Before ultrasound became a revolutionizing staple in the field of pain medicine, some brilliant, forward-thinking doctors used X-Ray (fluoroscopy) to add vision to their pain injections. But with these tools came drawbacks. Firstly, while fluoroscopy is excellent for viewing bones and spread of contrast, they do not let us see the intricate detail of muscles, tendons and ligaments. Secondly, they emit radiation, which means that they should only be used on an ‘as necessary’ basis. In our effort to provided safe, accurate and effective injections, about 10-15 years ago our field began using ultrasound to make major improvements. Not only is it 100% safe, ultrasound immediately transformed pain medicine patient outcomes.
Way before I became I pain physician I was acutely aware of a particular maxim: an ounce of prevention is worth a pound of cure. Despite its triteness, in this expression I found unbounded wisdom: wearing knee pads while rollerblading averted nasty knee cuts and ripped jeans, while a napkin in my lap discouraged tomato sauce stains. Back in my own days as an athlete – a batting helmet defended my skull from menacing fastballs. These days, this aphorism’s weighs heavily on my shoulders when I am confronted by yet another patient who is an athlete with an injury resulting from poor to complete reckless abandonment of sports nutrition. Many such patients have suffered muscle injuries and/or severe cramping that has resulted from dehydration, electrolyte abnormalities and/or potassium and magnesium deficiencies. This is not just frustrating because these kinds of injuries are extremely avoidable through a proper sports nutrition-inspired diet, but also failure to acquire the full range of protein, carbohydrates, micronutrients and vitamins an athlete requires will severely limit the ability to reach maximum performance. To put it in laypersons terms, without sports nutrition athletes will increase the likelihood of debilitating injury and will also be actively hampering their ability to perform to their full potential.
If you are considering back surgery because of a pain issue, it might not even be the most expedient treatment for you as it will not always alleviate or mitigate pain. Unless your back issue is neurological or an instance of instability of the spine, surgery simply is not your best course of treatment. If you suffer from muscular or myofascial pain, lumbar facet arthropathy or lumbar disc herniation, amongst other back pain issues, your best bet is to treat your back pain without surgery. Read my blog for the full details of the non-surgical treatments I recommend.
Musculoskeletal Ultrasounds (MSUs) are my go-to when attempting to pin down an issue that we don’t believe to be bone related. That means they are perfect for diagnosing muscle, tendon, and ligament injury – as this dynamic investigative and explorable procedure tells us in seconds the make-up of your musculoskeletal system. We have found that MSU has been pivotal in helping diagnose sports injuries and others who find they are in pain when they move a joint. Traditional analysis like x-rays and MRIs take static images where MSUs create dynamic images in motion. Let’s explore that some more.
Gymnastics is a sport that requires high levels of dedication and perseverance. Professional gymnasts display great flexibility and athleticism which are not developed without certain adverse effects to the body over time. As well as risk of injury from falling when performing a move, gymnasts also experience higher risks of back pain due to repeat impacts when landing or pushing off from the ground.
Neck exercises are somewhat overlooked in sports training but they are absolutely vital for preventing concussions and other types of injuries. The neck muscles support the cervical spine and the head (and therefore the brain). Concussions (mild traumatic brain injury) occur when the brain - the most fragile organ in the body - receives a sudden jolt and subsequently bounces in opposite directions.
By strengthening neck muscles, you prevent the movement of the brain because of the increased stability afforded to the head. In sports such as football, boxing and MMA where the head received sudden and powerful jolts frequently, it is crucial to have strong neck muscles.
In football, players are tackling and blocking all the time. The powerful shocks to the body and even directly to head cause a notorious amount of concussions in the sport. The neck muscles help stabilize the head so that in such collisions the brain’s movement is restricted, thus decreasing the likelihood of a concussion.
In boxing and MMA, fighters receive blows to the head frequently and get concussions as a result of the impact of the blow which sends a powerful jolt inside the skull, causing the brain to bounce in opposite directions. A strong neck, especially when combined with the correct defensive technique of keeping the neck slightly tucked in, can greatly reduce the chances of a concussion.
There are two main ways of strengthening the neck: a) bodyweight exercises and b) weighted exercises.
Neck Bodyweight Exercises
A very effective set of bodyweight exercises for the neck are bridges. This is when you put your weight on your neck – either from the front or the back – and roll on your head. The great thing about this exercise is that it works more than just your neck – it also targets your core, abs and more. You can start doing these exercises with your hands on the ground to give you support and move on to taking them off the ground to add more pressure to your neck as you gradually build neck strength. I’ve provided some videos below of how to do neck drills which include basic to more advanced exercises.
Neck Weighted Exercises
The best way to strengthening your neck with weights is using a neck harness. This allows you to add any amount of weights and move your neck to build a considerable amount of mass and strength. It’s a great way of training your neck because you have full control of how much weight you’re using. Below of some videos of how to use a neck harness to strengthen your neck. You can do them in various ways; standing, sitting or even lying down.
Brief History of MMA
The Gracie family invented Brazilian Jiu Jitsu and were determined to show the world that it was the very best of all the Martial Arts. They would video record themselves fighting other martial artists from various backgrounds such as Judo, Hapkido, and Karate etc.
23 years ago Rorion Gracie and his partners started the Ultimate Fighting Championships – a mixed martial arts (MMA) tournament. There were hardly any rules (apart from strikes to the eye and groin) making it a very dangerous tournament. To show the efficacy of their art, the Gracies picked the 176 lbs Royce Gracie as their representative to demonstrate that their art does not rely on size or strength. Royce Gracie would win multiple tournaments with victories over fighters who had considerable size and strength advantage over him (of course there were no weight categories in the early UFC events).
MMA has exploded since the early UFC events and there are now countless organizations promoting the sport all over the world from Japan and Russia to Europe and the US. The UFC is the most important of these organizations and recently sold for $4.2 billion dollars last year, having been bought for only $2 million 15 years earlier – which just goes to show how rapidly the sport is growing.
The sport has evolved over the years, becoming a fully-fledged professional sport with weight categories and rules to ensure fighters’ safety. The sport won a long legal fight last year becoming legalized in New York, celebrating its new legal status with UFC 205. The event did not disappoint, not least because of Conor McGregor’s historic win, becoming the first fighter in the UFC's history to hold titles in two divisions simultaneously.
With MMA being the fastest-growing sport, it’s important to understand common causes of MMA-related injuries and how to avoid them. This is particularly true for the millions of children who are now practising MMA and aspiring to one day take part as professionals.
MMA injuries and Prevention
Just like any sport, the standard practice to prevent injuries is also crucial in MMA. However, because of the dynamic of the sport, technique is much more pivotal in preventing injuries. This is a sport where you can get punched, kicked, kneed, elbowed, arm-locked, choked and more! Not only can you get injured from your opponent’s attacks but you can also get injured by executing an attack incorrectly or with bad timing. Another main cause of injuries is not knowing when to give up. Many fighters don’t quit because they cannot accept defeat and haven’t learnt to be smart and turn off the ‘relentless fighter’ mentality when it’s vitally needed. As such, their bodies are pushed over its capabilities which in turn leads to serious injuries. Below we look at some case studies.
Leg Injuries from Kicks
There are two main ways of getting injured from a kick. One is not being able to check a kick properly which leads to swelling and severe bruising of the thigh. The best example of this was Uriah Faber who absorbed the devastating leg kicks of the explosive Jose Aldo for five rounds. The other way of getting injured is by not kicking with proper technique or kicking after “telegraphing” which can result in a check which in turn can damage your own leg. A popular example of this type of injury is when Anderson Silva broke his own leg when it was checked by Chris Weidman. Anderson Silva is one of many who has broken his own leg when throwing a kick- the internet is full of videos and pictures of fighters breaking their legs by kicking incorrectly. Below the MMA veteran Bas Rutten explains the correct technique.
Falling Correctly
MMA is full of throws, takedowns and slams and so one must master the fall in order to prevent injuries. A good example of how an incorrect fall can injure you is when Mauricio Rua fell and broke his arm when getting taken down by the wrestler Mark Coleman. Another example is when Ricardo Arona was knocked out when Quinton Jackson slammed him. Both these injuries could have been prevented with proper technique. See below a short video of how to fall properly.
Knowing When to Quit
Very often fighters don’t give up when being held in a submission and therefore end up with serious injuries. Usually this is a mentality issue with fighters not wanting to accept defeat, especially if the fight is with an opponent with whom there’s a longstanding rivalry. Good examples of these types of injuries are Tim Sylvia vs Frank Mir and Razak Al-Hassan vs Steve Cantwell. Both fights were ended by the referee stepping in and stopping the fight after the fighters’ arms were dislocated from over-extension caused by the submission holds. It’s very important that young children learning MMA are taught to quit well in advance of any injury taking place and not being indoctrinated with the ‘warrior spirit’ and ‘never give up’ mentality which can be so detrimental in the sport of MMA.
It may not be a nationwide favorite like baseball or football, but hockey has been part of the North American sports scene professionally since 1917. This month, as a new season builds towards the Stanley Cup – and to celebrate the NHL’s centennial – we’re focusing on hockey injuries and how to avoid them!
If you think football is a dangerous sport, try imagining it on frozen water, at 30mph…with blades on the players’ feet. In fact, the last player to die as a direct result of an in-game incident in a major North American professional sport was a hockey player. In 1968, Bill Masterton, of the Minnesota North Stars, was knocked backwards in a collision and landed on his head, suffering internal brain injuries. And it is not just collisions you need to worry about. Hockey players have been hit in the face with speeding pucks, impaled on equipment, and slashed with other players’ skates. Thankfully, these incidents are extremely rare, and many have been prevented with the introduction of new and better protective clothing, but there are still opportunities for injury, as well as easy ways to help reduce the risk of them.
Arms
The most common hockey arm injuries are the result of crashing into the boards, the ice, and other players and can be particularly bad for the joints - shoulder, elbow and wrist. For injuries such as shoulder separations and broken collarbones, the only way to avoid them is to avoid the collisions – which may not be possible. Thankfully, these tend not to be serious and can be fixed with plenty of rest and a good sling. Players can protect their wrists from fracture by learning always to brace themselves with their forearms, rather than throwing out a hand to stop them. Bursitis in the elbow is also a common problem for hockey players – and involves the inflammation and swelling of a bursa. This is, essentially, a fluid-filled sack which forms over the joints and acts as a cushion between tendons and bones which can be a site of recurrent inflammation. The best way to prevent this is to make sure always to wear well-fitting elbow pads which provide support and protection.
Legs
Some of the most common soft tissue injuries in the game happen in the legs – particularly the groin and hips. The skating stride leaves hip flexors and groin muscles highly susceptible to injury so it is imperative that players undergo a strict off-season strengthening regime and that they warm up and stretch properly before practice. Again, bursitis of the hip pointer is also common but can be easily prevented by wearing hockey pants with reinforced padding. The ACL and MCL are also prey to injury during hockey games. The position of the leg with the skating stride, pushing the inside edge of the blade, can cause MCL strain and ACL disruption and torn cartilage in the knee can also occur.
Back
Quite apart from the obvious damage which can be done if a player falls badly on the ice, the hockey stance can also be bad for your back. The forward-leaning skating posture plus frequent hyperextension stress can lead to severe lower back pain and pulled muscles. The best way to avoid these is to strengthen your back muscles so they are more up to taking the strain, but also to strengthen the abdominal muscles and developing a strong core.
As with most sporting injuries, however, the basic rules for preventing hockey injuries are the same: warm up, undergo sport-specific strength training, get a full physical before the season begins, cool down properly, and wear the appropriate clothing and protective gear.
If you want to support your local NY teams – head over to NBCSN or TVAS tonight at 8pm ET to watch the Rangers play the Philadelphia Flyers or tomorrow tune in on MSG+, SNE or RDS at 7pm ET to watch the Islanders play the mighty Montreal Canadiens.
If you have any questions about any of the issues mentioned in this piece, or you have another health-related question, please do not hesitate to reach out via Facebook or Twitter or contact us here.
2016 is coming to an end, and now is the time to start planning for, and looking forward to 2017. Whether or not you are the sort of person who makes New Year’s Resolutions, we believe making the decision to get fit and healthy is a vital one for the year ahead – and here are just some of the reasons why.
1. Sleep better
It is no secret that how you act when you are awake greatly impacts how you sleep. In a time when increasing numbers of people report they have trouble sleeping or getting enough sleep, exercise could be the change you need to fix this. In a 2013 Sleep in America poll run by the National Sleep Foundation, it was found that 50% of people who did not exercise said they got fairly or very bad sleep, compared with just 17% of people who termed themselves “vigorous exercisers”.
2. Work better
People who exercise for half an hour a day, five days a week, have been shown to be far more effective workers. Frequent exercise keeps you sharp, makes you more productive, and boosts energy levels. So, while it may feel counter-intuitive to spend 30 minutes a day working out, instead of working for an extra half hour, in the long-term it can boost the quantity and quality of your work.
3. Feel better
As well as feeling fitter and better in your body, regular exercises does wonders for your mood. The extra blood flow to the brain helps lift spirits and mood-boosting endorphins are released as well. Exercising is an excellent stress reliever and has also been shown to ease depression and anxiety symptoms.
4. Good for your head
Exercise increases blood flow – and this includes blood flow to the brain. This means that exercising can leave you feeling more awake and focussed but it also has longer term implications for brain health. Exercising regularly can actually boost your memory skills and ability to learn, as it fuels the birth of new brain cells in the hippocampus. It can also help to protect against degenerative conditions associated with age – such as dementia and cognitive decline. It is even good for headaches! If you are a sufferer of migraine headaches, research suggests that exercise can be just as effective as relaxation therapy or medication for preventing these.
5. Good for your bones
While cardio exercise is excellent for helping to lose weight and boost general fitness, it is important to incorporate some strength training into your routine as well. One part of you which will particularly benefit from this sort of exercise is your bones. Like muscle, bones are made of living tissue and, as such, can be strengthened with regular exercise. Frequent strength training can help build up bone strength which, in the long-term, can help prevent against age-related conditions such as osteoporosis.
6. Good for your insides (diabetes, gastrointestinal tract, cancer)
Unless you overdo it, regular exercise is better for your overall health, boosting your immune system and causing you to get sick less frequently. While fewer colds a year is a huge bonus, exercise can help protect you against far more severe illnesses as well. Regular physical activity has been shown to have a significant impact on certain types of cancer, it has been shown to help with a number of gastrointestinal tract complaints, such as diverticulosis, cholelithiasis and inflammatory bowel disease. It reduces the levels of bad cholesterol in your body and increases the levels of good cholesterol, which helps protect you against heart disease. It also increases your insulin sensitivity, meaning your muscles are more able to take in glucose, lowering your risk of contracting type II diabetes.
Regular physical activity is good for your eyesight, your blood pressure, your muscles and joints and, perhaps most importantly of all, it can help you to live longer. Studies suggest that even 15 minutes of exercise a day can add as much as three years to your life. A resolution which can mean you have more New Years? What could be better than that?
For more information about anything covered in this article, please reach out to us over Facebook, Twitter, or via our contact form here.
Holiday season is here! And what better way to spend a bright, winter’s day than hitting the slopes or the rink? But be careful! Last year more than 245,000 people were treated for winter sports-related injuries, from skiing to skating, so this year follow our advice and avoid spending the snowy season in bed.
Skiing and Snowboarding
These are the two most common injury-causing winter sports, from strains and sprains, to bad falls, to collisions, the opportunities for injury on the slopes are numerous, but there are a few key things you can do to prevent any serious damage. Falling badly can lead to ACL and MCL damage by putting strain on, or twisting, your knees. If you throw your arms out to break your fall, it can also lead to wrist injuries, “skier’s thumb”, shoulder dislocations or rotator cuff tears. Therefore, it is imperative that you learn to fall correctly – tuck your arms in and roll with the fall, rather than fighting against it. Aim to somersault or land on your side or buttocks as this will spread the impact. It is also vital that you check and double-check your bindings, and have a ski mechanic do a release check – it could be the difference between another day on the slopes or the rest of the season laid up in bed.
Skating and Ice Hockey
The best way to keep safe on the ice is to make sure you have the right equipment. Figure skates for figure skating and, for ice hockey, everything from hockey skates and gloves, to kneepads and eye glasses. Rather than falls, the most common injury for skaters is collisions – with other skaters, with equipment, or with the ice itself. These can lead to bruising, pulled muscles, ligament tears and cuts or, more seriously, broken teeth and bones, dislocations, and concussions. If you do not wear the proper protective kit, your risk of these injuries increases tenfold. No player should be allowed to participate in a hockey game until they have demonstrated basic skating skills and the rules against checking from behind or to the head should be enforced at all times.
Sledding and Tobogganing
The cardinal rule for sledding is: do not go down face-forwards. However much more fun you believe it will be, the fun will only last until you run into something. Common sledding injuries include head and limb trauma, including concussion, and the variety of bumps, bruises and cuts sustained when you fall off or collide with something. The ways to avoid sledding injuries are fairly simple. Be sure to pick a hill which is free from obstacles, with plenty of space at the bottom, and well away from parking lots or bodies of water. Ideally, you should use a proper sled with runners and some way of steering it but, in any case, you should never improvise with sheet plastic or other thin material which could be pierced by rocks or twigs. Safest of all, is to wear a thick coat and a helmet, which should protect you from the majority of potential injuries.
General Rules
As with all sports, whatever the season, there are a few general rules which can be applied to all, and which will help you make the most of your winter season.
1. Drink water. Just because it is cold, does not mean you are immune from dehydration – engaging in any activity will cause your body to warm up, so make sure to drink lots of water before, during, and after your exercise.
2. Wear the right kit. Whether this is a helmet, the appropriate footwear, or simple a number of light, water- and windproof layers to keep you warm, this equipment and clothing is designed to keep you safe, so use it.
3. Stay in shape. The healthier your body is all-year-round, the stronger it will be, and the less likely you are to hurt yourself. Going from no exercise at all, straight onto the most advanced ski slope or into a lively game of hockey, is a recipe for disaster.
4. Warm up. As with any sport, it is crucial that you warm up gradually and don’t just jump right in. Do some basic exercises and warm-up stretches, holding each for 30 seconds, then do a few laps or an easy run before moving onto the harder stuff.
5. Know when to stop. Feeling sore? Feel a twinge? Feeling tired? That is your body trying to tell you something, and it generally isn’t wrong. Whenever you feel tired or in pain, stop and have a break. But if you follow our other tips, chances are you will be able to keep going for longer before this happens.
What sports or activities will you be doing this holiday season? Get in touch on Twitter or Facebook and let us know! And for any questions about winter sports injuries, please reach out to us via our contact form.
With the New York marathon taking place this week – November 6th – we decided it was the perfect time to talk about everything that is great about running…and everything that you need to watch out for!
Why Running is good for you.
As exercise goes, running is some of the best. First and foremost, it is a truly fantastic way to get fit – not only does it burn calories, but it carries on burning them after you have stopped running – but it is also great for your overall health. It improves bone mass, increasing knee health and decreasing your risk of developing osteoarthritis, it boosts your hearing (some research suggests) by increasing blood flow to your ears, and it can even diminish your risk of cancer. Studies have shown that people who run for 30 minutes a day could reduce their risk of dying prematurely from cancer by up to 50%!
Outside of physical health, studies have also shown that regular exercise, and especially running, can help with attention, concentration and organizing as well as boosting learning and memory. Running can also make you happier, through the release of “feel-good hormones” called endocannabinoids and by purging the blood of a substance called kynurenine, which builds up over times of stress and can be linked to depression. Some studies have shown that even 30 minutes of walking on a treadmill can lift the mood of someone suffering severe depression, as well as boosting sleep quality.
Common Running Injuries
Evolutionarily speaking, we humans have always been good runners, due to the natural necessity to chase prey and avoid predators, so why does it cause so many injuries? As a high impact form of exercise, most running-related injuries result from the pounding of knees and feet and going too far for too long or over rough ground.
Some of the most common running injuries include “runner’s knee” or patellofemoral pain syndrome, Achilles tendinitis, plantar fasciitis, shin splits, fractures, sprains, Iliotibial band syndrome and pulled muscles. Almost all of them come about through a combination of uneven running surfaces, overuse, overtraining, weak hips or incorrect footwear.
So, what can you do? Well, the benefits far outweigh the risks, so rather than give up, we suggest you keep calm and carry on running… while sticking to these few key tips.
How to Avoid Running Injuries.
1) ALWAYS warm up and cool down.
This is a must whatever exercise you are doing. Skipping it may save you time in the short term, but in the long term it will only mean you are out of play for longer while you recover.
2) Know your limits.
Again, this is important for all forms of exercise. Understanding your body’s capabilities will help you to walk the fine line between pushing yourself and staying safe. Once you have figured out how far and for how long you can run comfortably, stick to the 10% rule, never increasing your mileage by more than 10% a week.
3) Form.
If your technique is not right, it can make you vulnerable to a range of injuries, from shin splints to stress fractures. Study the right form, and perhaps consider consulting a trainer or physical therapist who can help you to identify any biomechanical issues you might have.
4) Choose your route wisely.
Running routes with uneven ground and a lot of hills put greater strain on your knees and ankles. If you must run up-hill or off-road, be sure to build up to it gradually, and vary this running with days where you run on a track which will be kinder to your body.
5) Strength Training.
As I mentioned before, weak hips can be a leading cause of running injury so it is important to strengthen them, as well as the other muscles in your legs, to help the bones, ligaments and tendons withstand the high impact. Add lifting and strength training into your exercise regime and you will be amazed at the difference it can make.
October marks the beginning of the 71st season of the National Basketball Association. The regular season kicks off on the 25th with 2016 NBA champions, the Cleveland Cavaliers, hosting a game against our very own New York Knicks. This being the case, I thought it only right that I wrote a post about basketball, the injuries it commonly leads to, and the best ways to prevent them.
Basketball is one of America’s favorite sports, but it is also the fourth most injury-prone there is. According to the National Athletic Trainers Association (NATA), two players from every high school basketball team get injured on average per season, with 200,000 under-15s ending up in ER due to basketball-related injuries every year.
So what sort of injuries are they? Basketball injuries generally fall into two camps – overuse and traumatic. Overuse injuries are the result of stressing an area over and over until it is damaged. For basketball players the most common are Achilles tendinitis or rotator cuff problems. Traumatic injuries, on the other hand, are caused sudden, forceful acts and can be anything from ankle sprains and jammed fingers to muscle tears and serious knee injuries.
The main secret to avoiding both is thoroughness. Have a thorough pre-season physical examination with a doctor and be sure to do a thorough warm up every time you play. According to NATA, 60% of all high-school basketball injuries happen during practice, so never skip out on warming up. A lot of the other main ways to avoid injury apply to all exercise – stay hydrated, maintain a good level of fitness, ease back into play gradually, and be sure to use the correct technique. Wearing the correct footwear with skid-resistant soles and ankle support also goes a long way to reducing injury in the lower leg.
In the event that you do suffer an injury, how you treat it will obviously depend on the nature of the injury itself and this varies from player to player. For some, even traumatic injuries, including ankle sprains, jammed fingers, knee injuries and deep thigh bruising, can be healed with methods as simple as RICE -Rest, Ice, Compression, Elevation. ACL tears and stress fractures, however, can be much more serious. In all cases, the top piece of advice I could give to any injured player would be to… go see a doctor, and do exactly as they say!
If you have any questions about the injuries covered in this piece – or any sports-related injuries in general – simply reach out via our contact page here and I will happy to discuss them with you.
Q. Jets or Giants this season? Why?
The Giants – because Eli Manning is very steadfast, he’s quiet but stable and leads a very steady ship.
Q. Who is your projected MVP?
Would have said Tom Brady, but he’s going to miss 4 games, so probably Aaron Rodgers of the Green Bay Packers.
Q. Which players do you have an eye on this season?
Odell Beckham, the wide receiver for the Giants, and Victor Cruz.
Q. Exciting rookies?
Based on last year’s college football, probably the Running back for the Dallas Cowboys – Ezekiel Elliott.
Q. College? Who’s going to win the national championship this year?
It’s hard to steer away from Alabama - they’d be the first choice – but I’m rooting for a non-big conference team to make some headway.
Q. Who are your Super Bowl picks and why? Who’s your winner?
I think the Patriots are going to make it back - they could take the Broncos. Also the Panthers – it might be Patriots vs. Panthers.
Football is one of our favorite sports, and with the Giants’ and the Jets’ seasons kicking off in September, there has never been a better time to get excited. But winning glory in the game often comes at an extraordinary cost, with some of the nastiest injuries of any professional sport being common on the field. So this week we are talking about Football injuries and the huge steps medicine has made in helping to deal with these.
One of the most common injuries – both in football and other running and cutting sports – is a non-contact ACL tear. The Anterior Cruciate Ligament is one of the four main ligaments in the knee and is largely responsible for the knee’s ability to bend and flex. If you are a Weekend Warrior who enjoys playing sport in their own time, an ACL injury will normally be dealt with through physiotherapy, regenerative medicine, interventions and sometimes steroids to help with the pain. If you are a professional athlete whose pay check is dependent on you getting back on the field… the only real option is surgery. Whereas in a non-professional, surgery is reasonable option, in a high-end athlete, surgery to repair an ACL tear will result in more stability and a more structurally-sound knee meaning you will be able to get back out there and, hopefully, play as well as you did before.
Ten years ago, an ACL-tear was generally believed to be a “career-ender”. For many players – especially those nearing their 30s – even if they recovered, their performance did not. Now, developments in medicine have meant that some pro athletes not only get back to the level they were at before injury, but sometimes even surpass it, going on to have the best performances of their lives post-recovery.
A great deal of this is attributable to the fact that athletes have an innate healing ability superior to that of a normal human. They also spend many hours a day with physiotherapists and personal trainers, working on their body and their health. However, a lot of it is down to the fact the surgeries have improved, the rehab process has improved, and our whole approach to pre-hab and re-hab has changed.
We have known for a long time that strength training alone tightens muscles – it may be important for power and strength but, without the flexibility to go along with it, strength training greatly increases your risk of injury. In the past the trend was muscle bulking, but now more focus is being placed on the importance of stretching, on lengthening muscles and increasing flexibility – a philosophy which has been repackaged as a fitness program by athletes like Tom Brady with TB12.
Of course, there are some football injuries which no amount of strength-training and stretching will protect you from, such as the infamous CTE. Discovered by Dr. Bennet Omalu in the early 2000s, Chronic Traumatic Encephalopathy is a progressive degenerative disease resulting from frequent and/or severe head trauma. The symptoms can include dizziness, disorientation, dementia, social instability, and even an impulse for suicide. As it is, we still do not have a great understanding as to the exact causes of CTE – whether it is the frequency of head trauma, the severity of the head trauma, the time elapsed between a first and second concussion etc. – but new ways to monitor and appropriate treatments for CTE are developing all the time.
And is not only the head which is at risk, but the neck and spine too. Football players, who are prone to getting hit hard in the cervical region, often experience what are known as “Stingers”. These involve a compression of the nerves causing intermittent shooting pains. Although unpleasant, Stingers generally pass and tend not to be a cause for concern, but injuries to the neck can often be more serious. In the case of Peyton Manning, who suffered from a narrowing of the spine, neck injuries can be enough to put an athlete out of play for a significant amount of time.
Although football continues to be one of the more dangerous competitive sports, the leaps in medical science mean that we may see fewer career-damaging or career-ending injuries in the future.
When it comes to exercise, it is never too late to get started – but the sooner you get active, the sooner you will feel the benefits and the easier it will be to keep going long-term. With this in mind, this week I will be covering my top tips for exercising at any age, depending on your goals.
1) To Lose Weight or Get Toned
Diet
While exercise can certainly help in this area, there is no denying that nutrition is key – not just for weight loss, but for general health and disease prevention – so getting serious about what nutrients you put into your body is a great start.
Strength Training
Strength training is about so much more than bulking up. Over time your muscles lose their strength, so strength training can help to preserve muscle mass which will help you stay toned as you get older. Muscle also helps you burn calories, so it is just as important for weight loss as cardio-vascular exercise. Learning the gym basics – exercises like squats, lunges, and push-ups) – in your twenties will stand you in excellent stead, but you can benefit from strength training whatever age you start. For example, women in their 40s tend to do extremely well with strength training.
Focus on your core
Strengthening your core muscles will help with your strength training, but will also work wonders as you get older by helping take some of the pressure off your spine.
Cardio
This is the best way to burn calories quickly – and it will be considerably easier if you are having fun doing it. Pick a class activity like Zumba, or water aerobics if you are looking for low-impact exercises.
2) To Boost Your Physical Health
Routine
This is the most important aspect of any exercise regime, making it part of everyday life. Make an effort to do some physical activity every day. This does not need to mean hitting the gym, it can simply be choosing to take the stairs rather than the elevator, but making light physical exertion part of your routine will help to make it feel like less of a chore. Most importantly, if you have a job which is largely sedentary, be sure to get up and walk around at regular intervals, taking time to stretch your upper body.
Walking
All of the exercises mentioned under losing weight will help boost your physical health, but even simple things like walking regularly can have a huge impact. Walking strengthens your bones, improves your cholesterol, helps you maintain healthy blood pressure and lowers the risk of heart disease and diabetes. Over time it can even help to improve your memory, as well as boosting your mood.
3) To Boost Your Mental Health
Set Goals
There is an indisputable link between physical and mental health. Aside from the positive chemicals released during exercise, daily physical activity can help you feel like you have accomplished something. The best way to maximise this positivity is to set yourself measurable goals – walk 2 miles, do a certain number of reps with a particular weight, lose 3 pounds – and to give yourself realistic time limits within which to achieve them. This is key to any fitness journey, but can be particularly helpful when coping with mental illnesses such as depression.
Swimming
As you get older, hormone changes can lead to severe mood swings and sometimes these coincide with certain physical activities becoming less open to you. Swimming has been proven to improve your mood and can be done at almost any stage of life. The buoyancy of the water means it is low-impact which makes it perfect for people with arthritis or joint pain.
Tai Chi
Another activity open to people of all ages, Tai Chi is low-impact and involves a series of slow, deliberate movements. Sometimes known as “Meditation in Motion”, Tai Chi requires you to be aware of your body and its capabilities. It is good for both the body and the mind and has been shown to help with relaxation, balance, and sometimes even pain relief.
4) To Help with Chronic Pain
Yoga
Along with Tai Chi and Swimming, Yoga is another great, gentle form of exercise you can practise, even if you suffer from chronic pain such as fibromyalgia. Opt for Hatha yoga – the gentlest form – which involves a series of postures, breathing, and meditation. Hatha yoga has been shown to reduce some of the physical and psychological symptoms of chronic pain, helping some patients become more mindful and accepting of their condition.
Stretching
A great activity to do, whatever your situation, stretching should always be done to cool down, rather than to warm up. It can increase flexibility, loosen up tight or sore muscles, and improve your range of motion. For people who suffer chronic pain, stretching can help you tolerate both other exercise and even everyday movements.
Everyday activities
When you suffer from chronic pain, it can often seem like too much to engage in normal daily life, but doing things like playing with your kids or grandkids, gardening, or doing light housework can actually help to relieve your stiffness, pain, and fatigue over time, as well as boosting your general quality of life.
Any questions about anything mentioned above? Get in touch via Facebook or Twitter, or drop into our office to find out more about these, or any other health-related issues.
Pain – both chronic and acute – can affect you at any age, but it is certainly more likely to strike the older you get. The body, like a machine, suffers a significant amount of wear and tear over time, and every passing decade brings new potential aches and pains. However, with the right care and attention, it is possible to limit, prevent, and sometimes even cure pain and this is what we will be discussing this week.
There are three major factors which contribute to pain as you get older, but the biggest of these is undoubtedly arthritis. Arthritis occurs when the protective cartilage between your joint and your bone breaks down, often as a result of age-related changes. This can happen at any age, but is mostly likely to occur when you are in your 60s and 70s and is, in fact, the most common cause of pain in people over 65.
Aging also causes changes to your muscles and tendons. Tendons lose a considerable amount of their elasticity, making them more prone to injury, especially repeat motion injuries, whereas muscle fibers become less dense. This change in your muscles means you become less flexible, and more prone to soreness, even experiencing aches after normal everyday injuries like gardening.
The most common pains people suffer as they get older are caused by one of these three things. Arthritis can cause carpal tunnel syndrome, as well as back and joint pain. Tendonitis from overuse and repetitive motion is exacerbated by the lack of elasticity in the tendons, and the change in muscle fibers means muscle pain becomes far more frequent.
But it is not all bad news, there are a number of ways to treat, and sometimes prevent, these pains -but a lot of it comes down to lifestyle. When it comes to preventing pain, the sooner you start the better. Simple things like eating a healthy diet, not smoking, not becoming overweight, and doing regular physical exercise will help shield you from a whole host of health issues, as well as lower the likelihood of pain as you get older. There are also a number of general pain relief measures which will help most lower level complaints. Massages, physical therapy, heating pads, and over-the-counter painkillers will help with a number of pain issues, but there are specific things you can do for the more enduring problems.
For muscle-related pains, strength training and cardiovascular exercise combined with stretching will help to build up muscles as well as increase flexibility. Stronger core muscles can help alleviate back pain by better supporting your spine, and staying supple can help prevent you pulling muscles. For repetitive motion complaints, such as tendonitis, many experts suggest RICE – Rest, Ice, Compression, and Elevation.
For arthritis, there is no sure-fire way to prevent it occurring, but there are measures you can take to reduce your risk of getting it and keep it at bay for as long as possible. Physical activity is key - it keeps blood circulating around the body which, in turn, helps to keep joints healthy. Also any exercises which strengthen the muscles around the joints will help take some pressure off the joint and the bone.
For long-standing pain caused by osteoarthritis in the knees there are also other steps you can take to alleviating pain long-term. Stem cell and Hyaluronic acid injections into the knee can help relieve pain from osteoarthritis for up to six months. These injections restore the cushioning and lubricating properties of the knee joint and are an excellent alternative to surgery. If you suffer from osteoarthritis and are interested in learning more, I will be giving a talk on Orthovisc knee joint injections later this month. For details on this – or any of the other issues covered in this piece – please do get in touch with any questions or to make an appointment.
As we come to the end of May the weather is warming up, people are spending more time outside and…hospitals are getting busier. Summer is peak sports injury season with a higher number of emergency room visits than any other time of the year. So, in this week’s blog, we want to help you avoid the wards and enjoy the weather by preventing those unwelcome summer sports injuries.
Why does Summer cause injuries?
It is not difficult to see why the arrival of the sunshine might precipitate a rise in trips to the hospital. After months spent indoors, weekend warriors – and even some professional athletes – are keen to get back into their favorite sports and often jump in before they are ready. And these injuries do not necessarily correlate to experience level either. For runners and high school and college athletes, summer is the time to start training in earnest before fall sports and race season kicks off.
Unfortunately, some of America’s top summer sports are also the highest ranking for injury among the over 25s. Cycling comes in at the top, followed by basketball, softball, football and soccer. The most common injuries include pulled muscles, ankle sprains, tendonitis, stress fractures and plantar fasciitis (a disorder which causes pain in the heel and bottom of the foot), none of which may seem serious but, over time, could lead to you having to quit your favorite sport for good.
So how do you avoid these problems?
The first, and most important thing to do, is prepare in the run up to summer. Be you a pro athlete or a weekend activity fan, easing into your chosen activity is a must. Going from zero to 100 immediately can only cause problems, so take four to six weeks gradually building up to normal activity levels.
If the weather outside is putting you off over the pre-summer months, there are plenty of ways to exercise your key muscles at home. Exercises like running, indoor strengthening and indoor cycling or spinning will work wonders. Identify the muscle groups you will be using and focus on those especially. Cyclists and runners should undertake lower body workouts, and tennis players should spend time toning the arms and shoulders. Almost all injuries can be in part prevented by a stronger core, so be sure to incorporate that in your workout too.
Once you have got back into your sport of choice, be mindful of your routine and any changes you might make and any small pains you might be feeling so you can stop potential problems in their tracks. Changed your grip slightly? Perhaps that is unwise. Always run on the same track? Maybe change it up a little, giving your knees a break on softer surfaces, or pushing yourself with new curves and inclines.
Most important of all, be aware of the two biggest injury-causes at this time of year: heat and dehydration. The main signs of heat illness include cold, clammy skin, lack of sweating, headaches, dizziness, loss of coordination, muscle cramps and nausea. Your body can generate up to twenty times as much heat as it normally does when you are exercising and that, coupled with the summer sun, can cause real unpleasantness. Avoid it by wearing light, non-cotton clothes which wick water away from the skin and trying not to exercise at the hottest times of the day.
Whatever the weather, hydration is key when you are exercising. If you get thirsty mid-activity, you are probably already one litre of fluid depleted. Get hydrated early on, with 17-20 ounces of fluid three hours before exercising, then another 10 ounces half an hour before. If you are going to be exercising for more than 45 minutes, make sure to have a drink with added carbohydrates or electrolytes ready for afterwards. Simply put, your dehydrated muscles will not work as well as they could, and you are more likely to pull a muscle, so it is best not to risk it.
Ultimately, summer is a great time to be active and make the most of the sunshine and the great outdoors, so be smart about it and you can enjoy the whole thing, pain-free.
Having a quick scan of the About section on this website will tell you a lot of what you need to know about Dr Spinner – from his background to his favorite beer – but when it comes to your doctor, the more you know, the better, so this month’s blog brings you a more in-depth look at the man behind the medicine.
A sports fan from an early age, Dr Spinner’s particular favorite has always been baseball (as you might be able to tell) but he is also a big supporter of winter Olympic sports and college basketball, and while he may dabble in other states’ teams for basketball (Warriors and Spurs for the NBA and Duke at college level) when it comes to football and baseball he is strictly a New York man.
So is it just the fact that the Giants, Jets, Mets, and Yankees spring from his home soil, or is there something special about NYC teams? “The best part about New York teams is the expectation to win. Having a good season and making the playoffs then not winning the championship is not good enough. New York mentality is go for broke”.
A mentality he well understands after years of playing sports himself – from volleyball, tennis and skiing to his long-term preference, baseball, which he was lucky enough to play all the way through his medical training. He himself managed to escape with nothing more than a broken finger or two and a spate of pulled hamstrings – the same cannot be said for most of his sport-loving patients! So what is it about sports injuries that he finds so interesting? “Sports injuries are particularly interesting to me because of the underlying biomechanics and pathophysiology. The way in which injuries occur, can be prevented, and are treated makes sense”.
This interest – which links up so well with his personal interests – also fits into the field of medicine he practices. “I always had an interest in musculoskeletal medicine, intertwining physics, motion, function, science, and medicine” but, he says, there are only a few specialties in medicine which allow physicians to delve into the musculoskeletal spectrum. Rehabilitation Medicine is one of these. Doctors who work in this field focus on treating conditions which affect the muscles, bones, joints, ligaments, nerves, brain, and spinal cord and they are trained to use the most cutting edge technology to treat them. (More information on these technologies can be found under Interventions above.)
A fellowship in pain management was the next natural step, allowing Dr Spinner to enhance the scope of conditions he treats. And an interest in pain management extends far beyond his practice into his charitable activities. For some time, Dr Spinner has been an avid supporter of the Facial Pain Association, after experiencing family members’ struggle with truly disabling facial pain. “This is the type of pain that changes one’s life. I hope that in supporting this research (and doing some of my own) we can find cures.”
The second charity which he supports also has links to his everyday life. “Physiatry training aligns really well with treating the normal Musculoskeletal injuries from being active.” The injuries suffered by those helped through the Wounded Warriors Project include brain and spinal cord injuries, amputee care, chronic pain, and disability. And, more importantly, as Dr Spinner points out, “I can’t think of a group of people that are more deserving of our very best efforts to help.”
To learn more about Dr Spinner’s practice, please explore the website, and for all questions and enquiries, please get in touch via the contact page.
The approach of Spring can only mean one thing in New York City – baseball season. The beginning of April brings the season home opener of both the Yankees and the Mets, two of our finest, home-grown sports teams.
As sports injuries go, Major League Baseball is at lower end of the risk spectrum out of the big four, but it is by no means injury-free. From home plate collisions to fractured skulls to even the odd foul ball in the groin, there has been some fairly dramatic damage done on the diamond. However, the most common injuries seen tend to be a little less theatrical – such as tendonitis or ligament and rotator cuff tears.
Normally, baseball injuries can be avoided by doing simple things such as warming up properly and not pitching on consecutive days or playing all year round, but if you are a pro player, some of these are impossible to avoid. So this month, we are taking a look at three major New York baseball players and their most famous injuries.
First up is Mets third baseman David Wright. Captain of the Mets since 2013, Wright has sustained his fair share of injuries in his time, from concussions to contusions. Most recently the 33-year old was placed on the disabled list for sixty days to deal with his spinal stenosis. Spinal stenosis involves an abnormal narrowing of the spinal canal and can be congenital or more commonly caused by aging and arthritis. With symptoms including pain, numbness, and loss of motor control, it is really pretty amazing to see such a productive comeback helping to lead the Mets to the World Series.
Next is Alex Rodriguez, considered by many to be one of the greatest baseball players of all time. A-Rod’s stellar career has been somewhat marred recently by hip and knee injuries and most recently had hip surgery to correct this. 40-year-old Rodriguez was suffering from a misshapen femur which, for 20 years, hasn’t fit perfectly into his hip socket. A common defect which the infielder has had since birth or childhood, which limits the movement he could achieve in his hip. Thankfully he underwent arthroscopic surgery to repair a torn labrum and had the femur shaved down to fit better into the socket and now is back and playing as well as ever.
Finally, we have Matt Harvey, the Mets’ 26-year old pitcher. Harvey recently missed the whole of the 2014 season due to surgery, despite being one of the most dominant young pitchers in Major League Baseball. Every time he pitches, his fans refer to it as “Harvey Day”, but he’s not the only Major League pitcher to have something named after him. Towards the end of 2013, Harvey had Tommy John Surgery, a procedure most commonly performed on baseball players and named after ex-Yankees pitcher Tommy John who first had the surgery in 1974. The procedure involves ulnar collateral ligament (UCL) reconstruction, where the UCL (in the elbow) is replaced with a tendon from elsewhere in the body. Although it took longer than Harvey had anticipated for it to heal, he was back throwing a baseball just 4 months after the surgery and came back on top form for the 2015 season. He is on the verge of dominating baseball in 2016.
If you want to learn more about any of these injuries – or you suffer from elbow problems, hip and knee problems, or chronic back pain (like these baseball superstars) get in touch here.
As we saw last month with Blizzard Jonas, the weather at this time of year can be highly unpredictable. This is just one of several reasons why Spring is so treacherous for athletes and so fraught with injuries. This week I’m going to run you through some of the main reasons why people get injured in the Spring, along with some tips on how best to prevent this.
Why does Spring cause injuries?
As I mentioned above, the weather in Springtime can be as unexpected as it is changeable, moving from the freezing cold in early Spring and early morning, to sunnier, warmer weather in the middle of the day and towards the start of Summer. This means athletes must be prepared for both – just because it is cold when you start training in the morning, doesn’t mean you will want to be wearing warm kit at midday, when temperatures are at their highest.
Secondly, the Spring season begins right after the holidays, when many athletes have taken a break from training during the winter or have been enjoying a well-deserved vacation. This pause, however small, means that you will have to ease yourself back into training slowly and carefully - if you push too hard too soon, you run the risk of hurting yourself.
As if that wasn’t enough, sports with seasons which begin in the spring are among some of the most notorious for causing both short and long-term injuries. Baseball and softball can lead to shoulder injuries, Lacrosse is known for knee injuries, such as ACL tears, Tennis can cause elbow injuries, Golf often brings lower back trouble, and Track is known for causing shin splints and pain in the outside of your leg, if not properly prepared for.
So how do you avoid these problems?
1. Before you go back, go have a physical check up with your doctor to make sure there are no underlying issues which could get worse when you train.
2. Take care of your muscles. When it’s cold, your muscles can contract and become stiff - start off slower than you normally would, warm up for longer than usual and do not stretch while standing in place. Similarly, you can get cramp when temperatures are too hot. Muscles regulate body heat by releasing sweat which leads to drop in fluids meaning you risk dehydration and heat exhaustion. Make sure you are wearing appropriate lightweight fabrics if it’s hot and drink plenty of water.
3. Do pre-habilitation exercises for the areas of your body you know will be trouble spots – e.g. shoulders, knees, elbows etc.
4. Practice the “heart rate method” – as good way to re-train your body for spring sports safely. Subtract your age from 220 – this will give you your maximum heart rate. Try to reach 75% your maximum heart rate for 30 minutes, 3-5 times a week in the weeks building up to the start of training.
5. Practice basic common Sense. Wear the correct clothing and be aware of changing temperatures throughout the day. If it’s warm and sunny – wear sunscreen and don’t exercise at midday. And, above all, listen to your body – if you feel sick or sore, STOP. It sounds simple – because it is!
Follow these tips and you should be all set for exercising all through the Spring, injury-free. And if you do have any problems, see your doctor immediately.
