward head posture that stresses soft tissue structures in the neck, shoulders, and back, often leading to pain in these areas.

Instead, keep your feet on the ground, engage your core muscles to support your back, and do all that you can to elevate the height of the screen so that you are not looking down for long periods.  Activating certain muscles to maintain good posture can be considered a workout.  Over time it will become easier to do and also easier to notice when you are in a poor sitting position.  Check out this link for more detailed information: ONS Workstation Ergonomics

Be Careful with Home Exercises

Home exercise injuryThere are many home workouts circulating now that are tailored to people sheltering at home to avoid infection.  Evaluate these workouts carefully before starting.  Instructions for your body position during the exercises should be clear and make sure the program is issued by reputable sources.

Do not deviate too greatly from the workouts your body is familiar with.  New stressors and movements can be beneficial in some situations, however, this is not a time to develop a new injury or aggravate an old one.

Exercise-Related Shoulder Pain

When patients present to our physical therapy clinics with exercise-related shoulder pain, there are usually some common denominators we uncover in their exercise history.  Previous injury notwithstanding, one of the most common causes of acute shoulder pain occurs when an  individual increases the level of activity too quickly.  When starting an exercise plan at home, select a program that gradually increases the activity in a methodical manner to avoid over-straining the shoulder girdle.

Another exercise-related shoulder pain results from performing repetitive exercises that irritate the soft tissue surrounding the ball and socket joint in the shoulder, or the rotator cuff, which is a group of muscles that stabilise the joint and allow the arm to be raised overhead.

Common Culprits

One of the classic complaints patients have is shoulder pain when raising their arm fully overhead.  In the context of someone active in the gym, or with home-based weight training, certain exercises can be detrimental to your shoulder.  Overhead presses, dips, and push-ups are the top three exercises that may lead to shoulder pain.  If the shoulder muscles that stabilize the scapula (shoulder blade) are not strong, an individual may perform the exercise using improper mechanics at the shoulder joint, causing inflammation and discomfort.  Discontinue any exercise that causes discomfort during the movement.  Strengthening the same muscles can be done effectively with lifting the arms no higher than the shoulders.

Push-ups and dips are two exercises that, if done too deeply, (elbow angle >90°) can overload the ligaments of the shoulder joint, leading to pain.  Perform these exercises slowly and through a comfortable range of motion, avoiding the extreme ranges that uncomfortably stretch the front portion of the shoulder.  Lastly, when performing upper-body resistance training, remember to warm up adequately and incorporate some light stretches to prepare the shoulder for the demands it will encounter.

Go Easy On The To-Do List

Finding ways to stay busy and productive during these trying times has resulted in many of us tackling projects around the house that we normally have little time to do. Some of us find ourselves undertaking one project after another, which is great for one’s sense of pride and accomplishment, but it may take a toll on the shoulder or low-back.  Work slowly when faced with projects that require lifting, digging, or sustained overhead work.  If you feel any shoulder discomfort, space out the work and take breaks as needed to do other less strenuous tasks.  If the pain persists, put that project on the back burner until you’ve consulted with a physician or physical therapist.

General Instructions

The takeaway here is that you should have a plan in place to minimize stress to your shoulders and total body through careful exercise selection, good body mechanics, and a gradual, progressive approach to all types of strenuous work you undertake.

There are some useful general strengthening and stretching exercises included in the following link; RANGE OF MOTION EXERCISES.  As always, check with your doctor before beginning any new exercise routine.

If You Develop Shoulder Pain

If you are experiencing shoulder pain that is slow to improve or may even worsen, refrain from strenuous upper body exercise and household work until you can be properly evaluated by an ONS orthopedic shoulder specialist.  Due to the COVID-19 pandemic, ONS has limited office visits to urgent orthopedic and spine injuries, by appointment only. Patient evaluations and consultations with ONS specialists are available to all patients online through ONS Telehealth.  Call 203-869-114 to make an appointment or you can schedule your  telehealth visit at any time using our new self-scheduling feature.