Do You Have Text Neck?


It seems like everywhere you look, people of all ages are looking down at their phones.  They do it at home. At work. In school. In restaurants.  While waiting for a train. Even while walking, driving and riding a bike.  Concern about the pervasiveness of handheld devices exists for a variety of reasons, not the least of which is the detrimental affect they have on the cervical spines of children, teens and adults.  Some call it Text Neck.

By some estimates, adults spend an average of 5 hours a day using a mobile phone or tablet, while teens report using their devices almost constantly throughout the day.  As a result, more and more people are developing neck pain caused primarily by holding their heads in an abnormal way.


Consider this. A quick glance down at your phone adds about 20 pounds of unnatural force to the discs in your neck. That weight more than doubles when you are fully engaged with your device.  Putting that stress on your cervical spine for hours a day, every day can accelerate the natural wear and tear on the cervical bones and discs.

Leaning your head forward also compresses and tightens the muscles in the front of your neck and lengthens the tendons, ligaments and muscles in the back of the neck. Over time, this can cause inflammation and weakness. Abnormal flexion also can be responsible for headaches, neck pain, shoulder pain and nerve-related symptoms such as radiating pain, tingling, numbness and/or burning in one or both arms. Your chances for disc herniation and early arthritis are also increased.

Neck pain from textingGrowing children and teens can develop those problems too, but they have the additional risk for skeletal deformity. Studies have shown that overtime, younger people who strain their neck muscles by holding their heads in a forward tilt for prolonged periods can develop an abnormal curvature in the upper back and neck.  In one study, researchers in Australia noted the development of bone protrusions similar to horns in the connecting tendons at the back of the neck in young teens who had used phones and tablets since childhood. There’s a name for that too. Phone Bone.


Physical therapy and in some cases, surgery can help alleviate the symptoms brought on by the overuse of these devices, but there are other steps you can try before it gets to that point.  Youngsters should be encouraged to partake in physical activities that help develop musculoskeletal strength and reduce time spent gaming and texting.  People of all ages can engage in activities that promote good posture, such as yoga or Pilates. When possible, use a desktop or laptop with the screen at the ergonomically correct angle. Or try lifting your phone so you are holding your head properly on top of the spine.  Long term, however, the solution is easier said than done. Look up from your device and notice what’s around you. The text can wait.

Contact Sports and Shoulder Injuries


Anyone can suffer a shoulder injury, but athletes involved in contact sports such as rugby, football and hockey are particularly vulnerable to fractures, separations and dislocations caused by the parts of the shouldercombination of speed and contact force to the shoulder upon impact, according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky.

“The three most common injuries I see in athletes playing contact sports are clavicle fractures, AC joint separations and shoulder dislocations,” Dr. Kowalsky said.


Clavicle, or collarbone, fractures can occur along the bone anywhere between its attachment to the shoulder and the sternum. Direct trauma, and falling on an outstretched arm, are both common causes of a collarbone fracture.

A shoulder separation is the result of trauma at the acromioclavicular joint (AC joint), where the collarbone and the highest point of the shoulder blade, known as the acromion, meet. With this injury, the ligaments that hold the the joint together become stretched or torn from the force of the impact to the area.

A shoulder dislocation occurs when the head of the arm bone (humerus), or the ball of the shoulder joint, is driven out of the glenoid socket.  The injury is considered a complete, or locked, dislocation when the ball remains out of socket and requires manipulation in order to be put back in place.  A partial dislocation, a condition known as subluxation, occurs when the ball is forced out of its natural position in the socket, but is able to slip back in place on its own.


Trauma is the common denominator in these injuries, and they all can produce significant pain. Along with pain, these injuries typically cause an obvious deformity, including squaring of the shoulder with a dislocation, or a prominent bump or prominence with AC separations.  Injured athletes will also notice difficulty raising the arm, as well as tenderness, swelling, and eventual bruising.  In the case of a shoulder dislocation, the pain usually improves significantly when a physician performs a closed reduction, during which he or she puts the shoulder back in place.


Diagnosis is made initially by physical examination of the shoulder and an X-ray.

Early conservative treatment for mild injuries usually includes sling immobilization to protect the shoulder and minimize pain, along with ice, rest and Nsaids.  X-rays are used to assess alignment and the presence of a fracture.  An MRI will be considered, particularly for shoulder dislocations, if a soft tissue injury such as a labrum tear or injury to the rotator cuff tendons, is suspected.

Depending on the severity of the injury and the complexity of the treatment, physical therapy is usually prescribed to help patients gradually regain strength and mobility.  Surgery is typically considered only for significant injury with wide displacement, or for certain athletes at high risk for recurrent injury.


Of course, some injuries are unavoidable, but having proper fitting upper body gear can go a long way to dissipate the impact.  Balanced strength and conditioning in the muscles that support the shoulder is also key to help prevent an injury, minimize the extent of the injury if one should occur. Additionally, studies have shown that pre-injury strength and conditioning is also your best shot at a fast return to play.

The shoulder has several muscles that attach the shoulder blade (scapula), humerus and clavicle.  While it is important to have balanced strength in all muscles in the shoulder, the muscles and connecting tendons that make up the rotator cuff are the front line for shoulder stabilization.


As with any new exercise, it’s important to consult with a professional therapist or trainer, particularly if you have a prior injury or limitation. Strength and conditioning programs are suitable even for our youngest athletes, but the program should be age-appropriate and supervised.  Start slowly, and gradually increase repetitions, sets and level of resistance. And it is particularly important to focus on proper form.  Exercises done improperly can put unintended stress on other parts of the shoulder or even elsewhere in the body.

Trainers and physical therapists can help develop a shoulder strengthening program that’s right for you.  Many exercises to strengthen the rotator cuff can be done using a resistance band, particularly for strengthening your internal and external shoulder rotation, and the muscles in your scapula. Your posture alignment and range of motion will also benefit.

Planks are good to strengthen the core, back and shoulders, as long you maintain proper alignment. You can challenge yourself with a variation on a push up, where you start at a low plank and push up to a high plank one arm at a time.


Stamford ASC Wins Apex Award

Stamford Ambulatory Surgery Center (ASC) has received a 2018 National APEX Quality Award for Excellence in Healthcare.

“ONS is honored to receive the 2018 National Apex Quality Award because it reflects our practice-wide commitment to the highest standards of quality care and patient satisfaction,” said Seth Miller, MD, a founding partner at ONS.

This national distinction recognizes outstanding healthcare providers who have demonstrated excellence in patient satisfaction and overall care during the previous calendar year, according to a statement from SPH Analytics, the national healthcare analytics firm behind the awards.

Apex winners represent the top 10% of SPH clients with the highest satisfaction scores for measures tied directly to care and are based solely on patient feedback and evidence-based success.

For eligibility, a minimum of 300 patient surveys from each SPH client were collected and analyzed from January 1, 2018 – December 31, 2018. In all, more than 633 healthcare facilities in the United States were eligible for the award; 96 were selected as winners.  The Stamford ASC was one of only three facilities selected from the state of Connecticut.

“We applaud all recipients of this year’s award for their exceptional impact in driving satisfaction for their patients,” said Amy Amick, President and CEO of SPH Analytics.

Youth Sports and Hydration


Did you know that the majority of young athletes are already dehydrated with they show up for practice or a game?

According to ONS Sports Medicine Specialist, Dr. Marc Kowalsky, improper hydration impacts mental alertness, physical performance and increases the risk of injuries.

“As little as 2 % dehydration can cause muscle fatigue and affect a young athlete’s aerobic performance, strength, stamina, and reaction time,” he said. “It can also put undue strain on the heart.”

Adequate hydration is vital to maintain normal blood pressure and improve blood flow and circulation, which affects the levels of oxygen and nutrients that are delivered to the muscles.


When anyone exercises, the core body temperature increases. Sweating dissipates excess heat in response.  “Hydration replaces the water lost through sweat and helps prevent cramps, heat exhaustion and heat stroke,” Dr. Kowalsky said.

Decreased athletic performance is just one sign that an athlete is fluid deficient.  He or she may demonstrate such symptoms as irritability, fatigue, nausea, headache, muscle cramping and difficulty paying attention.


So how much does a young athlete need to drink to stay properly hydrated?  The exact amount depends on a variety of factors, including the youth’s body size and the level of training and exertion expended during practice and games.

“In general, young athletes should drink ½ – 1 ounce of water per pound of body weight and minimize his or her water weight loss to no more that 2 percent of that body weight,” Dr. Kowalsky advised.  In other words, a 100- pound child should lose no more than 2 pounds during exercise. The easiest way to establish a general guideline is to weigh your child before and after intensive athletics.

General hydration levels can also be checked by looking at the color of the player’s urine.  The goal is for a clear, water-like appearance; from there changes toward a more concentrated color and density indicates dehydration.

Parents can help by encouraging their athletic children to drink plenty of water during the day, particularly an hour or two leading up to exercise, when they should have at least 16 ounces. Ideally, while playing, they should shoot for half a dozen big gulps of water every 15 – 20 minutes. After activity, 16- ounces for every pound lost through sweat should be replenished.  However, over hydration has its own set of problems, so don’t let them go overboard with the fluids.


In general, water is best for sports sessions of an hour or less.  Sports drinks can help to replenish the fluid, electrolytes and carbohydrates that are lost during more physically taxing conditions such as sports participation that exceeds 60 minutes, if there is extreme heat and humidity and/or if the young athlete is prone to excessive sweating.  In these circumstances, experts recommend a sports drink with at least 110 – 240 mg of sodium per 8 ounce serving.


In general, mild symptoms of dehydration should go away shortly after the child has started hydrating.  However, consult with a doctor right away if the symptoms persist, worsen or if the child  faints, or seems disoriented.

ONS Named Official Medical Team


The Connecticut Whale of the National Women’s Hockey League (NWHL) announced that ONS will serve as the team’s official medical practice. The new partnership provides the CT Whale with access to one of the leading specialty orthopedic and spine practices in the region. The Whale has officially named ONS Sports Medicine Specialist, Marc S. Kowalsky, MD, as their team physician and medical director.

“The Connecticut Whale are thrilled to announce our partnership with Dr. Kowalsky and the exceptional ONS team,” said Whale general manager, Bray Ketchum. “Our priority with the NWHL and with the Whale is to provide our players with the best professional care. There is no doubt we have that with ONS.”

Dr. Kowalsky is a renowned orthopedic surgeon with expertise in surgical and nonsurgical management of sports injuries. He has cared for professionals and amateur athletes at every level of competition. Dr. Kowalsky is currently a team physician for the US Rugby National Team, Iona Prep Rugby, and other local sports teams He has previously served as an assistant team physician for the New York Islanders and New York Jets.

“With the growth of the women’s and girls’ hockey in the US, we are proud to be affiliated with the CT Whale, who have been trailblazers in the National Women’s Hockey League,” said Dr. Kowalsky. “ONS is a natural fit for the team because we share a commitment to quality, player safety and a completely healthy return to play if an injury does occur.”

The ONS Sports Medicine and Women’s Sports Medicine Centers have been providing the highest standard of orthopedic and spine care to athletes in Fairfield and Westchester counties for more than 20 years. They are experts in advanced surgical and non-surgical techniques and have been pioneers in non-opioid pain management.  The ONS team of 26 sub-specialty trained physicians are recognized for their expertise and exceptional brand of patient-centered care.


Established in 2015, the NWHL was the first professional women’s hockey league in North America to pay its players. The mission of the the league is to fuel the continued growth of the sport and brand of pro women’s hockey. The league is made up of the Boston Pride, Buffalo Beauts, Connecticut Whale, Metropolitan Riveters, and Minnesota Whitecaps. Visit and follow on Twitter and Facebook @NWHL and Instagram

Make it to the Marathon

Sports Medicine Specialist and marathon runner, Marc Kowalsky, MD, provides tips to stay the course leading up to a big race day.

How do you handle the last few weeks leading up to a big race?  You have dedicated months to training. You’ve re-arranged your schedule to fit it all in. You’ve plunged into cold waters time after time, spent hours on the bike and covered countless miles running.  Chances are most of this training has taken place before sunrise, or after dark, while others are sleeping or relaxing at home. Congratulations for getting to this point. Now, in the final stretch, it’s important to to keep the following advice in mind.


The lion’s share of your training has already occurred. Now is not the time to radically ramp up your training, or try to make up for past lapses in your training program.  Too much training in the final stages before a big race only increases your chance for an injury that could put you on the sidelines instead of the starting gate. Have confidence in the incredible amount of work you have done, and maintain your momentum during the home stretch.


It’s extremely important for endurance athletes, particularly those new to the sport, to focus on fuel in these final days of training.  Proper hydration, nutrition, and sleep are as important as training and will give you the energy reserves you’ll need to safely reach your goal.


Regardless of what inspired you to take part in this Triathlon, now is the time to remind yourself of the reason you began this process and the progress you’ve made.  You are about to accomplish an amazing feat of athleticism.  Congratulate yourself for that and remember to thank everyone else who helped get you to the finish line.

ONS Welcomes Two New Physicians

Heeren Makanji, MC Dr. K. Choo




We are pleased to welcome two new physicians, Heeren Makanji, MD, an orthopedic spine surgeon, and Kevin J. Choo, MD, an adult reconstruction and joint replacement surgeon, to our growing team of top tier specialists.

Dr. Choo will see patients at the ONS offices in Greenwich and Stamford, CT.  He specializes in primary hip and knee replacement for the treatment of degenerative osteoarthritis, inflammatory arthritis, avascular necrosis, hip dysplasia, and post-traumatic arthrosis.

Dr. Makanji will treat patients with spine disorders at the ONS offices in Greenwich, CT and Harrison, NY.  His expertise includes complex cervical and lumbar reconstruction and minimally invasive and robotic navigation-assisted spine surgery. He is experienced in treating degenerative conditions as well as tumors, trauma and infections.

“Dr. Choo and Dr. Makanji were hand-picked for their elite level of training and demonstrated commitment to delivering the highest standard of care to patients,” said Seth Miller, MD, president of ONS.  “Their contributions to ONS will further our mission to provide the highest standard of musculoskeletal treatment with compassion and convenience to our growing community in Fairfield and Westchester Counties.”

Dr. Choo earned his medical degree from the University of Chicago and completed his internship and residency at UCSF (University of California- San Francisco). He was fellowship-trained at Rothman Institute, Thomas Jefferson University in Philadelphia, PA, in direct anterior hip replacement, use of computer- and robotic-assisted technology, and partial knee replacement. Dr. Choo has presented and published on such topics as the biology of bone healing, the reduction of opioid use after orthopedic surgery, periprosthetic joint infection management, and partial joint replacement. Dr. Choo was named an Emerging Leader by the American Orthopaedic Association (AOA) and is a reviewer for the Journal of the American Association of Orthopaedic Surgeons (JAAOS).

Dr. Makanji earned his medical degree Harvard Medical School and completed his residency through the Harvard Combined Orthopaedic Residency Program at Massachusetts General Hospital/Brigham & Young Women’s Hospital/Beth Israel Deaconess Medical Center. Dr. Makanji was fellowship-trained in orthopaedic spine surgery at Rothman Institute, where he also served as a clinical instructor in orthopaedic surgery.

A Road to Recovery


How can a 54-year old man come back from knee replacement surgery to complete a 100-mile bike race just 18 weeks post-op and an Ironman competition four months after that?

Ken Harris Story
Ken at the Gran Fondo

According to Greenwich resident Ken Harris, the answer is determination to be physically fit before surgery, setting goals to achieve after surgery, and selecting the joint replacement surgeon he could trust to do the best job.  That surgeon was Frank Ennis, MD, of ONS.

“Dr. Ennis understood that I wanted to achieve certain things and we worked together to get me there. I learned that losing weight and getting fit before surgery would make the entire process so much easier, so I did what I had to do,” Ken said.

Indeed, studies have shown that people who are in good physical condition prior to surgery are much more likely to have an easier, faster and successful recovery than those who are in poor shape.  Ken, for one, reinforces those findings.


However, Ken’s road to pre-surgical fitness wasn’t an easy one.  Over the past 25 years, Ken’s athletic pursuits were moved to the back burner while he raised a family and built a residential contracting business.  At the same time, Ken began to experience pain in both knees that interfered with his ability to exercise. In 2014, the former Ironman and triathlon competitor contracted a MRSA virus in his right knee after seeking treatment for pain. That episode took a grueling six months to overcome.

Traumatized by the experience, Ken put off seeking any further pain treatment, even as it worsened over the years.  By 2018, Ken was so debilitated by pain, he couldn’t perform  many of the tasks required in his line of work or simply climb a flight of stairs. He knew he had to do something. That’s when he went searching for a joint replacement surgeon who would give him confidence that his previous medical nightmare would not be repeated. Friends recommended ONS and Dr. Ennis.


“Dr. Ennis immediately put me at ease. He genuinely listened to my concerns and was cautious and sensitive to what I had been through,” Ken said, “He gave me faith that I could get my life back and he was there guiding me every step of the way.”

With confidence in Dr. Ennis’s surgical expertise, Ken didn’t feel any angst or fear going into the procedure.  After, he was amazed that he didn’t need narcotics for pain.

“I took one painkiller after leaving the hospital but once I realized that I only felt discomfort, I threw out the rest.  There wasn’t really any pain,” he said.

Ken’s exceptional recovery was helped along through 12 weeks of rehabilitation at the ONS Physical Therapy Center at the Harrison office.  By the time therapy was finished, Ken was ready to rebuild his strength and endurance on a bike so he could participate in the New York Gran Fondo six weeks later.

While Ken may never run a 2:43 marathon again, he is motivated by what he can do, as long as Dr. Ennis gives him the okay.  On August 18, Ken completed an Ironman competition at Mont Tremblant in Canada. It was just 7 months and 7 days from the date of his surgery.

“When I asked Dr. Ennis about doing the Ironman, his main concern was whether I felt up to it. And he advised me to walk during the part of the race the involves running.  I could live with that,” he said.

Watch Your Step With A Twisted Ankle


photo: AAOS


Many people delay seeking medical attention for a twisted ankle. For mild cases, that’s okay. Rest, NSAIDs and ice can usually take care of the problem within a week or two. But if it takes longer than that to get better, or if you have strained your ankle to the degree that it becomes tender, bruised and swollen, you should see a doctor, according to Mark Yakavonis, MD, orthopedic foot and ankle surgeon at ONS.

“Without proper treatment and rehabilitation, severe sprains can weaken the ankle and increase the likelihood of re-injury. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and instability,” he said. Moreover, severe pain and swelling that extends from the foot to the knee or higher is usually a symptom of a fractured ankle. That condition should be treated as soon as possible.

Children, in particular, should see a doctor right away if an ankle fracture is suspected, said Dr. Yakavonis. “A child’s ankle fractures typically involve growth plates.  If it’s not treated properly, the natural growth and development of the child’s leg may be compromised,” he warned.


An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. This is a common injury that occurs among people of all ages as a result of the foot rolling or twisting to one side. Sprains range from mild to severe, depending upon how much damage there is to the tissues.

You can treat most ankle sprains without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized properly.  Depending on the severity of the sprain, your physician may wrap the ankle in a bandage or recommend a device for protection and support, such as a boot or an air brace. Mild sprains usually resolve within two weeks. Severe ankle sprains can take as long as 12 weeks to recover.


Similar to ankle sprains, ankle fractures are most commonly caused when a person trips and twists or rolls the ankle in the process, or if there is impact from an accident.

Ankle fractures involve two joints: the ankle joint where the tibia, fibula and talus meet, and the syndesmosis joint, which is the joint between the tibia and fibula. A fracture can range from a simple break in one bone to multiple fractures. Some fractures may coincide with injuries to the ankle ligaments that keep the ankle bones and joint in its normal position.

Absent of a physical deformity such as a bone protruding from the ankle, an X-ray may be required to determine which bones, if any, are broken and the extent of bone separation or displacement.

Children’s ankle fractures, on the other hand, typically involve the tibia, fibula and growth plates. Growth plate ankle fractures require immediate attention because the long-term consequences of an improperly healed fracture can cause the leg to grow crooked or of unequal length to the other. For this reason, a child who has broken an ankle should have regular follow-up check-ups for as long as two years after the injury to make sure that growth proceeds properly.


Of course, the complexity of the treatment depends on the severity of the fracture, the bones involved and whether there is displacement or dislocation. Most fractures require elevation to reduce the swelling and decrease the risk of damage to the surrounding tissue. Splints are usually positioned to support the ankle until the swelling has gone down, at which point a cast or fracture boot will be put in place.  Your physician will determine the length of time you’ll need to use crutches, a walker or wheelchair to avoid weight bearing.  This can range from a several days to several months.  Severe breaks will require surgery to re-position bone fragments to their normal alignment and the insertion of special screws, metal plates and rods to keep everything in alignment.

Dr. Yakavonis and Michael Clain, MD, are fellowship-trained orthopedic surgeons who are experts in the surgical and non-surgical treatment of all foot and ankle conditions.

Call 203-869-1145 for to make an appointment or request an appointment online.


ONS’ New Partnership

Orthopaedic & Neurosurgery Specialists (ONS), the leading provider of multi-specialty orthopedic and neurosurgery services in Connecticut and Westchester, announced today a growth capital investment from Kohlberg & Company, L.L.C. (“Kohlberg”), a leading private equity firm headquartered in New York. Kohlberg is partnering with ONS to continue expanding its extensive offering of clinical care capabilities and ancillary services while serving a broader base of patients in the Tri-State area.

ONS, headquartered in Greenwich, Connecticut, is a multi-specialty physician group with three locations in Greenwich, Stamford, and Harrison. The Company’s clinical offering covers a wide range of sub-specialties including orthopedic, sports medicine, joint replacement, neurosurgery, physiatry and ancillary services such as physical therapy and MRI. ONS partners operate an ambulatory surgery center and an urgent care center, providing the highest quality of care through a full continuum of care.

Seth Miller, MD, Co-Founder and Executive Committee member of ONS, remarked, “We are incredibly excited to partner with Kohlberg and to pursue the next chapter of the Company’s growth. Kohlberg brings extensive industry experience and financial resources with a proven track record of investing in leading healthcare services companies.” Mark Camel, MD, Co-Founder and Executive Committee member of ONS, stated, “We believe Kohlberg will be the ideal partner to help implement our plans for strategic growth and to expand our clinical model to better serve our patients today and going forward.”

“ONS is a clear market leader in orthopedic services with an unparalleled reputation for providing best-in-class patient care and delivering industry-leading clinical outcomes,” commented Robert A. Cucuel, Operating Partner of Kohlberg. “We are thrilled to partner with ONS, and we look forward to supporting ONS’ continued expansion as well as their unwavering commitment to delivering the highest-quality patient care.”

About Kohlberg & Company, L.L.C.

Kohlberg & Company, LLC (“Kohlberg”) is a leading private equity firm headquartered in Mount Kisco, New York. Since its inception in 1987, Kohlberg has organized eight private equity funds, through which it has raised over $7.5 billion of committed equity capital. Over its 32-year history, Kohlberg has completed 76 platform investments and nearly 200 add-on acquisitions, with an aggregate transaction value of over $15 billion.

For more information visit:

Jumping for Joy with New Knees


No one expects the pain of arthritis to affect a thirty-something adult, but that’s what Westchester middle school teacher, Mallory Chinn, was faced with.  For 5 years, Mallory tried every non-operative treatment available to ease the worsening pain in her knees. Some treatments would work for a while. Others did not work at all. By the time Mallory turned 40, her pain was debilitating. She had trouble walking and climbing stairs, and missed out on family activities such as bike rides and hikes in the woods.

“I was pretty much immobilized,” recalled Mallory, now 43.  The defining moment came one day when her youngest child, then 7 years old, ran ahead of her.  “When I tried to chase up the hill after him, I was stopped in my tracks by an excruciating stab in my knee.  I thought ‘this is ridiculous. How can I be so young and not mobile?”

By this time, Mallory’s arthritis was severe, often referred to as bone-on-bone. She looked ahead to the life she wanted to have going forward and it didn’t include constant pain and physical limitations.

“I wanted to be able to live an active life and keep up with my kids, so I decided to go for it,” she said of her decision to undergo a double knee replacement procedure.


On August 11, 2017, Dr. Demetris Delos of ONS performed the surgery at Greenwich Hospital. The procedure went according to plan. However, as anyone who has recovered from a knee replacement can attest, the road to recovery is a slow, challenging process that requires months of rehabilitation.

Following surgery, Mallory recuperated for a few weeks at an in-patient rehabilitation facility.  Upon release, she went to a number of local physical therapy centers to continue her rehab program. Time after time, she was disappointed by the therapists’ indifference to her concerns and pain. As soon as Mallory learned that ONS had a state-of-the-art physical therapy center at the Harrison office, she made an appointment. At ONS, she found the physical therapists were kind and highly-skilled at helping joint replacement patients get moving again.


“Everyone made it a happy, safe place to heal. I actually looked forward to going to therapy because it felt like I was a part of a big family,” she said. Mallory praised the therapists and PT Techs and the integrated care she received.  Once when there was a concern about one of her wounds, the therapist, Robert Spatz, PT, reached out to Dr. Delos and received a reply within a minute.

“Dr. Delos and the Physician Assistants were always there if I had questions or needed a prescription refill.  Whenever Dr. Delos was at the Harrison office, he always came over to PT to see how I was doing,” she said.  When it came time to come off the narcotics, Dr. Alex Levchenko, an ONS physiatrist, introduced Mallory to alternative pain management strategies.  “I didn’t even know ONS had doctors that could do that,” she said.

Mallory was particularly impressed by the amount of time Spatz, who is also the director of PT at that office, spent working with her.

“In other places, I’d see the therapist for a minute and then I’d be handed over to a tech for the rest of the hour.  Robert always gave me a big chunk of his time,” she said.  “He was respectful of my tolerance and goals. He went out of his way to educate me about each step of the recovery process.”

Mallory went to PT three times a week until she “graduated” in December of that year. She was strong and stable enough to continue her strengthening using a tailor-made workout she could do at the gym.


Since then, Mallory has fully reclaimed mobility in her life and enjoys activities with her friends and family.  She has hiked in the mountains of Colorado, and can spend an entire day walking around New York City.  At a summer camp last year, Mallory led a group of 30 girls through a physically challenging Ninja Race course.  In May, Mallory picked up a jump rope during her school’s Wellness Week, and got hopping.  “I wasn’t the bounciest person out there, but I could never have done it before my knee replacements.”

Although Mallory is completely recovered, she has had occasions to visit ONS.  She brought her husband to the Harrison office when he needed treatment for back pain. She was back again when her daughter sustained an athletic injury. Each time, she has been welcomed with the same kindness she first experienced during her time there. “I tell everyone that ONS is the best.  I’ve sent family members and friends there. I wouldn’t even think of going anywhere else,” she said.

Take your first step toward an active life.   Schedule an appointment online with an ONS total joint replacement specialist or call 203-869-1145.

Female Athlete Triad Syndrome

By Katherine Vadasdi, MD, director of the ONS Women’s Sports Medicine Center


It is well known the students of all ages benefit from sports and exercise. However, when girls and young women become too intense with training and overly restrictive with their diet, their health may be at serious risk.

Relative energy deficiency syndrome (RED-S), more commonly known as Female Athlete Triad Syndrome, occurs from a gross imbalance between the nutritional needs of a maturing female body and the amount of energy that is expended during sports or exercise.  Triad refers to three resulting conditions: disordered eating, amenorrhea, or the cessation of menstruation, and osteoporosis.

Many girls who develop this disorder try to lose or maintain a low body weight to improve their athletic performance.  Sadly, the opposite is more likely to happen.  Athletes with RED-S become more easily fatigued and their concentration is diminished.  If a girl doesn’t have enough fat on her body,  the muscles will be starved to supply energy to the body, making them weaker.

At a time in life when girls should be building bone mass that will support them throughout life, girls with RED-S have lower levels of estrogen. When combined with poor nutrition,  her bones to become thin and possibly deformed. Girls with early onset osteoporosis are more vulnerable to season-ending stress fractures, broken bones and other injuries. Internal organs, including the heart, also suffer.

Intense exercise and caloric restriction can decrease the hormones that regulate the menstrual cycle. This may compromise her reproductive system later in life.

Schedule an appointment with an ONS women’s sport medicine specialist or call (203) 869-1145


The girls at greatest risk for developing RED-S tend to participate in sports that classify athletes by weight, or those where there is a perceived advantage in appearing thin. Low self-esteem, a tendency toward perfectionism, and stress from school, peers or at home are compounding risk factors.


Because RED-S has physical and psychological factors, the most effective treatment is a team effort among doctors, coaches parents, nutritionists and professional counselors.

If you suspect someone you know is at risk for female athlete triad syndrome, it is important for her to see a sports medicine specialist who can recognize the signs of the disorder.  Left untreated, the toll on her body will have lasting effects that in extreme cases, can lead to death.

Girls can be protected from developing this serious condition if they are empowered to set realistic expectations for themselves. Moreover, they need to be educated about the healthy nutritional and hydration requirements for their level of daily activity. They should also understand the importance of sleep and rest to allow the body to recover. Stress management techniques such as meditation, yoga or other calming activities will help them build healthy coping skills that will be useful for a lifetime.

Schedule an appointment with an ONS women’s sport medicine specialist or call (203) 869-1145

NY Magazine 2019 Best Docs

Best Doctors NY Metro

Congratulations to the five ONS physicians who are included in the New York Magazine 2019 Best Doctor issue, now on newsstands!

The New York Magazine Best Doctor issue recognizes medical specialists in the NY metro area who have been ranked above others in their area of expertise. Published annually, the list of leading physicians is culled from the database of the medical research and information company, Castle Connolly Medical Ltd.

Best Doctors in Neurosurgery


 Best Doctors in Orthopedic Surgery

Best Doctors in Physical Medicine and Rehabilitation




Castle Connolly conducts annual peer-review surveys across the country to compile regional and national lists of top doctors. The Top Doctors: New York Metro Area database, for instance, reflects those physicians whom Castle Connolly has determined to be among the top 10 percent in the region.  In January, 15 ONS specialists appeared in Moffly Media magazines, Top Doctors in Fairfield County, which also relied on Castle Connolly data.

ONS Urgent Ortho Care in Stamford

Following last month’s successful launch of ONS Urgent Ortho Care (OUOC) during business hours at the ONS Harrison, NY office, ONS has introduced walk-in, daytime hours for emergency musculoskeletal treatments at its offices in Stamford, CT at 5 High Ridge Road, 3rd floor. ONS is in network with all major insurances.


As with OUOC in Harrison, Stamford area residents now have a fast, cost-effective and convenient alternative to the long waits and expense that can accompany a trip to a hospital emergency department for treatment of sprains, fractures or other musculoskeletal injuries. 

During the hours of 8:00 am through 5:00 pm, patients with injuries to a bone, joint, ligament, muscle or nerve can receive immediate treatment from the region’s leading orthopedic and spine professionals in Stamford.

According to ONS President, Seth Miller, MD, the addition of the daytime ONS Urgent Ortho Care services in Stamford now provides residents in and around Stamford with convenient access to emergency orthopedic care, day and night.

“We have found that patients prefer the high standard of specialized orthopedic care that ONS delivers, where and when they need it most,” said Dr. Miller.  


After hours, walk-in care has been available at ONS Greenwich, 6 Greenwich Office Park, for nearly one year. In Greenwich, no appointment is necessary from Monday through Friday from 5:00 – 8: 00 pm and from 12:00 through 4:00 pm on Saturdays. 




Dr. Kowalsky at Int’l Rugby Tournament

Dr. Kowalsky Team DoctorDr. Marc Kowalsky will be in Alicante, Spain this week as team physician for the Northeast Rugby Academy Men’s U23 team, who will compete in the 33rd Annual Costa Blanca Rugby Sevens Tournament.  The Northeast Academy Men’s U23 team will compete in the Elite division along with teams from Europe, Africa, and South America, including several national Sevens teams.

Sevens games are more fast moving and free flowing than a regular union rugby match.  A union game of 15s rugby, when there are 15 men on the pitch, lasts 80 minutes. Sevens, on the other hand, with 7 players on the pitch, has 7 minute halves, with a 2 minute half-time. In Sevens, players who have been subbed out are allowed to go back into the game.

Dr. Kowalsky has served as medical director for this organization since November, 2018.  Northeast Academy is the official USA Rugby National Development Academy for the identification and development of athletes from the northeast region for participation in the USA Rugby national teams and the USA Olympic rugby teams.  Dr. Kowalsky is also team physician for the USA Rugby national team, the Eagles.

ONS adds Urgent Ortho Care hours in Harrison


Orthopaedic & Neurosurgery Specialists (ONS) has launched walk-in emergency orthopedic services during weekday business hours at its office at 500 Mamaroneck Avenue in Harrison, NY.  No appointment is necessary.


ONS Ortho Urgent Care provides patients with a fast, cost effective and convenient alternative to hospital emergency room visits in the event of a sudden, acute musculoskeletal injury.  During the hours of 8:00 am through 5:00 pm, patients with injuries to a bone, joint, ligament, muscle or nerve can receive immediate treatment from the region’s leading orthopedic and spine professionals. ONS is in network with all major insurances.


By offering daytime hours to emergency patients, ONS is expanding on the success of the after hours. Further, walk-in urgent orthopedic care that has been available at the ONS office in Greenwich at 6 Greenwich Office Park in Greenwich since June 2018. ONS Urgent Care in Greenwich is available from Monday through Friday from 5:00 – 8: 00 pm and from 12:00 through 4:00 pm on Saturdays. 

According to ONS President, Seth Miller, MD, the introduction of the daytime ONS Urgent Ortho Care services in Harrison provides patients with the convenience of emergency care options, day and night.

“Accidents can happen to anyone at any time,” said Dr. Miller, “With ONS Urgent Ortho Care available during the day in Harrison and after hours in Greenwich, ONS is continuing its mission to provide patients with convenient, specialty care where and when they need it most.”