Set for The Slopes?

There is still a lot of winters left and with February break coming up I know a lot of readers will be hitting the slopes. Whether you’re Olympic Gold Medalist Chloe Kim or a newbie headed for the bunny hill proper warm-ups and cool-downs are incredibly important. They will reduce the chance of injury and decrease soreness throughout the ski vacation.

Warm-ups:

Before heading out wake up about 20 minutes early to start the day. Spend 5 minutes doing something that gets your heart pumping. It can be skipping rope, running in place, jumping jacks, etc. This will get your body used to use ions essential for muscle contraction and health more efficiently. More efficient muscle contractions mean more muscle pliability. Think about jumping and landing on a sidewalk vs. landing in a swimming pool. More pliable muscles are like landing in the pool.

After you have a sweat going get into a stretch sequence. Skiing is a very front dominant sport so make sure you spend time stretching your quads and hip flexors are important. In addition, you can stretch anything that is normally tight on you: calves, hamstrings, glutes, and shoulders would be helpful.

Next get into some muscle activation drills to get the major muscles of the hips and knee firing. Getting the glutes firing is an absolute must! Exercises such as glute bridges, hip hinges, chair squats, and the lateral band walks with a theraband will be invaluable for protecting the hip, knee, and low back. Do 10-15 reps of each exercise. The warm-up is done! Go enjoy yourself.

Cool-Downs:

You made it back injury free! Now it’s time to cool down before you relax in front of the fireplace all night. Drink plenty of water and try to replenish your electrolytes. Using a supplement such as a Catalyst from Thorne is just what the doctor ordered. It’s high in electrolytes and B-vitamins, but very low in sugar. Wearing compression socks for the evening will help pump any lactic acid out of the legs preventing the soreness. Utilizing a lacrosse ball to lightly work into the glutes, calves, hip flexors and the arch of your feet will leave you feeling like you have new legs in the morning.

Dr. Dustin DebRoy

Running Rehabilitation

A Novel Approach

 In my experience with sports rehabilitation, I’ve found that an evidence-based approach is the most successful plan we can utilize. The following are my thoughts on this subject.

In my rehabilitation career, I’ve worked with athletes from all levels and backgrounds including the most elite. Before I moved to the east coast I practiced in the mountains of Colorado. There I carved out a niche in the running field of sports medicine and rehabilitation. As we lived at a higher elevation, our area attracted some of the most elite runners, particularly ultra-runners, in the country (probably the world as well). This allowed me to create a practice that focused almost exclusively on treating running-related injuries, as well as training and coaching runners for major competitions.

The running world is full of misinformed and mismanaged athletes not only in the general population, but at the highest levels as well.

Let me give you an example to better understand what I mean.

While working in Colorado, I had a high-level weekend warrior runner as a patient. They competed in the master’s categories for most races and typically finished top two rather consistently. The patient’s nagging hamstring injury was hindering their performance. In my initial conversation with the said patient, they described to me their previous history with therapy, training, and exercise in general. What this patient told me was that during their first few bouts of-of experiencing this hamstring ‘strain’, their typical recovery would include visits to therapy and rest.

The patient would get put on a hot pack for 15 minutes, followed by 12-15 minutes of ultrasound. After they would be directed on how to stretch, foam roll, and ‘strengthen’ their core. They would refrain from running during this period, then as the injury appeared to start feeling somewhat better, they would return to their normal training and hope they were fully recovered. My initial thought: ‘oh boy’.

How do I treat?

Treating each and every patient that I work with as if they were an elite athlete is what I pride myself on. I find myself frustrated to hear an approach like this when seeing an elite athlete. Why? Because they’ve were misguided when it comes to their health and performance. First of all, in order to have a good idea of how we want to treat an injury, we need to have a fairly good understanding of the underlying pathology going on. In the case of this patient, they were actually dealing with a chronic proximal hamstring tendinopathy. This is important as the way we rehab tendons differs quite significantly from how we rehab muscle strains.

Rehabbing an injury like this is being able to understand the mechanisms associated with this injury. The demands that the athlete is putting on their body consistently. For a running injury, this would include assessment of their running mechanics and general capacity test. The passive treatments we choose to utilize should be efficient and beneficial in aiding optimal healing.  Here’s where a systematic approach to rehabilitation comes into play.

Now rehab itself can be as complicated as we want to make it, but high-quality rehab takes into account the basic understandings of anatomy, physiology, strength, mechanics, and psychosocial components combined. Utilizing these key principles allows us to efficiently and effectively treat the athlete in front of us, and here’s where I feel Greenwich Sports Medicine truly stands out from the rest.

A novel and evidence-based approach revolving around the foundation of three main stages of rehab:

1. Deloading the area of injury
2. Desensitizing the patient and their symptoms
3. Reloading the athlete and returning them to play

We can fit in a number of modalities such as movement literacy, hands-on treatment, strength, and endurance. The proper understanding of how of to do so is of the important piece here.

With the new addition of our biomechanics lab, we can now understand loading mechanics and movement like never before. This helps guide our de-loading stage and show how we want to keep an athlete active and moving efficiently. This is a very important key to any good rehab program. We fully assess running gait to get a clear picture of how an athlete’s movement may contribute to ongoing issues. Greenwich Sports Medicine has some of the best in their field. They can effectively treat patients during the desensitizing stage. This typically involves hands-on treatment, injury education, and early stage rehabilitation.

Our therapy staff can properly address the reloading stage. This consists of therapeutic exercise, strength and endurance training, and return to play activities and measures. This is what makes a rehab program great. I feel that the care you’ll receive at Greenwich Sports Medicine is so far above the rest.

This is the most successful way at getting runners back to running and helping them perform at a higher level. A proper gait analysis and capacity test followed by guidance through desensitizing and reloading the area of injury prove this.

Recovery Techniques

People now are more active and taking control of their lives and health. Above all, focus on diet and exercise is the most noteworthy change. With the increase in activity, it seems like there is a need for increase in recovery, too. There are many tools and techniques for recovery. The three I recommend are cryotherapy, Infrared light therapy and also, Contemporary Medical Acupuncture.

Cryotherapy

Cryotherapy is a great tool for recovery. When you hear of Cryotherapy, you are probably thinking about Whole Body Cryotherapy Saunas. You can also use it for more focused treatments such as your leg or arm. The treatment utilizes liquid nitrogen while exposing your body to the extreme temperatures. This method will then allow it to heal. Cryotherapy has many physical benefits for the body. Decreasing pain and discomfort, improving blood circulation, detoxifying the body, weight loss and muscle soreness to speed up recovery time.

Infrared Light Therapy

These saunas are a type of sauna that uses heat and light to help relax and detoxify the body. Infrared light waves create heat within the body that stimulate physiological healing processes. One of the best benefits of Infrared Saunas are their anti-inflammatory effects on the body. Detoxification and relaxation, along with reduction of inflammation, improved circulation and weight loss are all benefits of Infrared Light Therapy Saunas.

Contemporary Medical Acupuncture

Contemporary Medical Acupuncture is the use of very thin metal wires inserted into specific areas of the body that correlate with particular areas of injury and/or dysfunction. This is not to be confused with Traditional Chinese Medicine Acupuncture which utilizes hypothetical meridian lines throughout the body as target sites for the needles.

Contemporary Medical Acupuncture focuses on treatment of the musculoskeletal system by increasing blood flow and neurological stimulus to the targeted structures. Why is it important to improve blood flow when injured? The benefits increase your body’s ability to recovery from strenuous exercise/activity and also heal as injuries. Acupuncture improves how your body’s metabolic systems are functioning which direct the physical systems to perform at an optimal level.

Dr. Christopher Rago

5 Ways to Supplement Your Health

There are a lot of supplements on the market and it can leave the consumer feeling lost and confused at the checkout counter. Most importantly? All supplements are not created equal.

There are three important grades when it comes to supplements.

Pharmaceutical Grade: tested and meets medical standards.

Food Grade: meets standards for human consumption.

Feed Grade: meets standards for animal consumption.

———————-

Pharmaceutical Grade: is what physicians sell because they have been tested by multiple outside sources for guaranteed purity and quality. Pharmaceutical grade ensure that your supplement is sourced with the highest quality active ingredients, has no binders, fillers, dyes, or unknown ingredients.

Food Grade is what would be found in a grocery store or a local supplement store.

Feed Grade is the supplements that we give to pets and farm animals to stay healthy.

Why is Taking High Quality Supplements Important?

Many people take vitamins all their lives and continually have medical problems. Probably because of poorly sourced vitamins. Furthermore, improperly made and poor-quality vitamins can magnify health problems. Taking high quality vitamins is as important as taking the correct vitamins.

Below is a list of supplements that everyone can benefit from on a daily basis and a Greenwich Sports Medicine approved brand for pharmaceutical grade quality. This is especially important to take note of as winter is sweeping through and putting us at risk of illness.

Vitamin D3

Because of our exposure to the sun during the summer months, Vitamin D is created in our body. However, during the winter, all northeasterners are deficient in Vitamin D. Because Vitamin D is actually a hormone, when we become deficient it can wreak havoc on our bodies. This has been shown to help chronic inflammation, immune dysfunction, and also depression. Take with a meal high in fat, or with fish oil (number 3 on this list). It is best to absorb this while consuming fat due to Vitamin D being a fat-soluble vitamin.

Where to get it:

1. Vitamin D3 Liquid by Metagenics
2. Hi-Po Emulsi-D3 by Designs for Health
3. Vitamin D/K2 Liquid by Thorne Research

Magnesium

This mineral is used by over 250 processes in the human body. So it
goes without saying that this is important to take. Too little magnesium causes the nervous system to go into overdrive. So, be deficient in magnesium can suffer from depression, high stress, headaches, and difficulty sleeping. It critical for rest and stress recovery, and also shown to help to maintain healthy blood sugar levels and normal blood pressure.

Where to get it:

1. Magnesium Biglycinate by Thorne
2. Mag L-Threonate by Metagenics

Fish Oil

This one has a lot of buzz around it for a reason. This supplement is packed with healthy fats that are sometimes difficult to get in a diet. It improves insulin sensitivity, increases metabolic rate. It also is a natural anti-inflammatory due to its high omega-3 concentration. This helps offset the high omega-6 consumption that many western diets have.

Where to get it:

1. Omegagenics EPA-DHA 300 by Metagenics
2. Omega Plus by Thorne
3. OmegAvail by Designs for Health

Probiotics

Bacteria that found naturally in the stomach. But,
when supplemented, probiotics can provide many more health benefits. They can aid in digestion, vitamin and mineral absorption, body fat reduction, and inflammation. Some studies suggest they can also prevent cellular damage from alcohol and NSAIDs such as aspirin.

Where to get it:

1. Probiotic Synergy by Designs for Health
2. UltraFlora Balance by Metagenics
3. FloraMend Prime Probiotic by Thorne
4. You can find these Probiotics in things such as kombucha, kefir, sauerkraut, and greek yogurt.

Multivitamins

There is a lot of controversy about whether or not a multivitamin is worth taking. Taking a multivitamin offers a lot of vitamins and minerals as a result to being difficult to obtain from food. It also prevents you from having to swallow 900 pills every morning. Taking a daily multivitamin can help speed illness recovery, improve cognitive function, improve energy, and improve prenatal health. Take your daily multivitamin with food to prevent any cramping or stomach problems. Zinc and iron can maybe make people feel nauseous when taken on an empty stomach.

Where to get it:

1. Phytomulti or Multigenics by Metagenics
2. DFH Complete Multi by Designs for Health
3. Multi-Vitamin Elite by Thorne

Make an appointment with Dr. Dustin DeBroy at our Stamford Office, you can call (203)-541-5155

Dr. Dustin DebRoy

The 72 Hour Window

Purchase an Acute Phase by visiting our Metagenics page!

Dr. Aaron Gerard

Loading Dysfunction, Yay or Nay?

The topic of loading dysfunction frustrates me. It seems pretty obvious in my eyes in order to stay away from true pain but I see it over and over again. Is the movement actively or passively painful? If so, do you think it’s a good idea to put it through a weighted movement? You need to learn how to control the movement first, without pain.

Pause! Lets rewind. What is loading dysfunction? When we think about dysfunction in the movement world we mean that a person does not have full access to a movement pattern i.e. a squat. Loading dysfunction would suggest adding weight or resistance to a movement pattern that someone hasn’t mastered yet. An example would be someone that can not body weight squat correctly, but goes in the gym and does a 200 lbs barbell squat.

Whether you’re feeling pain because you’re moving the joint incorrectly, because something is “tight” and pulling your movement out of alignment, or something is weak and not keeping it in alignment — that’s what you need to figure out.

If you can’t figure that out yourself, find someone who can help.

There is no other way. For those of you who are thinking, ‘not everything can feel great,’ I agree. You need to know the difference between fatigue, pressure, “nervy” or achy pain, or sharp pain. I do not believe that you should move joints into pain, yet fatigue is a different story.

If the movement isn’t painful, yet, you do not have the full range of motion that you should, then we need to gain back the range of motion lost. You must have full access of the movement pattern with little to no compensation patterns. For example, can you retract your shoulder blade fully in all directions without use of the low back coming into extension or the neck protruding forward?

Have you had a practitioner tell you to avoid the movements because it hurts?

For example, ‘you shouldn’t deep squat because it pinches the front of the hip’, or ‘don’t do external rotation for shoulder health when it when it hurts’. If you can’t do shoulder external rotation without pain, you should DEFINITELY not be adding a band or cable to the movement.

Have you had an MRI? Have you been told something is structurally wrong and you need to give it time to heal? We need to figure out why such a movement is creating pain. On that note, even if something isn’t structurally wrong, there is a reason why there was wear and tear to that structure.

Beware …

For those practitioners who tell you “you can never ever load the joint in this way again,” they are oblivious to the rigors of the real world. For those practitioners who say, you can load dysfunction with/without pain, they fail to understand the kinetic chain of movement. (Kinetic chain = a system whereby movement at one joint produced or affected movement at another joint in the kinetic link.)

There is undoubltly a time in which we should begin to load a joint in what we may consider a “poor movement pattern”. It is unrealistic to assume we should ALWAYS be staying in “good form.” BUT, the key message here is we need to access full movement of the joint and create “good movement” patterns before we move through poor movement patterns that can essentially create pain. Loading dysfunction will not help anyone. The easiest example to this is a patellar Tendinopathy. Why is the tendon irritated? It may because it is overused at the area of the insertion. First, we learn how to move the chain correctly in “good form”, then we start to load the chain correctly. Then we start to bring the tendon into a loaded state where we can make the tendon resilient to real world rigors.

If your practitioner did not check the active and passive range of motion for the joint and corresponding joints in the chain, they are doing you a disservice. There is no reason to be loading a dysfunctional joint, especially on the first couple sessions.

Bottom line

Don’t load a dysfunctional joint until it becomes functional again. Make sure you can move through almost full range of motion. Then own that motion. Then start to load it.

Andie Bruce

How Is It Possible…

that a 14 year old star soccer player did not recover from an ankle sprain even though he was told by a top orthopedic surgeon he was cleared to return to play?

A 14 year old male soccer player came to Greenwich Sports Medicine with no pain but a severe decrease in athletic performance. According to his father, a former professional soccer player, his son was cleared to return to soccer by his orthopedist after rolling his ankle 12 weeks ago. However, while observing his performance, both his father and his coaches noticed a very different athlete.

“It looked like he was running with cement shoes tied to his feet. He told me he was trying his hardest, and I believed him, but he just did not look like his old self” the soccer players father noted.

His coaches suggested he see a running coach. However, his dad, a former patient of Greenwich Sports Medicine, called Dr. Gil Chimes.

According to his dad, “We just returned from the orthopedist. He reviewed an updated MRI of my son’s ankle and said everything looks great. His torn ankle ligaments have fully healed. But he couldn’t answer my question on why my son was not the athlete he was prior to his injury.” Dr. Chimes asked the father,

“What treatment did he have for the injury?”

The dad explained they saw they “best” physical therapist and they were very thorough.  “My son had extensive treatment on his ankle did every ankle exercise asked of him. He was very diligent and we saw the PT several times a week for 6 weeks. The PT and the orthopedic surgeon both agreed that his  ankle was as good as new. So, it is very frustrating that he is not playing like his old self.”

When he rolled his ankle, the soccer player saw his orthopedist  for x-rays and an MRI. A grade III ankle sprain and put in a boot and given crutches was the diagnoses.

“Was there any evaluation or treatment beyond the ankle?” Dr. Chimes asked.  “What I mean is did they look at anything other than the ankle?”

“No” answered the father. “Why do you ask?”

“Well, It’s very common that injuries to the foot or ankle can have a deleterious effect on the leg above the ankle.”

Dr. Chimes explained to the young soccer player and his father that when a joint, like the ankle, becomes non-weight bearing and put in a brace, as well as on crutches, many of the associated muscles and joints can suffer.

“It frustrates me when I hear stories like this. The orthopedist is usually concerned with the ankle healing but not the consequences of unloading the extremity,” Dr. Chimes explained.  “What usually follows is atrophy (muscle wasting)and decreased neo-vascularization (new blood vessel formation which is important to bring nutrients and oxygen to the tissue which is more critical to athletes). There are also neurological consequences (muscles shut off, tensile forces are decreased) due to this unloading period.”

Dr. Chimes described what he would be assessing. “We have to evaluate the whole chain from the low back down to the toes. Testing each muscle to ensure it hasn’t atrophied or inhibited due to the lack of loading for those 6 weeks. The muscles flexibility then needs to be tested. We need to make sure he has the pliability and elasticity he needs for those soft tissues to absorb and disperse the weight of his body. Joints stiffen and they lose their range of motion. This effects the bodies ability to move fluently and propel oneself.”

“When we evaluate him, we will know exactly what he needs to do in order to get back to where he was prior to the injury.”

Research:

“There have been dozens of times in my 20 years of practice that a young person ended up with another injury because their initial injury was not completely treated.” – says Dr. Gil Chimes

We have come to understand that if we do not evaluate the complete chain, the whole leg, unfortunately that athlete NEVER completely recovers from their injury. And, most importantly, it has lifetime consequences!

It’s no surprise to us here at Greenwich Sports Medicine that modern research has backed up this observation. “Researchers have reported that patients with CAI (Chronic Ankle instability) are restricted occupationally, have more functional limitations, and have a poorer health-related quality of life.” according to a research article from PubMed titled  “Physical Activity Levels in College Students With Chronic Ankle Instability.”

Greenwich Sports Medicine makes sure your recovery is complete and through. Don’t trust your body to just anybody.

Dr. Gil Chimes