Are You Set for The Slopes?

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.


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.


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

A Novel Approach To Running Rehabilitation

Running Treatments - Greenwich Sports Medicine

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

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 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

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


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


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.


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

Acute Phase Care

The 72 Hour Window

So, you sprained your ankle. What do you do now? Everyone knows that following an injury, R.I.C.E (rest, ice, compression, elevation) seems like the immediate protocol. However, the body needs nutrients in order to heal efficiently and properly.

With the right nutrition it is possible to limit the initial damage from acute injuries. The first 72 hours after an injury there is a very important window of opportunity to provide essential nutrients to the body so the acute injury doesn’t became a chronic issue.

Acute Phase Metagenics: People who need muscle tissue support and pain relief should take this. This product features premium grade proteolytic enzymes, targeted herbal extracts and also essential minerals.

This trifecta is designed to reduce pain and inflammation, muscle spasms and at the same time, increase circulation to the injured area. It is the ideal nutritional component for the first three days after an acute injury. Some examples of injuries that would benefit from usage would be muscle strains, tendon injuries, sprained ankles, wrist, shoulders etc.

The major active ingredients in Acute Phase Metagenics are listed below as well as how the body uses them to heal faster.

Protrypsin: A proteolytic enzyme formula that is designed to support tissue health and regeneration.

What does this mean to you?: It will fight inflammation.

Myocalm: This supplies important minerals involved in muscular contraction and relaxation responses. This is made from passion flower extract and valerian root.

What Does This Mean to You?: It will help relieve muscle pain associated with stress or physical exertion and help to prevent night time leg muscle cramps. It also helps to reduce muscle spasm and decreases nerve sensitivity which helps to reduce pain.

Inflavnoid Intensive Care: This features an extract of boswellia, turmeric, ginger, cayenne and quercetin.

What Does This Mean to You?: These ingredients are designed to reduce pain and inflammation. Another way to think about that is that it is similar to taking an herbal aspirin while in contrast, it won’t cause stomach problems. Cayenne is an herb that has long been prized for its many benefits such as the relief of pain, which complements the activity of the other herbs. Quercetin provides excellent muscle tissue support and relief of minor pain.

Proteolytic Enzymes: Digests and breaks down protiens, reduces harmful inflammatory chemicals (PGE2), increases circulation to the injured area for better nutrient delivery.

What Does This Mean to You?: It helps improve blood flow to the injured area to help you heal faster.

Wrapping Up

Acute phase is a fantastic way to get you out of pain quicker, speed up your healing time and get you back on the field faster. Because of this, I recommend that patients keep an acute pack in their bag. So, if you get injured and can’t get immediate treatment. Begin the healing process by taking the essential nutrients.


Purchase an Acute Phase by visiting our Metagenics page!


Dr. Aaron Gerard


Biomechanics Lab At Greenwich Sports Medicine

Introducing Our New Clinical Biomechanics Lab At Greenwich Sports Medicine

We are beyond excited to introduce our newest addition here at Greenwich Sports Medicine; our new state-of-the-art biomechanics lab from Noraxon. This lab will give us the opportunity to measure and gather real-time, high-quality data. Treatment plans will make rehabilitation, return-to-play, and high-performance more precise because of this data.

Having access to research-grade testing including sEMG (muscle testing), dual force plate analysis, joint capture data, and a pressure-plate treadmill now makes us one of only a handful of clinics in the country to provide patients with this technology.

What Can We Measure?

With this new technology we are able to measure and test a number of sports-specific movements which will aid in not only treating our patients, but assisting in performance as well as injury prevention. We will be implementing the following testing protocols into our evaluation process:

➢ Running Gait Analysis ➢ Cycling Analysis
➢ Neuromuscular Function ➢ ACL Return-To-Play

➢ Movement Pattern Assessments (Squat, Jumps, Cutting, etc.)

We will also be utilizing this data for biofeedback training with patients. This will be beneficial for gait retraining as well as neuromuscular training in postoperative patients and more.

Who Could Benefit From The Lab?

Because of our lab, we will be able to see sport-specific data. We will be able to see things such as, how muscles are firing, how force is being generated, and how joints are operating under load, all of which will guide our treatment plans and help to assist trainers, coaches, and parents in decision making.

Patients that can benefit from this data include:

  • ➢  Athletes looking to enhance performance by fine-tuning biomechanics and force production via our full gait analysis software, sEMG, joint capture capabilities, and dual force plate assessment.
  • ➢  Those looking to return-to-play following injury/surgery such as ACL repair, labral surgeries, or rotator cuff repair, by assessing symmetry, power, force, and fatigue
  • ➢  Runners wanting full gait analysis utilizing our research-grade pressure plate treadmill
  • ➢  Cyclists hoping to improve performance/decrease injury risk by getting feedback on their positioning
  • ➢  Chronic pain patients by assessing muscle recruitment and static/dynamic movement

The data our new lab provides will help take recovery and performance to the next level. allowing us visualize and objectively measure movement and activity that is not possible with the human eye.

From the Noraxon website :

This new addition to the office is expected to be a game-changer in sports medicine. We will observe, measure, treat, and rehab patients like never before. This will add to our expertise and continue to make us the leader in our field.

Interested in more information regarding our new Biomechanics Lab? Please call the Greenwich office at 203-531-3131today!

Alex Svac

Blood Flow Restriction Training

Blood Flow Restriction Training

Blood flow restriction training (BFR), also known as occlusion training, has recently become popular in the sports rehabilitation world as a way to reintroduce training under low-load situations. It’s sudden rise in popularity comes after numerous studies have begun to show benefits in areas such as:

-Muscle size
-Muscle endurance
-Prevention of muscle atrophy
-Increase in type-II muscle fiber recruitment -Increase in local growth hormone

While this list may seem like a fairytale to some, browsing the research will show you not only are all these things possible with BFR, but that they can be accomplished at 20-30% max load. That’s right, you can work out with 20-30% of your maximum capacity, and still achieve results typically seen at 70% max. This is an excellent adjunct for those returning from an acute injury getting back to play after surgery.

How is all this possible?

The thought is that restricting venous flow while creating muscle contraction overloads the cells with fluid, blood, metabolites and hormones, causing an increase in size and recruitment of certain muscle fibers. This sudden change forces the body to quickly adapt, sending growth hormone and other factors to the area, increasing the aforementioned qualities.

The one thing most people are concerned with are the side effects. The beauty of BFR is that there is no more risk than regular exercise. This is huge for the sports rehab world as it can potentially allow us to maximize results following injury with much less load on the body. BFR can also help to reduce atrophy during recovery as the effects are seen not only distally to the cuff being used, but proximally as well.

At Greenwich Sports Medicine, we utilize the Occlusion Cuff daily in our sports rehab setting. The Occlusion Cuff allows us to accurately measure the amount of pressure being utilized during a session, and is much more effective and beneficial than other means.

If you’re interested in checking out what exactly blood flow restriction training entails, or would like to enquire about beginning a BFR program, feel free to give our office a call at 203-531-3131.


Loenneke, J. P., J. M. Wilson, P. J. Marín, M. C. Zourdos, and M. G. Bemben. “Low Intensity Blood
Flow Restriction Training: A Meta-analysis.” European Journal of Applied Physiology. U.S. National
Library of Medicine, May 2012. Web. 09 Apr. 2017.

Clark, B. C., T. M. Manini, R. L. Hoffman, P. S. Williams, M. K. Guiler, M. J. Knutson, M. L. McGlynn,

and M. R. Kushnick. “Relative Safety of 4 Weeks of Blood Flow-restricted Resistance Exercise in

Young, Healthy Adults.” Scandinavian Journal of Medicine & Science in Sports. U.S. National Library

Loenneke, J. P., G. J. Wilson, and J. M. Wilson. “A Mechanistic Approach to Blood Flow Occlusion.”
International Journal of Sports Medicine. U.S. National Library of Medicine, Jan. 2010. Web. 09 Apr.


Alex Svac

Loading Dysfunction

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

10 Tips for Moving and Feeling Better

 How to Move and Feel Good Doing It

Feeling better and living pain free usually revolves around one simple concept; better movement. Movement is the key to optimal function, joint and tissue health, neurologic function, and a better overall mindset. However, getting out and moving is unfortunately put on the back burner nowadays with our sedentary lifestyles and busy work schedules. Below I’ve provided 10 tips that I feel will help you with moving and feeling better for the long haul!

Simply Move

If you’re going to start somewhere, why not start with just getting out and moving. The point of this list isn’t to give you a particular set of workouts or movements.Rather, to solidify the idea that movement is everything. Our joints and tissues crave movement to keep them properly lubricated and hydrated.

So, sitting on the couch every weekend is only doing you a disservice. Instead, focus on being active in any way you can, be it walking, hiking, climbing, playing with your kids, or anything else that gets you up and moving around! Better movement isn’t always about pushing yourself and getting in an exhaustive workout. It’s about counteracting your sedentary lifestyle.

Our cells and tissues rebuild and recycle all the time, so if you’re constantly in poor postures, sitting for most of the day, your cells are going to adapt to that. This in turn will limit your physical capabilities. It’s super important to keep your body moving whenever possible!

Start Slow

Whether you’re just getting into movement practice or exercise, or you’ve been taking part in some sort of physical activity for years, it’s important to start slow. There’s no need to rush into things, especially when it comes to moving better. As I’ll talk about below, strive for quality over quantity. Moving is all about doing what feels good to you as an individual. You shouldn’t be comparing yourself to someone else and their capabilities. Instead you should be focusing on what you can accomplish on a day-to-day basis. If this means simply getting out and walking for 10 minutes, then great! Start somewhere, start slow, and build up from there.

Another important concept as it relates to starting slow, is moving in a pain-free manner. The whole point of moving to feel better is to teach your brain and your body new ways to do things. If you’re working out, running, or whatever else you might be trying out, it should be as pain-free as possible. The goal here is to let you body adapt to new stressors, so if those stressors are painful, that’s what it will adapt to. Take things easy, let your body process this new information and adapt to it, then continue. Making this simple is so much easier in the grand scheme of things!

Have Goals In Mind

Goals are what motivate us to improve. If you don’t have at least one goal in mind when it comes to feeling better and getting out of pain, then what’s the point of doing anything in the first place?! Think of something you hope to accomplish as it relates to your health. Write it down, and do everything you can to accomplish that goal. It’s fine to start small with goals too.

If you are simply looking to feel better, than maybe make a goal of getting your pain down from 8/10 to 4/10. Once you reach that goal, make a new one of getting down to 2/10, and so forth. Creating realistic goals helps to keep your motivation high, which will in turn help you to continuing progressing. The more you progress at your own pace, the better you’ll feel, and the more you’re going to want to keep at it!

Get Good At The Basics

As I’ve already mentioned, I always encourage people to strive for quality over quantity. If you don’t own a movement, progressing that movement by increasing the difficulty will only set you up for failure or injury. If your goal is to go faster or heavier with an activity, then earn it. An example I’ll give is the hip hinge movement pattern. You can find some examples of the hip hinge pattern by searching my Youtube channel, but the important concept to consider here is how someone might progress this pattern.

The hip hinge is the basic structure of a deadlift, so in the case of quality over quantity, you should be a master at the hip hinge pattern before you decide to add heavy load and make it a deadlift. Pavel Tsatsouline, the godfather of kettlebell training, calls this concept “greasing the groove.” In other words, you should have a basic foundational pattern down so well that it’s engraved in your brain. The same can be applied to running, biking, skiing, or any other activity. Get good at the basics, then progress from there!

Keep Progressing

To build off the last concept, the basics are great, but eventually you need to progress. While our bodies love movement, they can adapt quite easily to certain stimuli. If you are trying to get stronger, and you only lift 10 pounds every time you workout, you’re not going to get very far. While any sort of movement is key to feeling better, if you want to keep creating new goals for yourself, you’re going to need to progress your activity. That might mean going for longer walks, picking up hiking or running, beginning a workout program, or developing new skills and hobbies. Whatever it may be, try to continue to better yourself.

Make Moving Fun

The theme of this whole discussion is movement, but if you’re not having fun, then you’re only going to see exercise and physical activity as chores. Take the opportunity to enjoy yourself, have fun with friends and loved ones, and do something you find rewarding. I don’t think this one needs much more explanation.

Eat Better

I’ve noticed on many occasions while working with patients that diet can be put on the back burner during the rehab phase. This drives me crazy, and is the exact opposite of being productive towards our goals. When we’re learning new things, stressing our brain and body, and trying to adapt to the changes ahead, we should be fueling all that in the most efficient way possible. If you’re trying to make a change in your life, but you’re still swinging through the drive-thru on the way home from work, what’s the point?

As your brain changes to accommodate all the new found freedom that your body is experiencing, you should be focusing on giving it clean, usable fuel. This means cutting out the refined sugar, eating healthier carbs, increasing your healthy fat consumption, and simply eating in a way that makes you feel good. I don’t have some magic diet to talk about here, instead I think it’s most beneficial to follow the theme of this discussion and keep it simple. We’re in the business of feeling better now, so why not do all we can?!

Emphasize Recovery

Recovery is the key to progression. I tell all my patients this, and it without a doubt holds true. If you’re pushing yourself to the limits nonstop, not letting your brain and body catch up to the changes you’re throwing at them, you’ll never reach those ultimate goals you’ve set for yourself. Take the time to make recovery an important part of the process.

What do I mean by this?

It’s easy really; get more sleep and take some mental breaks. You should without a doubt be striving for a minimum of 7-8 hours of sleep every night. If this means getting to bed earlier or sleeping in a little later, do it. I know this can be difficult, especially with kids and other commitments, but sleep is the only time of day that our brain and body have to rebuild and learn from the previous day, so allowing ourselves as much time to do that is key.

Taking mental breaks can be as simple or as time-consuming as you want to make it. The idea here is to actually do it. Shutting things down for even a small amount of time during the day can reap tremendous rewards. Turn off the electronics, find a quiet space, and let your mind wander. I like to recommend the app Headspace to patients of mine. It’s an awesome way to meditate for 10 minutes a day, which is usually pretty easy for people to think about incorporating into their routine.

Create A Better Mindset

If it hasn’t been clear already through some of the things I’ve talked about, then let’s spell it out here and talk through it; the brain is the target for all of these changes we’re trying to make. When it comes to feeling better and getting out of pain, your brain is where change needs to occur.

It may seem like all this exercise and physical activity is improving range of motion, strength, stability, and everything else joint and tissue related, but it’s your brain that’s letting those changes happen. Your brain is the driving force behind all the things that happen in your body. So, it would only make sense to optimize it on all fronts, which includes your mindset.

Eventually if we add too many things into that cup, it’s going to overflow. That overflow is pain, and everything being added into that cup, such as poor movement, work stress, lack of sleep, poor attitudes, and so on, are leading to that pain we feel. If we can find a way to limit or take away from the things that fill up that cup, then we can limit or take away the pain.

Our mindset is just another thing that could contribute to that overflow, so why not try to improve that as much as possible? I think that all the previously listed steps are a great start to having a better mindset, but it’s really up to you and what you want to put into this mentally. Have a positive outlook on your progress.

Enjoy the small victories, and don’t let each and every little setback get to you. The more work you put into this, the better the outcomes. Believe in that.

Follow Through 

If you get anything out of reading this, it should be that nothing you’re going to do to get out of pain will be easy.   Now I know that may be a somber way to end this, but I want to be practical here. If feeling better was easy, you wouldn’t be reading this.

The whole process of getting yourself right can be long and strenuous, but it’s the follow through that will make you successful. You may have ups and downs in your endeavours. It may take longer to reach your goals than you had originally hoped, but keeping at it is what will give you the best chance at feeling good and moving well.

Take into account each and every step you’ve read up to this point. Implement them to the best of your ability, know that you are not fragile and that you can improve. Know you’ll get there!


Dr. Alex Svac

The  Mystery Of The Star Soccer Player


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.”


“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

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