Hip Check

Improve Performance, Prevent Injury, Prolong Careers

Pliability, flexibility, mobility and overuse. All terms that are currently floating around the sports world. They have become buzzwords as athletes are playing into their 40’s, or worse, fizzing out in their first or second year. So, what do all these words mean, and, above all, what can be done about it.

Pliability is the body’s ability to adjust and adapt to change. Adapt to stress, change direction, recover after workouts all fall under the umbrella of pliability. Being pliable means being more resilient. Flexibility is the quality of bending easily. As a result, flexibility is an important quality for joint and muscle health. Mobility is the ability to move freely and easily. Mobility is arguably more important than flexibility. Because it is the body’s ability to be strong in its ranges of motion. Overuse rather, is the pain. This is weakness, or an injury that is the result of repetitive stress.

More important than the definitions, how can these be improved and prevented on an athlete? Both are addressed through the GSM Hip Check Program. This is an individualized comprehensive neuromusculoskeletal screen. Rather, a fancy way of saying it assesses the normal function of the body’s joints, soft tissue, and nervous system. Patients are assessed using sport specific motions and tests as a result.

Repetitive motions, such as skating, only strengthen certain muscles of the hips and legs. As a result, this creates imbalances and stresses the weaker muscles. Consequently leaving them vulnerable to injury. The aforementioned scenario is the perfect equation of an overuse injury. This is what it might look like in a math book: 

Repetitive Motions x Muscular Imbalances / Compensation Patterns = INJURY!

The philosophy of injury prevention certainly works when all systems of the body work in unity. Proper joint range of motion, muscle length and dynamic strength allows this. Having a sports medicine physician assess for these imbalances helps diagnose problems. As a result, this will facilitate recovery to correct compensation patterns and prevent injuries.

The hips are the base of every human. Properly functioning hips translates to full body athleticism. Using a sport specific assessment is the only way to ensure that an athlete is performing at their peak while not paving the path towards an overuse injury. Seems like GI Joe got it right: “Now you know and knowing is half the battle.”

Bibliography:
“Women’s Ice Hockey .” Holy Cross Women’s Ice Hockey , 13 Oct. 2017,
goholycross.com/ViewArticle.dbml?SPSID=917323&SPID=157212&DB_OEM_ID=3310
0&ATCLID=211672950&_ga=2.232363999.1155228610.1543858561-
777374612.1543858561.
“TKA Axial Alignment .” Orthobullets , 20 Sept. 2018, www.orthobullets.com/recon/5014/tka-axial-alignment

Dr. Dustin DebRoy

Scar Needling with Dr. Chris Rago

What are we needling and why?

“We treat the scars of post surgical injuries in order to create hydration as well as create elasticity. We do this by needling around the area. The acupuncture around the scar helps bring stem cells to the area. This helps produce healthy and fresh collagen cells. They become elastic in nature so that way the inhesion of the scars itself don’t create discomfort by catching little branches of nerves and other fascial planes.

We will do some electro-acupuncture with high frequency. Hence, the electricity is coming a little faster. It has a great affect on ligamentous and tendons tissue because it has an irritating factor to it. It helps to promote blood flow. as you can see where the needles are under the skin, they criss cross and overlap the whole scar.” 

– Dr. Chris Rago

https://www.youtube.com/watch?v=V9wkFqsZoHs

Check out our YouTube channel for more! Check out Dr. Chris Rago’s Instagram page, too!

Dr. Chris Rago

 Greenwich Sports Medicine – The New Standard in Concussion Care

What sets our concussion baseline and management apart from others?

Most physicians perform a concussion baseline test using only one method; an ImPACT test. What’s the problem with this? The rest of the brain remains untested and untreated because of this. Concussions, consequently, also have a higher chance of going undetected because of this.

Concussions leave long lasting symptoms and complications because of improper treatment. As a result, they can affect several aspects of the brain. Therefore, having your injury go untreated can certainly be detrimental to your recovery.

So, what do we do instead?

First of all, at Greenwich Sports Medicine we utilize eight different tests. Rather than just testing one area of the brain, we take it up a notch. Far too many concussions go undiagnosed/improperly treated because of this method. Our doctors take it to the next level. As Chiropractors, we also asses the muscles around the neck. Why? Because when you get a concussion, almost all get whiplash. When seeing a traditional doctor they are unable to do this. These muscles are responsible for concussion symptoms. We also provide a neurological exam because the symptoms can also be picked up that way, too. It is most noteworthy to know that our doctors leave no stones unturned in this set of testing.

This allows for an accurate diagnosis, guides effective treatment strategies and allows for a faster recovery, return-to-play process, and decreases long lasting effects.

OUR TESTING:

ImPACT Test
– Neurocognitive assessment.
– 20 minute duration.
– Can be done at the office and home.
King-Devick Test
– Assess rapid eye movement, attention and language function.
Short-term recall memory.
– Assesses capacity for holding and manipulating small amounts of information.
Long-term recall memory
– Assesses the ability to store information that happened minutes before.
Force Plate Balance assessment
-Assess balance, postural control, and center of pressure.
Vestibular Assessment
– Assesses the inner ears involvement in symptoms.
Strength
– Assess strength in areas that become weak with a concussion.
Reaction time
-Assesses the response time to a particular stimulus.
Musculoskeletal Evaluation
– Evaluating muscles that are involved with a concussion that exacerbate symptoms.
Neurological Exam
– Evaluation of the brain and nervous system.

PRICING:
$245
$150 for 6 or more.

A baseline on an individual athlete takes 30 minutes. We offer baseline testing for teams! Bring in your teams of six or more for an hour baseline test. To learn more about our Complete Concussion Management program, please contact us at (203)-531-3131.

We look forward to working with you to instill safety in sports!

Golden Milk

What is it, what are the benefits and how to make it?

As the weather begins to change from warm to cold, we ALL could use an immune boost! We should be increasing our Vitamin C and D levels as we approach the winter months due to the lack of sunlight and time spent outdoors. There are so many things we could be doing to prevent ourselves from low Vitamin D and C levels such as taking supplements and drinking Golden Milk!  This drink is the perfect complement to fight colds and nagging joint pain!

Golden Milk dates back thousands of years and was originally created as a nourishing and delicious beverage in Ayurvedic Medicine. It’s said that to naturally helps strengthen vitality, clarity of mind and sleep.

There are many reasons why Golden Milk is beneficial to your overall health. The main ingredients are powerful antioxidants to help protect against cellular damage and lower risk of infections and acquired disease. Curcumin, the active compound in turmeric, has a powerful anti-inflammatory that reduces joint pain and lowers the risk of disease. It also is prone to promoting the growth of brain cells by increasing the level of BDNF (Brain-Derived Neurotropic Factor). Because of this, it helps ward off brain diseases such as Alzheimer’s and Parkinson’s disease.

Golden Milk has the ability to help protect against heart disease. Heart disease is an inflammatory condition that reduces oxidative cell damage and systemic inflammation that can be reduced by drinking Golden Milk. due to its anti-inflammatory ingredients. The ingredients, cinnamon, and ginger have been shown to naturally improve insulin sensitivity. The anti-inflammatory properties of Golden Milk strengthens the immune system as well as naturally fighting bacteria and viruses, which makes it the perfect winter drink!

Making Golden Milk is so quick and simple it should be a staple of your nighttime routine this winter.

Ingredients:

1 cup unsweetened coconut milk

a cinnamon stick

1 tsp turmeric

1 half inch piece of ginger, thinly sliced.

¼ tsp of black pepper

1 tsp of honey (additional can be added for taste)

½ teaspoon vanilla extract

1 tbsp of coconut oil

Combine all ingredients into the pot and whisk till blended together. Set your stovetop to low heat and let the mixture simmer for roughly 10 minutes, stirring occasionally. Pour into a cup and top with a dash of cinnamon! Enjoy this tasty treat while increasing your Vitamin D and C levels to prepare you for the winter ahead!

Dr. Dustin DebRoy

Two Easy Ways to Keep Perfect Posture While Driving

            With the amount of time many of us spend in our car, driving can be detrimental to our health. Sitting in hours of traffic getting honked at can make for a stressful environment that leads to neck pain or low back pain. And, bad posture in the car leads to bad posture while we’re sitting in other situations. Since Americans sit, on average, for over 9 hours a day that can lead to a lot of problems.

First off, ditch the wallet.

 Sitting with a wallet in one of your back pockets raises up one side of your hips which puts a lot of stress on your low back. Muscles adapt to static positions that they are in for long periods of time. This can lead to adaptive lengthening and shortening of muscles every time you’re sitting. This causes muscles to pull on the spine in abnormally and can lead to a scoliosis type curve in your back.

Secondly, sit up TALL!

Most people can only sit in perfect upright posture for a few minutes without cueing. So, in the car, when we are focused on road safety, we instantly curl up into bad posture. To prevent this, set up little reminders in your car. The first thing to do when you sit in the car, sit up tall and adjust all the mirrors in the car. Now, when you break good form and try to use a mirror, you won’t be able to see what you’re looking for. This will be a constant reminder. Also, you can mentally check yourself. Set up your own reminder. An Example could be “every time I am at a stop light I need to straighten up my posture.” Or, “every time I change the radio station I need to do a self-posture check.” This can make a huge difference in your daily driving routines!

After doing these for a couple weeks you will notice huge differences in posture and comfort. Especially if you’re already suffering from low back pain or neck pain. It’s the details in life that reduce chronic pain or help prevent pain from occurring in the future. And, since driving has become such a staple of everyday life, proper driving posture is one detail you don’t want to miss!

Dr. Dustin DebRoy

If you were offered the most powerful legal performance enhancing drug available would you take it?

What if I said you already have it and aren’t using it to its full potential? Every 24 hours you get the chance to pick up your prescription for health and performance. What is it?  Sleep. If you get less than 7 hours of it every night, you are depriving yourself of the most powerful drug on the market.

Why should you sleep more you ask?  It optimizes a diversity of functions in the body.

• Sleep enhances our ability to learn, memorize and make good decisions.
• It keeps us emotionally stable so we can make cool headed rational decisions.
• It helps to restore the immune system and fight malignancies, infections and even the common cold.
• It also regulates the balance between insulin and circulating glucose which helps to manage our appetites and our gut health.

What happens when you don’t get enough sleep?

The list is long and scary.

1. Insufficient sleep demolishes your immune system.  Chronic lack of sleep increases your risk of both cancer and Alzheimer’s disease.
2. Inadequate sleep for as little as a week disrupts blood sugar levels to the point you would be classified as pre-diabetic.
3. Have you ever noticed you are hungrier when you don’t get enough sleep?  Lack of sleep suppresses hormones in your body that signal your brain that you have had enough to eat.  This causes you to eat more than you should.  A lack of “ZZZs” also causes you to make unhealthy food choices.  You will have a tendency to eat anything in front of you instead taking the time to find and prepare healthier food options.
4. If you are trying to lose weight and dieting but aren’t sleeping enough, you will lose lean body mass and not fat.  Lack of sleep is detrimental to every part of your body.  As you can see, the list of health issues is considerable.

So how do you optimize your sleep?

Sleep is so important that you should take steps to increase the amount and the quality of it.  Two very important steps you can take immediately are to stop drinking caffeine after 1pm and limit your alcohol consumption at night. Both of these substances make it impossible to get into a deep sleep at night.  Caffeine has a half life of 5-7 hours.  This means that it takes that long to get 50% of the caffeine you just drank out of your system.  Because the caffeine is lingering in your body you’re unable to get into a state of deep sleep.  Alcohol has a similar effect.

A few other ways to improve your amount and quality of sleep is to utilize black out curtains or wear a mask to black out all light sources.  Light tricks your brain into keeping you awake at night. Avoid screens at least one hour before bed. The light from these screens mimics daylight and delays natural melatonin production for at least 3 hours! Also, try cooling your bedroom temperature down to 65 degrees. Your brain and core temperature need to drop 3-4 degrees to get into a deep sleep.  A sleep hack that helps this happen is taking a hot shower before bed. The hot water actually helps your body reduce its core temperature.

Now, a challenge.

Sleep is the most powerful legal drug on the market, and you’re probably not getting enough of it.  I challenge you for the next 7 days to get at least 8 hours of sleep per night, and cut out caffeine after 1pm.  After a week, take a moment to examine the positive effects that healthy sleep has on your life.  Sleep is the key to health and performance. You’ll be amazed at the differences you observe.

 The Long Distance Runner

The following is a case study. Details have been left out in order to maintain patient privacy.

I wanted to share a case study that involves our new BioMechanics Lab! It has been an interesting progression so far and is still evolving as we go. I had a patient referred to me for a full running analysis. The patient had been experiencing chronic ongoing low back pain following long distance runs. They have had physical therapy care in the past that included hands-on therapy as well as strengthening and mobility-based rehab. Due to the lack of response from their rehab they had stopped running for the time being.

The first step was to hooked up the patient to a 3D mapping joint-capture system and performed three separate running tests. Each test has different speeds relative to the patients’ regular running program. In combination with the pressure-plate treadmill, the 3D mapping gave me insight as to how they looked while running. This data picked up on issues that would be hard to find without this equipment.

What I discovered was a significant lack of pelvic control in the form of a bilateral pelvic drop. I also saw increased rotation in the low back, decreased movement in the upper back, as well as increased vertical ground reaction forces especially upon initial contact. Taking into account their history and current presentation, addressing these issues is the first place to start their rehabilitation.

My initial plan for this patient was, to begin with, a course of gait retraining along with biofeedback training utilizing our surface EMG technology.

At the inital visit we used LED sensors placed on the wall in front of the patient to cue for their increased hip adduction during the swing phase. This immediately was helpful in addressing their pelvic drop but was very taxing on the patient’s endurance.

How did we follow up with this data?

During the follow-up appointment, we added two sensors to the back side of their pelvis and cued them to run while keeping the sensors even. This was very difficult and frustrating for them to perform. We saw a significant decrease in the ground force being absorbed (which was a good thing for them!). At the next two visits, we stuck with our initial cue of trying to correct the increased hip adduction. While this was tiring for the patient, they began to become comfortable with the change. When in the initial stage, we included sEMG biofeedback training. This was to teach the patient proper motor control of their hips/gluteals. Again, this was difficult but beneficial for them during the beginning learning process.

At the time of this write-up, the patient is halfway through their recommended treatment plan and has yet to have an episode of low back pain. While everything is under very controlled scenarios, running at controlled speeds and having the assistance of biofeedback in a lab setting, the results are promising so far! They were having episodes of pain after every run previously, so being able to run, even for 20-30 minutes, has been very exciting.

Dr. Alex Svac

Deadlifting 101: Are Deadlifts Safe and Should I Be Doing Them?

Hearing the word “deadlift” probably evokes a very clear image in your head. It could be a massive powerlifter heaving incredible amounts of weight. Maybe you think about how much you love the exercise. Maybe you may hear the word and think of discs bulging, spines breaking and just overall ‘back pain.” Either way, I rarely hear middle ground with deadlifts. People either have embraced the awesomeness or avoid them like the plague.

Whether you love them or hate them, you end up deadlifting every single day. It may not be picking a loaded barbell off the floor, but when you pick a purse up off the floor, put your child into a crib, or loading groceries into your trunk, you’re doing a deadlift. So, since it is such a common movement in everyday life, don’t you think you should be training for them?

First off, when done correctly, deadlifts are a safe exercise! So, let’s get any misconceptions about the exercises safeness out of our heads. As with most exercises, proper form is key. But, even more so in a deadlift because if performed incorrectly your spine is in a very vulnerable position. When doing a deadlift incorrectly you are putting your spine in what clinicians describe as a loaded, flexed position. In this position, you do put a lot of stress on the vertebra and discs in the spine. But, it is important to note that in this position, you can injure your spine lifting 5 pounds, or 500 pounds.

Exercise should be about more than just trying to look good or burning calories from the dessert you ate. It should be viewed as training to function more efficiently throughout life without putting yourself at risk for injury. That being said, deadlifts are as functional as a functional movement can get. You literally do this movement in everyday life hundreds of times per day. Adding this exercise to your training program allows you to perform this movement in the most efficient way possible in and out of the gym.

So, are deadlifts safe? Yes! Should you be doing them? Unequivocally, yes! Deadlifts will not only transform your body composition but if trained correctly, they will help you become more resilient in all aspects of your life. Start doing them and see how anti-fragile you are and how strong you can become!

Next month we will discuss different variations of a deadlift and how to perform each one correctly. Stay tuned!

Concussions

Are They  Being Treated Properly?

Has the term “Concussion” become a buzzword in today’s society? Are athletes suffering from more head injuries than they were in the past? How can we eradicate this athletic epidemic?

A few things you should know about concussive brain injuries. Concussions fall into the LEAST severe type of brain injury. This is known as a “mild traumatic brain injury.”

Misconception?

Mild traumatic brain injuries cause permanent and long-term deficits. Improperly managed and treated injuries cause long-standing symptoms. There is no relation between a mild traumatic brain injury and long-term deficits. The media publicized CTE (chronic traumatic encephalopathy) as one of these injuries.

Despite the advancement in medical research and awareness of the injury, concussion injuries are as prevalent today as they were 10-20 years ago. This is because the treatment methods have stayed the same. As researchers dig deeper into this, the public eye and media coverage increased.

Concussions (mild traumatic brain injuries) illustrate symptomatic deficits in result to improper treatment. The symptoms include fatigue, dizziness, confusion. As a result, this slows the processing speeds of information in the brain on the field or in the classroom. These signs and symptoms linger due to mismanagement of the injuries and poorly educated injured individuals.

Unfortunately, there is no way to avoid these types of injuries when playing contact sports. We can be better prepared for these injuries when/if they do occur. Get evaluated prior to having these injuries by participating in our baseline testing. This testing will result in the athlete being evaluated as accurately and concisely as possible. Baseline testing leads to a quicker healing time and returns to their sports and academics. Having the appropriate education certainly leads to a well informed and a properly treated athlete. 

Not only do we want to properly treat these athletes but rather, want to educate them as well. It is crucial that if you are going to participate in a contact sport that you know how to protect yourself and your long-term health.

Greenwich Sports Medicine is not only about performing top of the line treatment but to educate our patients as well. We want our patients to take the information they have learned from us outside the practice and with them throughout the longevity of their lives!

Dr. Christopher Rago

Treatment for Achilles Tendinopathy

Treating the Flexor Hallicus Longus and Tibialis Posterior Muscle for Achilles Tendinopathy

Achilles Tendinopathy is produced by an overload of the calf musculature and the Achilles tendon. It’s been found that with runners who have a mid and forefoot striking patterns, the foot loses its dynamic patterns. The foot fails to unlock during the gait cycle which puts an excessive and abnormal load into the muscles of the feet and the ankle.

Muscles should behave more similarly to rubber bands than to ropes. When they don’t, they start to wear away causing a tendinopathy in, this case, the Achilles. The flexor muscle of the big toe is incredibly important in the gait cycle. It is the driving force of pushing your body forward when walking.

In this particular case, the big toe is not driving the foot forward as aggressively as the calf musculature because of his forefoot striking pattern. This leads to an overload of the Achilles tendon. The patient also is getting an overload of the tibialis posterior muscle due to the loss of dynamic ankle motion. Treatment of the muscles of the big toe and the medial foot will help to neurologically reinforce proper foot mechanics, leading to decreased load on the Achilles tendon.

https://youtu.be/yi-33tVm4Vk

Dr. Christoper Rago