How Can We Treat Calcific Tendonitis?

Greenwich Sports Medicine

What is Calcific Tendonitis?

Calcific tendonitis is a common condition that predominantly affects individuals aged between 40 and 60 years. Women canbe more affected by this than men. Clinically, calcific tendinitis is characterized by severe, disabling pain which occurs spontaneously. This usually occurs in the morning. Frequently it occurs in the shoulder and it involves the supraspinatus and infraspinatus tendon. There can be concomitant stiffness, giving rise to a frozen shoulder.  

Tendons calcify due to a number of factors both mechanical and metabolic. Mechanically, if the tendon is constantly rubbing against a bone in the subacromial space, especially with bone spurs in the acromioclavicular joint, the tendon can calcify. It is the constant irritation and repair in the multiphasic response of the immune system that can cause the tendon to calcify. This is similar to a callus forming on your hand from too much yard work.

Other factors play a role in this condition. Abnormal activity of the thyroid gland, metabolic diseases (e.g. diabetes), and genetic predisposition. Still experiencing chronic pain even after several months of conservative treatment? An attempt on arthroscopic removal of the tendon is then recommended. Recently, extracorporeal shockwave therapy has shown encouraging results in treating calcific deposits.

What is Shockwave (ESWT) Therapy?

ESWT is based on the use of single pressure pulses, otherwise known as shock-waves. It uses the same shockwaves that Lithotripsy machines use to break up kidney stones. Calcification finds its focus from ultrasounds or any radiographic guidance. One study by Cosentino et al. (30) showed that ESWT led to decreased pain and increased shoulder function. In 31% of their cases, complete resorption of the calcification isreported. Cacchio’s et al. (31) study reported complete resorption of calcifications in 86.6% of their treated patients and partial resorption in 13.4%. Therefore the success of resorption of the calcification can range from 31-86 percent according to current data. 

If you have been suffering from a calcific tendon and would like to avoid surgery consider extracorporeal shockwave therapy by one of the therapists at Greenwich Sports Medicine!


How To Stop Your Aging Brain

Greenwich Sports Medicine


How Can You Aide Your Aging Brain

Are you experiencing a foggy brain?  Forget where your keys are at?  Can’t remember the name of that song you’ve heard a thousand times? These are all common complaints people have as they get older.  Typically, we assume there is nothing we can do about it. It’s just part of the aging process. However, imagine if you could maintain your mental sharpness and even improve it.

Is This Possible? 

A protein called B.D.N.F. is the key!  High levels of B.D.N.F. rapidly rewire your brain, helping you learn faster, improve your memory and age slower. B.D.N.F. stands for Brain-Derived Neurotrophic Factor (B.D.N.F.) which is a stimulatory protein that produces new cells in the brain and improves the power of existing cells.

Think of brain-derived neurotrophic factors as fertilizer for your brain. You have billions of neurons (aka cells), and BDNF keeps them flourishing and strong. When you release BDNF, it flips the switch on a series of genes that grow brand-new cells and pathways. BDNF also strengthens the neurons you already have. Along with keeping you mentally alert and improving memory high BDNF carries many other benefits, too.

Neuroplasticity is used to describe this tendency for the brain to keep developing, changing, and potentially healing itself.  As you release BDNF, your genes “turn on” new brain cell growth, the more BDNF you have the quicker you learn, the more you remember, the less your brain ages and you actually reshape your brain.  Every stressful situation in your life, from work to home, slightly damages your brain cells. B.D.N.F. actually increases the plasticity of your brain so it actually minimizes the impact of stress on brain cells.

How Do You Increase B.D.N.F.?

The first and most immediate way to increase B.D.N.F. is via electroacupuncture.  Research has shown stimulating specific points via electroacupuncture immediately produces the B.D.N.F. protein.  It’s important to note that traditional acupuncture does not produce the same results as electrical acupuncture.


It should come as no surprise that both the quality and duration of your sleep increase BDNF. The deeper stages of sleep stages 3 and 4, increases BDNF release. Stage 3 and 4 are the deeper, restorative stages of sleep. There are four sleep stages, and you cycle through them every 90 minutes or so.


Both endurance and intense exercise increases BDNF.  Endurance exercise increases B.D.N.F. at a more substantial rate.  Getting your heart rate up is important.


Activities such as meditation, sauna, and general downtime all promote B.D.N.F. Stress is toxic to B.D.N.F. No surprise, then, that meditation increases BDNF, specifically strengthening areas that correlate with pain tolerance, body awareness, memory, emotional control, happiness, and attention. Start by meditating for 5 minutes every morning. Some days you may quiet your mind, while other days your thoughts may run rampant. When beginning a meditation practice, don’t get too attached to the results. Consistency is more important than “getting it right.”


These antioxidants stimulate brain-derived neurotrophic factor and protect you from stress. Coffee, green tea, dark chocolate, blueberries, and colorful vegetables are all excellent polyphenol sources. Coffee fruit extract (the red fruit surrounding coffee beans) is especially potent, and 100 mg of coffee fruit extract raised BDNF by about 140 percent in several studies. The boost lasted for a few hours. Coffee fruit extract can be supplemented.  Designs for health makes the highest quality version.


Exposure to the sun can increase your mood and improve the amount of BDNF you produce. It also increases vitamin D production, and actually decreases your risk of skin cancer, provided you don’t burn yourself.  Try to get at least 20 minutes of direct sunlight every day. Avoid putting sunscreen on for 20 minutes so you can absorb the sun’s rays. You want the UV rays hitting photoreceptors on your skin and retinas.


The use of a low carb high-fat diet can greatly decrease inflammation and help with overall brain health. (Ketogenic type diets)


Zinc, CBD oil, Omega 3’s and coffee fruit extract have all been shown to increase B.D.N.F. production in the brain.


What to Avoid?


Excessive stress blocks your ability to produce BDNF, increases cortisol and shortens your telomeres.


Always checking your phone and staying in a mode of always being “on” decreases B.D.N.F. You’re constantly bombarded with work, advertisements information, pollution, artificial lighting, and all kinds of other stimuli that tax your biology. It’s important to be “bored” sometimes to allow your mind to recharge.


These foods have been shown to directly inhibit your ability to make ample amounts of the protein B.D.N.F.


Being isolated socially leads to lower BDNF levels and contributes to depression. Social interaction has positive impacts on your development.



Are You At Risk For ACL Tears?

What Are The Risks to ACL Tears?

An ACL injury is a tear or sprain of the anterior cruciate ligament. This is one of the major ligaments in your knee. ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing. This would happen in sports such as soccer, basketball, football, and downhill skiing, to name a few.  Recovery for an ACL injury depends on the severity of the injury. However, what players and parents might not understand is that there is a wrong way to treat an injury. Athletes face the consequences of this every day.

A common theme among youth sports today is the growing demand for injury prevention and risk management. This comes with good reason. ACL injuries are on the rise in youth athletics. This is especially so in female athletes from the ages of 13-17. They have seen a 59% increase in ACL repair surgeries over the last 14 years! It gets worse, 10% or more of these athletes will go on to experience a reinjury. 50% will experience trauma induced arthritis later on in their lives. These numbers can be scary as a parent to an athlete. However, there are proven ways to address risk factors contributing to ACL injuries. That’s where the lab at Greenwich Sports Medicine comes in.

What Can We Do?

Using our state-of-the-art Portable BioMechanics Lab we established a protocol. Our Doctors will screen individual athletes and entire teams in the pre-season. This allows us to give a detailed opinion about the possible risk of injury. With individual athletes, we’re able to run through a full range of tests. Looking at the balance, jumping, cutting, dynamic stability, and much more. With teams, we use research-backed protocols to observe sports-related tasks. This gives us an idea of which athletes need more attention!

Between the two versions of our screening tests, we are able to create an objective score for each athlete. This will allow us to put them into one of three risk categories; high, medium, and low-risk. All youth athletes should be participating in some form of the injury prevention program. Those that fall into the medium and high-risk categories will receive more individualized attention. We will address some of the movement faults that put them into those categories in the first place.

            Working with the athlete’s coaches and trainers, we’ll plan to create and implement an evidence-based prevention program that they can work on leading up to, and during the season in order to minimize their risk of ACL injury. While there are plenty of risk factors that we don’t have control over, addressing the ‘modifiable’ risk factors has been shown time and time again to decrease overall ACL injuries (up to 60% reduction according to research).

            If you have a student-athlete that you want to be tested before their season starts, please feel free to reach out to the staff at Greenwich Sports Medicine, or let your child’s coach or trainer know. Our hope is to screen as many youth athletes as possible in order to implement these ACL injury prevention programs and do our part in reversing the trend of youth sports injuries. Help do your part and spread the word!


Dr. Alex Svac




Turmeric, Not Just a Supplement

You’ve probably heard of Turmeric. The golden spice that has been used to treat inflammation, bacterial infections and digestive issues. This all around miracle supplement has more benefits than just making food taste great!

In turmeric, you will find Curcumin. Curcumin is the main active ingredient in turmeric and has powerful anti-inflammatory effects. However, it is nearly impossible to achieve these benefits by only having turmeric in your foods. The curcumin level in turmeric is not THAT high. The best and most sure fire way to assure that you get all of the benefits is by supplementation!

However, it is IMPORTANT to note that not all supplements are the same!

It is very important to know that there is quality in supplements. Any over the counter supplements you find at a grocery store, pharmacy  and most surprisingly GNC, does not always contain the ingredient breakdowns that we need from the supplement. For example;

It helps to consume black pepper with turmeric. Why? Because black pepper contains Piperine, which is a natural substance that enhances the absorption of curcumin. The best curcumin supplements contain piperine. This substantially increases the effect of the supplement and increases their effectiveness. To ensure that we are consuming a supplement that has all of the benefits we expect tp be getting from this supplement, we should avoid buying over the counter supplements.

You get the best benefits from your supplements by purchasing through your healthcare provider. the supplement companies that we sell and that we TRUST are Metagenics and Designs For Health . These companies in particular test their ingredients to ensure that they are at their purest before putting it into the supplement. This is a guarantee that you will be getting the best of the best!

With Good Quality Product, The Better Results (Affects?)

Turmeric and its prime ingredient, curcumin, have a vast array of health benefits that everyone could use. One of the biggest being the role it plays in Inflammation.

Nearly every chronic disease process and acute trauma in the body is associated with inflammation. Inflammation produces mental fatigue, irritability, anxiousness, as well as the inability to heal and further states of disease. By adding foods and supplements that have anti-inflammatory properties are key to fight the inflammation we create in our bodies daily. Turmeric is a supplement you can add to your daily routine to help reduce your chances of becoming sick and unhealthy.

By properly supplementing, you may have the ability to avoid taking medications to fight these inflammatory diseases. For example, to avoid taking medications that fight your chronic inflammatory arthritis, why not take a supplement instead? Otherwise, you’re left taking medications that you see on TV that come with a long list of side affects. Why not start adding healthy supplements that can and will delay the onset and intensity of disease states? By doing so, you’re only increasing your chances of being and staying healthy!


The Benefits of Turmeric Supplements

  • Aids in soreness of muscles
  • Acts as an anti-inflammatory agent without inhibiting muscle growth
  • Reduces body fat
  • Helps prevent muscle loss in the case that you are unable to workout
  • Helps enhance cardiovascular health and protect arteries
  • Supports healthy cholesterol levels
  • Improves gut health
  • Decrease in depression and anxiety


Turmeric is fantastic. It is an awesome source to include in your supplementation. The many benefits it has are amazing for anyone to take at any age! you can really benefit from this product! why wait any longer? Contact our office to set up a Nutritional Consultation with Dr. Christopher Rago to address your individual nutrition and health concerns!

Dr. Christopher Rago

Acupuncture & Alzheimer’s

How Acupuncture and Alzheimers Connect

Alzheimer’s Disease is being called Type 3 Diabetes. We know the detrimental effects that sugar has on our physical appearance. However, sugar

has a gross affect on the inside of our bodies too. Long-term studies along with the functional MRIs that we see are showing us that sugar effects our brain function. More and more studies are linking poor glucose (sugar) metabolism within the brain to dementia and Alzheimer’s Disease.

We know the basics to improve glucose metabolism. Diet modification is number one. A diet low in sugar. 

Low sugar diets ultimately mean a low carbohydrate diet. Elimination of breads, pastas and sweets will greatly reduce sugar consumption. Regular physical exercise is a close second. Exercise improves the insulin sensitivity on cells and allows muscles to pull glucose circulating in the blood into muscles. We should all be getting at least 150 minutes of moderately intense exercise per week.


Is there anything we can do to stave of Alzheimer’s Disease?

Studies are showing that electroacupuncture is improving brain function and reducing the incidence of Alzheimer’s Disease. Researchers have noticed a trend. When electroacupuncture is administered during a functional brain MRI, there will be an increase in function of the hippocampus. The hippocampus is an area of the brain that is necessary for encoding and retrieving memories. It does this by increasing glucose metabolism in the brain. This is important because decreased glucose metabolism interrupts learning and memory and has been directly correlated with dementia/Alzheimer’s Disease.

Medical Acupuncture at Greenwich Sports MedicineMedical Acupuncture at Greenwich Sports Medicine

Electroacupuncutre also increases a protein called BDNF (brain-derived neurotrophic factor). This is crucial for brain development as well as its ability to adapt. The only other modalities that have been shown to increase BDNF are exercise and a healthy diet.

ACL Return to Play Guidelines

Greenwich Sports Medicine

Unsure When You Can Return to Play?

Last summer, researchers from the American Orthopedic Society of Sports Medicine (AOSSM) held their their annual meeting. The topic? ACL injuries in youth sports. The major discussion point was the standards on return-to-play protocols for these athletes. The current standard of assessing readiness following an ACL repair does not seem to be adequate. In their discussion, they review a study  performed by a number of elite-level researchers. They are looking at the incidence of 2nd ACL injuries in 13-25 years old.

How Often Does This Happen?

In this age-range, the re-injury rates range from 25-33%. Most of which happen in the first 12 months following a repair. This number is quite concerning! According to this research, 117 out of 159 athletes assessed did not meet traditional return-to-play guidelines. Without being properly assessed for readiness, 117 athletes were allowed to return to play. This is a huge deal and is likely the reason the re-injury rate is so high in this population, unfortunately.

We seem to run into the same problem every time!

There is no general consensus or follow-through when it comes to monitoring the rehab process. This is especially following surgery, nor does there seem to be thorough testing done with this population. I often hear that an athlete’s doctor or PT used more of a time-based approach to releasing the athlete. They were cleared to play once they reached 6 or 9 months.

This is an issue as every athlete is different in their healing process as well as recovery process. Some athletes don’t even start introducing plyometrics or skill-based work until 5-6 months (as they’re reluctant or fearful). How could we allow them to start playing a sport that involves jumping and cutting? Then we have the athletes who are more progressive with their rehab. How do we know that they’re loading the injured side the same as the non-injured side? How do we know that athlete has adequate strength, neuromuscular control and coordination, and force output? This is where monitoring and testing come into play, and where the lab at Greenwich Sports Medicine stands out.

Image provided by Matt Jordan, PhD of Jordan Strength

Here at GSM,

we’re utilizing our state-of-the-art Biomechanics Lab. Not only to test our athletes before they play again, but to monitor them throughout the process too. We use a milestone-based approach as outlined in the diagram (left). We observe their movement patterns, test their loading parameters and velocities. Then we record and study complex tasks once progressed to that level. The rehabilitation process isn’t always provided by us. However, our ability to monitor these progressions is the major key. This helps us in partnering with other facilities that don’t have the available technology that we have.

Our return-to-play testing is multifactorial in nature. Looking at everything from the forces created with jumping and landing, to balance and stability. We are also looking at running mechanics and other ‘sport-specific’ activities. All measured and scored objectively. This sets our testing apart from what it appears others are doing. We’re able to quantify every move an athlete makes, rather then guess and blindly make a decision. This is of extreme importance for these athletes. Not having data to support our decisions ends up leading to these high rates of re-injury, and no one wants that.

Interested in preventing re-injury? Give our office a call today!


Dr. Alex Svac

The Importance of The Vitamin D Supplement

Vitamin D: Not Just For Strong Bones

Vitamin D has always been best known to help with Calcium absorption, leading to us having stronger bones and reduce fracture rates. But, research is now showing multiple benefits of this sunshine vitamin. While mainly absorbed from the sun, it can also be obtained in small quantities in the food we consume.

What Foods? 

Egg Yolks (pasture raised)
Beef Liver
Shitake Mushrooms
However, the most absorbed form is called Vitamin D3. You obtain that from sunlight, as it is the best source. This becomes a problem during the winter months. We are not exposed to as much sunlight, which leads us to staying indoors. This has become an issue because of the inaccurate skin cancer prevention campaigns. Did you know that by using sunscreen at the lowest SPF of 15, cuts the skins vitamin D production by 99 percent? This supports recent research that says three-quarters of the US teens and adults are deficient in Vitamin D.

What Other Benefits?

1. Reduces Inflammation
2. Reduces Autoimmune conditions
3. Increases Immunity
4. Improves Brain Function
5. Reduces Cancer Cell Growth
6. Enhances Mood and Sleep
7. Reduces Risk of Heart Disease
Many of the Vitamin D deficiencies and symptoms/conditions result from chronic inflammation. One way deficiency promotes inflammation is by altering immune function. This results in a rise in pro-inflammatory cytokines that trigger inflammation. In one study, the anti-inflammatory properties help manage irritable bowl disease by modulation of inflammatory cytokines, TNF Interleukin 6. Vitamin D deficiency also associated with a lower risk of metabolic syndrome and hight cholesterol and low HDL’s(Good Cholesterol).


In sports, Vitamin D deficiency has been linked to higher incidence of muscle strains and core abdominal strains that are found in the NFL. Supplementation helps with pain and reduces infection in cancer patients. It also decreases pain and lowers pain scores on chronic pain patients. I use it as a go to supplement for my chronic pain patients. Deficiency is also associated with an increased risk of Dementia and Alzheimer’s. Supplementation also protects against acute respiratory infections. In the winter when we are not exposed to as much sun and spend a majority of time indoors, we end up decreasing our natural Vitamin D. This then leads to increasing our risk of getting sick. Possibly a contributing factor in why we get sick more frequently in the winter.

How Much Should I Take?

At Greenwich Sports Medicine we do a comprehensive blood panel that looks for inflammatory markers that we believe contribute to most disease states. Vitamin OH-D3 is one of the markers we check. Normal range of vitamin D is 32ng/ml-100ng/ml but optimal levels to reduce inflammation and improve health is between 60ng/ml-80ng/ml.

Please Note:

Vitamin D is a fat soluble vitamin. When supplementing, it is important to eat healthy fats! Such as, almonds, walnuts and avocado. Also, remember to supplement Magnesium as well. It is a cofactor for vitamin D absorption. High intake will cause depletion of Mg. Taking the right dosage based on your biomarkers is crucial. If you want to know what supplements you need and in what dosages, (such as vitamin D and Magnesium), feel free to make an appointment with one of our qualified doctors.


If you would like to purchase high quality from GSM certified nutritional companies, please follow the links below!

Dr. Chris Mah

Brain Injury Awareness Month!

Brain Health Awareness Starts Here!

March is Brain Injury Awareness month! There are so many treatment options for minor head injuries, including concussions. In today’s active and highly athletic population, the incidence of traumatic brain injuries like concussions have become a common and prevalent injury. A concussion is a mild traumatic brain injury that can cause symptoms of headaches, anxiety, depression, and concentration difficulty.

Common medical practice to treat concussions are rest and medication (anti-depressants) to address the symptoms possibly associated with these injuries. However it is in my opinion that there are more conservative ways to address these symptoms.

An alternative approach to treating the signs and symptoms of a concussion include Acupuncture. For thousands of years, practitioners have used Acupuncture for a countless of ailments. Acupuncture is a therapy that aims to restore normal blood circulation and neurological integrity to injured area and body. Acupuncture is so effective because of the results that come with using it. This technique treats headaches, anxiety, depression, and altered cognitive function as well as so many other aliments.

Just like a Formula 1 race car, your body is just as much of a highly tuned machine. Our bodies function correctly when they are being continuously “tuned up,” such as a race car would. If you want your body to function correctly, you must take care of it when it is asking for help. Acupuncture acts on our system to create homeostasis, which allows us to heal best.


Dr. Chris Rago

Spring into Health!

Spring is Around the Corner!

This means more sun, longer days, allergies and spring
cleaning. Here are some tips to make the most out of your spring.

Kickstart Your Health:

Wake Up Early to Exercise
Make the most of these long days. The sun is rising earlier and the mornings are
warming up. Working out before work adds clarity and energy to your day.

Organize the Fridge and Cabinets
Go through and remove any processed or sugary foods to jumpstart healthier eating.
Replace the empty space with vegetables, fruits, nuts, and lean meats.

Outdoor Movement:

Use equipment on both sides of your body.

Proper Lifting
Don’t bend at your back! Protect your spine and lift with your hips and knees.

Take Breaks
Even though the work does not seem especially difficult, you are using muscles in ways
That you haven’t used in months. Take it slow!

Allergy defense:

Cold and Caffeine
Cold compresses and caffeine can be soothing to puffy irritated eyes.

Studies show that butterbur works as well as over the counter anti-histamines. Take as
directed or instructed by your physician.

Keep Your House Allergen Free
Keep your windows closed and at first limit outdoor pets to certain rooms so they don’t
bring in any unwanted allergen.

Raw, local honey can have antibodies to pollen according to some studies.

Clean Your Nose
Use a neti-pot to clean out your nasal cavity. This will lower the inflammation in your
nose and help prevent runny noses.

Make Your Diet Fight on Your Side

Grains, sugar and processed foods cause inflammation in the whole body. This means
when your body tries to fight off allergens it mounts an all-out war. Making your allergy
symptoms worse. Anti-inflammatory foods will reduce your symptoms. Some beneficial
foods are nuts, fish, greens, citrus fruits, red grapes and apples. Go organic and wild
caught when you can!

Spring Cleaning:

Toxic Cleaners
Cleaning is a great way to start the season. But, many popular cleaners have harmful
chemicals in them. These chemicals can simulate allergy symptoms or exacerbate allergy
symptoms. Get rid of the cleaners that have these common ingredients: sodium
hypochlorite, butyl cellosolve, nitrobenzene and thirourea.


Dr. Dustin DebRoy

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