If your back pain is caused by pressure on a disc somewhere in your spine, a minimally invasive procedure such as a laminectomy or discectomy can be very effective treatment options. Join ONS Neurosurgeon, Dr. Amory Fiore, as he explains the difference between the two surgeries and what will determine if one of them is right for you. Q & A. Free.
Please register.
Poor posture can create back and neck pain and worsen a painful chronic spine condition. In this live webinar, Amanda Rausch, PTA at ONS Physical Therapy in Greenwich, will explain the many ways posture can impact the joints and muscles in the spine. She will offer practical tips to improve your posture and discuss at-home exercises to help build the muscles needed for good posture. Q & A,
You can access this meeting on Thursday, July 16 at 5:00 pm through Microsoft Teams Live. Note: IOS users may need to download the free Microsoft Teams app to join this session.
Join ONS Neurosurgeon, Dr. Scott Simon, for an in-depth, live discussion about spinal fusion surgery and the conditions that have the most successful outcomes from this procedure. Q & A.
Get access with Microsoft Teams Live
NOTE: IOS users may need to download the free Microsoft Teams app to use the above link.
Roughly 80 percent of adults experience back pain at some point in their lifetime and most instances can be managed without surgery. In this live webinar, ONS physiatrist, Dr. Alex Levchenko will discuss common causes of low back pain and treatment options including physical therapy, medications and injections. Q & A at the end of the presentation. Click here to access Microsoft Teams Live. NOTE: IOS users may need to download the free Microsoft Teams app to access the program.
Although a snowstorm is not forecast in the near future, now is the time you should be training your body for the heavy lifting that is sure to come at some point this winter. “People commonly 
underestimate the physical challenge involved in clearing large amounts of snow,” said Dr. Alex Levchenko, a board-certified, fellowship trained physician who specializes in the non-operative treatment of spine, joint and muscle pain. “This is especially true for people who lead inactive lives, but even someone in good shape can suffer back pain from the strain of lifting and rotating the back to toss snow in a pile.”
Dr. Levchenko advises everyone to strengthen the muscles in their core and back before starting any strenuous upper body activity. “You wouldn’t try to lift 100 pounds at the gym if you’ve never lifted that much weight before. It’s the same with shoveling snow. You have to build up to it,” he said.
Dr. Levchenko said the number of patients he sees with back pain increases after every large snowfall. “People tend to think of shoveling snow as a nuisance when it is really an intense form of exercise.”
When large snowfalls do occur, he recommends getting ahead of the accumulations by shoveling smaller amounts every few hours rather than waiting for inches of snow to pile up and freeze.
As with any exercise, it’s important to warm up your muscles before you head outside. Once the shoving is underway, maintaining proper posture and body mechanics will minimize stress to the weaker back muscles. That means keeping a straight back while leaning forward and having a slight bend in the knees.
It’s also important to use your core, hips and hamstrings to provide strength and stability rather than relying on your back and shoulder muscles to do the heavy lifting. Using ergonomically designed “push” shovels can also help ease lower back strain. If back pain develops during the activity, stop and rest for a while.
If the pain continues, conservative treatment using anti-inflammatory medication and ice to the area usually reduces the discomfort. However, back pain that lasts more than a few days should be evaluated by a physician who specializes in spine conditions.
Dr. Levchenko advises people with pre-existing back conditions to avoid shoveling altogether. “It’s better to pay someone else to do it and save yourself from all the ways the increased back pain will impact your life,” he said.
Back pain following a few hours of shoveling snow is all too common. In a recent article that appeared in the Fairfield and Westchester town sites of the Daily Voice, interventional sports and spine specialist, Dr. Alex Levchenko, advised readers to make sure their back muscles were in working order well before the first mounds of snow fall.
The article, It’s Time to Train for Shoveling Snow, Says ONS by John Haffety, Dr. Levchenko warned that all too often, people who are inactive throughout the year underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting and tossing snow onto a pile.
“You should take the time to strengthen your core and back muscles just as you should before starting any strenuous activity,” he said. “You wouldn’t walk into a gym and try to lift 100 pounds if you haven’t lifted weights before. You would build up your strength. It’s the same thing with shoveling snow.”
Dr. Levchenko said the number of patients he sees with back pain increases after every large snowfall. “People tend to think of shoveling snow as a nuisance when it is really an intense form of exercise.”
When large snowfalls do occur, he recommended getting ahead of the accumulations. Start by shoveling smaller amounts every few hours rather than waiting for it to pile up and freeze.
Before tackling the job, it’s important to warm up your muscles. Once outside, maintaining proper posture and body mechanics will minimize stress to the weaker back muscles. Dr. Levchenko recommends avoiding rounding the lower back. Instead, shovellers should keep a straight back and lean forward with a slight bend in their knees.
It’s also important to use your core, hips and hamstrings to provide strength and stability rather than relying on your back and shoulder muscles to do the heavy lifting. Using ergonomically designed “push” shovels can also help ease lower back strain.
Dr. Levchenko advises people with pre-existing back conditions to avoid shoveling altogether. “It’s better to pay someone else to do it and save yourself from all the ways the increased back pain will impact your life,” he said.
Did you know that 80 percent of Americans experience low back pain at some point in their lifetime? According to neurosurgeon Dr. Scott Simon of Orthopedic and Neurosurgery Specialists in 
Greenwich and Stamford, the majority of low back pain is due to a lower back muscle and ligament strain or sprain.
“This type of low back pain usually occurs as muscles tighten after exercise or other exertions,” he said, adding that stress has also been shown to make people more susceptible to episodic low back pain. Avoiding sudden lifting away from your body and stretching before or after exercise can often help prevent pain.
In most cases, back pain from strains or sprains lasts two to five days. It is best treated with heat and anti-inflammatory medication such as Naprosyn or ibuprofen. In the vast majority of cases, the pain subsides on its own without the need for additional treatment. Even as the pain dissipates, however, Dr. Simon recommends easing back into exercise. “Re-injury can occur if the muscles and ligaments are still healing,” he said.
Despite the claims of manufacturers, there is no conrete evidence supporting the use of a product to prevent or treat back pain. “The best mattresses, pillows or chairs are the ones that are most comfortable according to the needs and prefences of the individual,” Dr. Simon explained.
Those who experience back pain that lasts longer than a week or produces leg pain, weakness, numbness or tingling sensations may have a more serious problem and should seek medical attention. Pain that radiates down one or both legs may be due to nerve irritation or pinching from either a disc herniation or arthritis. In the majority of these conditions, patients can be treated with physical therapy
Anyone should see a doctor immediately if the low back pain is a result of trauma or if the pain is accompanied by any of the following symptoms:
In the past, most cases of damaged tissue within the body were considered irreversible, but developments in regenerative medicine hold the potential to change all that, writes Christopher Sahler, 
MD, an interventional pain management specialist at ONS, in this week’s edition of the Greenwich Sentinel. Although research into harnessing the body’s own healing process using amniotic fluids, blood, tissues, growth factors and stem cells is ongoing, certain biomedical therapies are in use today to help ordinary people suffering from orthopedic conditions and chronic pain. The most common treatment, using platelet rich plasma collected from a patient’s own blood, is administered in a physician’s office using ultrasound guided injections directly into the diseased or damaged tissue to restart and increase the healing process. Read the full article in the April 1 edition of Greenwich Sentinel.
Does your own blood hold the key to healing your medical condition? The evolving field of regenerative medicine uses biomedical materials, often from your own body, to regenerate cells and rebuild diseased and damaged tissues. Join Dr. Christopher Sahler to learn about this exciting new medical field that uses therapies from blood, platelets and stem cells to treat pain and cure complex, often chronic conditions of the musculoskeletal system. Healing Yourself: The Promise of Regenerative Medicine for Chronic Pain and Orthopaedic Care will take place on Thursday, March 10 at Greenwich Hospital’s Noble Auditorium. 6 – 7:30 pm. Free. To register, call 203-863-4277 or go to greenwichhospital.org.
If the local forecasts are to be believed, many of us will be doing a fair amount of snow shoveling this weekend. Before you bundle up and head out, though, Dr. Jeffery Heftler, an interventional pain 
specialist at Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, has a few words of advice to protect your back from strain and injury.
“The most important thing is to stay ahead of the accumulation of snow. It’s much easier on your back to shovel after every few inches has fallen than to wait and lift heavier loads of snow for a longer period of time,” he advises. Waiting can make the task even harder if the snow melts and then freezes over. Dr. Heftler also recommends investing in so called “push shovels” that are specially designed for pushing the snow aside while shovels with bent handles can help ease the tension on back and shoulders.
Without a doubt, Dr. Heftler sees more patients with back pain following a large snow storm. One reason, he suggests, is that people tend to think of shoveling snow as a nuisance and chore, when in fact it is an intense and strenuous exercise. “All too often, people who are generally inactive underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting the snow and throwing it over their shoulder,” he says.
To protect your back, it’s best to take a few moments to warm up your muscles before going out in the cold. When shoveling, maintain the correct posture and technique to minimize the pressure on your weaker back muscles. Avoid rounding your lower back, for instance. Instead, go through the motions with a straight back leaning forward and your knees slightly bent. Use your core, hips and hamstrings to provide strength and stability instead of relying on your back and shoulder muscles to do the heavy lifting.
People with pre-existing back conditions are most vulnerable to shoveling related injuries and should avoid the activity altogether. “Even if you have to hire someone to clear the snow for you, it will pay for itself in terms of avoiding pain and days lost from work and winter sports,” Heftler says.
If you do experience pain while shoveling, Dr. Heftler says to stop, go inside and rest in a comfortable position until the discomfort passes. He recommends anti-inflammatory medications such as Advil or Aleve, and using ice or heat directly on the area where the pain is most acute. If the pain is severe and persists through the next day, consult with a physician.
The knee is the most vulnerable body part for any athlete, including skiers. Downhill skiing produces large amounts of torque on the knee, challenging the integrity of ligaments and tendons. Whether from a fall or overuse, the most common injuries in skiers are tears to the MCL (Medial Collateral Ligament) or ACL (Anterior Cruciate Ligament), two important structures that give our knee stability. When a skier is thrown off balance, his skis will sometimes shoot out in front of him, creating extra torque on the knees and damaging our stabilizing structures.
Both novice and experienced skiers are at risk of hurting their knees. We frequently see novice skiers hurt themselves when they do not know how to turn, stop or fall properly. Taking lessons and working with an instructor goes a long way in preventing knee injuries for beginner skiers. Experienced skiers frequently take risks and assume that they can manage faster speeds on any slope. Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. In poor visibility or icy conditions, a beginner trail becomes an intermediate trail, and an intermediate slope becomes advanced slope. Keep injury prevention in mind, if the conditions are difficult, ski down a level.
A second reason injuries occur is fatigue. Most skiers’ bodies are not accustomed to exercising 6-8 straight hours. In addition, many skiers push their bodies to take advantage of the whole day, even when they start to feel tired and stiff. For this reason, injuries tend to happen at the end of the day.
Having the knowledge of what places skiers at a higher risk for knee injuries, we are passing on recommendations about how to stay safe on the slopes. Both beginners and experienced skiers can benefit from these tips!
Good luck and stay warm!
If you become injured, while skiing, remember, ONS sports medicine physicians are trained at the top universities and hospitals in the country and have expertise in the latest treatments for sports-related injuries in high-performance and recreational athletes.
Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit https://onsmd.com/ or call 203.869.1145.
On Tuesday, December 4 at 6:30 p.m. Tamar Kessel, MD will present a seminar in the Noble Conference Center at Greenwich Hospital on conservative treatments for neck and back pain.
When physical therapy and oral anti-inflammatory medications fail to resolve a spine-related problem, some patients achieve significant relief from a spinal injection. Injection therapy is a way of delivering anti-inflammatory medication directly to the injured area of the spine. ONS physiatrist Dr. Tamar Kessel uses steroidal and non-steroidal injections to help patients return to their normal lifestyle. Learn how these treatments are given, who is benefited most and what to expect from interventional therapy.
Tamar Kessel, MD graduated from Cornell University and earned her medical degree from Albert Einstein College of Medicine. After completing a residency in physical medicine and rehabilitation at New York Presbyterian Hospital of Columbia and Cornell, she received fellowship training in spine and sports medicine at Hospital for Special Surgery in New York.
Registration required. Please call (203) 863-4277 or (888) 305-9253, or register on-line at www.greenhosp.org.
Tuesday, April 3, 6- 7:30 p.m. 
Noble Conference Center, Greenwich Hospital
Speaker: JEFFREY HEFTLER, M.D. , PHYSIATRIST
at Orthopaedic and Neurosurgery Specialists PC and Greenwich Hospital
When physical therapy and oral anti-inflammatory medications fail to resolve a spine-related problem, some patients achieve significant relief from a spinal injection.
INJECTION THERAPY is a way of delivering anti-inflammatory medication directly to the injured area of the spine.
ONS PHYSIATRIST JEFFREY HEFTLER, MD uses steroidal and non-steroidal injections to help patients return to their normal lifestyle.
Learn how these treatments are given, who is benefited most, and what to expect from interventional therapy.
Registration required. Please call (203) 863-4277 or (888) 305-9253, or register on-line at www.greenhosp.org.
ONS physiatrist Dr. Jeffrey Heftler was recently interviewed by The Daily Greenwich about treatments for back pain and interventional physiatry. It is a subject near and dear to his heart since he suffered two herniated discs when he was 18 years old. Read the complete story.>
