Return to the Pre-Injury ‘You’ With Our Orthopedic Clinical Specialists

Surgery is always a big deal and is generally only recommended when non-operative treatments and therapies are no longer seen as viable ways to return to pre-injury mobility. Yet, if you are about to undergo or have undergone an operation on the hip, shoulder, knee, wrist, hand, neck, foot, ankle, spine or any other part of the musculoskeletal system, the surgery is but a very important step in the process that will restore you to your pre-injury self. The far longer bit that takes you from the moment in which the anesthesia wears off to you finally jogging, mountain biking or playing soccer like the pre-injury you again is the absolutely essential post-operative rehabilitation program through which your Mount Sinai Orthopedic Clinical Specialist (OCS) will guide you. 

After surgery, your ability to regain normal motion, strength and to return to your pre-injury self, is dependent on the restorative orthopedic rehabilitation plan your OCS will devise for you. Orthopedic rehabilitation will bring you through a range of exercises to strengthen the muscles around the affected joint(s). Strong muscles are not only necessary so your body functions as it once did, but they will lower the risk of the once-injured joint re-injuring or dislocating itself by protecting it and absorbing any force that might occur during physical activity. Orthopedic rehabilitation will also improve circulation and flexibility to the affected areas to aid and hasten the healing process, prevent the appearance of blood clots and to gradually increase your range of motion to its pre-injury level.

Your Mount Sinai OCS is your post-operative guide to returning to the pre-injury ‘you’. An OCS is specifically trained to restore your strength and range of motion without compensation and to help prevent re-injury during the recovery process. When you are working with an OCS, you are under the expert care of the most qualified and experienced physical therapists available. All OCSs are recognized by the American Board of Physical Therapy Specialists as clinicians with the highest levels of expertise and specialization in orthopedic physical therapy. What is more, to attain the celebrated distinction of OCS, a therapist must have a minimum of 2,000 hours of direct patient care in the area of orthopedics. 

Among the first people you will see when you wake up from your surgery will be your OCS who will first give you a thorough evaluation and then set you a structured post-operative physical therapy plan to minimize pain and swelling and to restore normal movement, flexibility and function as soon as possible. Your first session with your OCS will likely be in your hospital bed or in a chair. As you heal and progress, the exercises will become more dynamic and might include a medley of ankle pumps, squats, flexions, abductions, rotations, extensions, contractions, bends, raising exercises and stretching. As you move toward a full recovery, your OCS might recommend swimming or pool exercises, cycling or even low impact activities like golf and dancing. Sports like basketball, soccer, football and others that require high impact movements – as well as weight training – should be avoided until your OCS gives you the go-ahead. 

Are you interested in what your recovery from orthopedicsurgery might look like? Do you have any questions about our Orthopedic Clinical Specialists and their transformative rehabilitation programs? Please get in touch with us at (212) 241-6321.

Olympic-Level Care With Dr. Gerardo E. Miranda-Comas

This week Mount Sinai is proud to introduce you to Assistant Professor of Rehabilitation Medicine, Dr. Gerardo E. Miranda-Comas. Trained in Physical Medicine and Rehabilitation, Dr. Miranda-Comas has sub-specialized in Sports Medicine, with a clinical focus on a vast range of sports-related injuries. His medical interests include the diagnosis and non-surgical management of musculoskeletal injuries, sport-related injuries, exercise prescription, electrodiagnosis, regenerative medicine, and diagnostic-therapeutic musculoskeletal sonography. With every injury case, Dr. Miranda-Comas believes that the best intervention lies in increasing patient awareness and education, and he aims to aid early return to function, and improvement in the patient's quality of life.

Dr. Miranda-Comas' interest in sports medicine began while completing a fellowship in the field at the University of Puerto Rico School of Medicine. Since then he has been involved in sports medicine at every level, being invited to lecture at scientific meetings at both national and international levels, as well as having published many articles on the subject. His interest in sports stretches beyond his professional life, to his involvement in covering sporting events from high school-level, right through college sports and up to elite-level events.

A true testament to his expertise within the field, Dr. Miranda-Comas was selected to be a member of the medical team at the 2016 Olympic and Paralympic Games in Rio. Only the best physicians are selected to become a member of the Olympic medical team, following a long application process, and are required to have an intimate and expansive knowledge of athletic injuries. However, this is not the only mass participation event that Dr. Miranda-Comas has contributed his medical knowledge to, being present in a professional capacity at both the New York City Marathon and the Pan American Games.

On top of his real-world experience with sports injuries, Dr. Miranda-Comas has earned four board certifications in Physical Medicine and Rehabilitation, Sports Medicine, Electrodiagnostic Medicine, and Musculoskeletal Ultrasound. Holding roles as the Associate Program Director of the Mount Sinai Sports Medicine Fellowship, and as a core member of the of the Physical Medicine and Rehabilitation Program faculty, Dr. Miranda-Comas is extremely qualified to treat a range of sports-related complications. But don't take our word for it – take a look at his customer experience rating of 4.8 out of 5 stars on our website as a true testament to his knowledge and skill in the field!

To book a consultation with Dr. Gerardo E. Miranda-Comas, request an appointment here

The Long-Term Effects of Sports-Related Head Trauma

 At least 300,000 sports-related head injuries occur in the United States every year. The short-term effects of sports head injuries have long been known. Concussions, as the result of a blow to the head can cause headaches, dizziness, and nausea in the short term. More recently it has been discovered that head injuries can cause problems long after the initial incident.

Post-Concussion Syndrome (PCS)

Around 15% of people who have suffered a single concussion develop persistent, injury-related symptoms. These can last anywhere from a couple of weeks, to a few months, up to a year. While the immediate symptoms of concussion are fairly mild, PCS can manifest itself in the form of noise sensitivity, concentration and memory problems, depression, and anxiety. It is thought that this condition can be exacerbated by pre-existing psychological conditions, being female, and being an older individual. While PCS cannot be treated as a whole, medications can be administered to alleviate certain symptoms, while psychotherapy and neurotherapy can be carried out to improve mental health and brainwave activity.

Chronic Traumatic Encephalopathy (CTE)

Another, more extreme consequence of repeat head injuries is CTE. This syndrome only manifests itself around 8 to 10 years after injury, and is most prevalent in professional athletes in sports such as football, boxing, wrestling, and ice hockey.

Symptoms develop in four stages- the first stage is characterized by a deterioration in attention, increased disorientation, headaches and dizziness. Later this condition develops to cause memory loss, social instability, erratic behaviour, and poor judgement. In the final two stages, patients may suffer from progressive dementia, reduction in muscle activity and control, vertigo, deafness, and, in extreme cases, suicidal tendencies.

The reasons behind why this happens are largely unknown and currently the only method of diagnosis is through post-mortem direct tissue examination. Treatments may include the use of speech and language therapists, and occupational therapists, however, as there is currently no cure, most treatment revolves around supporting the patient, and making him or her comfortable.

There is presently little conclusive research on the prevention of CTE, however, it is thought that immobilizing the head during a blow may prevent the future memory loss and learning difficulties associated with CTE. Of course, the best preventative action is to reduce the risk of head injuries, and to allow time to fully recover following any concussion which, for 85% of cases is up to three weeks.

Introducing Dr. Spinner

Last month we met Dr. Joseph Herrera. This month we introduce you to Director of Pain Medicine and Minimally Invasive Spine Surgery for the Department of Rehabilitation Medicine, Dr. David Spinner.

Dr. Spinner has always had a keen interest in sports, specifically baseball, basketball and the winter Olympics. Besides being a fan of various teams, he has also participated in many sports over the years, including volleyball, skiing, tennis, and most preferred of all, baseball. This interest in sports directly links to his current particular interest in sports injuries and the related field of musculoskeletal medicine. Musculoskeletal medicine is left largely unexplored in most medical sectors and it was his interest in this niche topic which led him to eventually specialize in Rehabilitation Medicine.

The medical education leading towards Dr. Spinner's eventual specialization began at Emory University, before being continued at the New York College of Osteopathic Medicine. Following this he completed an internship at Maimonides Medical Center, Brooklyn and subsequently embarked on a residency at the Icahn School of Medicine. In 2015 he won an award for pain medicine fellowship excellence for his work during a fellowship in Interventional Pain at the Beth Israel Deaconess Medical Center and the Harvard Spine Center. He has made contributions to furthering the field of Rehabilitation Medicine through investigating new ways to advance procedures and improve patient care. Dr. Spinner is one of the first physicians in the country to be certified in diagnostic musculoskeletal ultrasonography, and performs many musculoskeletal pathologies. His focus lies in ultrasound guided interventions, advanced spine interventions, and minimally invasive spine surgery, and he has written several publications concerning these techniques. The list of other interventions that Dr. Spinner performs also includes spinal cord and peripheral nerve stimulation, kyphoplasties, endoscopic rhizotomies, and disectomies.

As a specialist within his field, Dr. Spinner lectures on musculoskeletal ultrasonography across the country and was the lead editor for the Atlas of Ultrasound Guided Musculoskeletal Injections, the first textbook on this subject. He has developed his own unique strategies towards the treatment of both acute and chronic pain.

The interest that Dr. Spinner has in this field continues beyond his professional practice. He is a supporter of various pain and musculoskeletal charities, including the Facial Pain Association, a resource for information and guidance for those suffering from neuropathic facial pain. Dr. Spinner is also an active and involved supporter the Wounded Warriors Project, whose mission it is to honour and empower war veterans who suffer from physical and mental ailments in relation to their military service.

A man who started as an athlete and became a Physical Medicine specialist. An interview with Dr. Herrera. 

We sat down with Dr. Joseph Herrera, a Rehabilitation and Physical Medicine specialist at Mount Sinai, to learn more about his specialism, career, passions and hobbies. Hope you enjoy!

Q: Why did you decide to become a doctor?

A: My overall purpose and why I get up in the morning is to help others get back to life. I love problem-solving and developing strategies for patients to overcome disabilities.  Whether it's knee pain and developing a plan to get back on the field to play soccer or if it is shoulder pain and developing a plan to put on a shirt, getting a patient back to their maximal function is my ultimate goal.

Q:  Could you tell us a little more about your specialties?

A: Physical medicine rehabilitation is such a broad field that covers all aspects of disability. Physiatrists can practice in several different subspecialties such as pediatrics, spinal cord injury, traumatic brain injury, sports medicine, pain management, and neuromuscular diseases to name a few.  The overall goal of the field is to maximize function and minimize disability. It is one of the most rewarding fields to be in. 

Q:  Where did your interest in fluroscopy/electrodiagnostic testing/sports injuries etc. begin?

A: I have always been active playing both recreational and competitive sports. I was a college athlete that suffered an injury and was treated. The process of return to play intrigued me. 

 My interest in electrodiagnostics and fluroscopic procedures occurred during residency.  I became especially intrigued in the ability to help people with pain through injections. 

Q: What is it that interests you in rehabilitation medicine specifically?

A: The ability to get people back to living their life is what interested me in rehabilitation medicine.

Q: How did you get into this field?

A: I was  introduced to the field in medical school. 

Q: Why Sports injuries?

A: Prior to medical school I was a crew coach and an athlete. Having the knowledge of biomechanics and knowing the mechanism of injury has helped me diagnose and treat various athletic injuries. 

Q: Favourite sport?

A: I love a number of sports rowing, baseball, football, basketball.

Q:   Favourite team?

A: Yankees, Giants, Knicks, Rangers and, of course, Rutgers University sports.

Q:  Favourite thing to do in New York City?

A: The Restaurants scene!

Q: Fun Fact about yourself.

A: I was a coach before going to Med school. 

Introducing Dr. Herrera

Here at Mount Sinai we understand that, as a patient, it is of paramount importance that you feel you know, and can trust, your physician. With this in mind, every month we will be introducing you to one of our doctors in more depth, so that you can get to know them a bit better, and we are beginning with our System Chair and Director of Sports Medicine, Dr. Joseph Herrera.

Dr Herrera began his training at the DO, University of Medicine and Dentistry in New Jersey, before undergoing his residency training in Physical Medicine and Rehabilitation through a combined program organised by Columbia Presbyterian Medical Center and Weill Cornell Medical Center. Following this, he then did a further fellowship in Interventional Spine and Sports Medicine at Beth Israel Medical Center in New York.

Following his training he was appointed to the New York State Athletic Commission and served as the Chief Team Physician for USA Boxing Metro. His work treating and evaluating both amateur and professional athletes led to him being awarded the Rocky Marciano Physician of the Year Award, for excellence in the field of Sports Medicine. This is just one of the many awards Dr. Herrera has won during his time, including being named one of the Best Doctors in America, one of New York’s Super Doctors, a Castle Connolly Top Doctor, and an American Pain Scholar by the American Pain Society.

  

Dr. Herrera has authored and edited a number of prominent medical works, including the “Manual to Musculoskeletal Medicine” and “Essential Sports Medicine”, served as Chief Editor of Medical journal “Current Reviews in Musculoskeletal Medicine” and has been interviewed on TV and radio, and in a number of popular publications, for his expertise.

Having been fellowship trained in Interventional procedures for spinal and joint conditions, he now heads up our own Interventional Spine and Sports Medicine Program as Fellowship Director. He is also the Residency Program Director for the Physical Medicine and Rehabilitation Program. His research and clinical interest focuses on sports-related injuries, knee, back, and shoulder pain, electrodiagnostic studies, and fluoroscopic guided spine and joint intervention. His interventional procedures include – but are not limited to – discography, radiofrequency neurotomy, and interlaminar and trasforaminal epidural injections.

Most importantly, his average patient experience rating is 4.8 out of 5!

If you think Dr. Herrera could help with your condition, you can book a consultation here. 

Supporting a Loved One through Rehabilitation

Supporting a loved one through Rehabilitation can be one of the most difficult and isolating experiences there is. Serious injuries, and the subsequent care, can affect families and caregivers as much as the individual themselves. However, there are steps any caregiver can take to do make the transition to rehabilitation as smooth as possible.

The first thing to remember to do always is take care of yourself. If, at any point, you find yourself feeling too isolated or too stressed, reach out to other people – be they friends and family, an external support group, or a doctor. Learn to relax, get enough sleep, and find out which coping strategies work best for you – and this applies to all caregivers.

Brain Injuries

Daily structure and normality are extremely helpful for those coping with a brain injury. Be sure to stick to a routine every day, factoring in plenty of rest and limiting the number of visitors and amount of noise, so as to avoid over-stimulation. Include your loved one in family activities and conversations, wherever possible, and do whatever you can to be as natural as possible with them. Remember to be respectful, treating them as an adult and being sure to consider their likes and dislikes. Point out milestones and try not to lose patience. You should also bear general safety matters in mind – make sure there is no clutter around for the sufferer to trip on, and keep sharp objects out of harm’s way.

Stroke

The road to recovery after a stroke is different for every patient, as there are a number of complex variables which can lead to someone having a stroke. The most important thing to remember, then, is that comparisons with other people’s rehabilitation can only be harmful, not helpful. Steps forward can come quickly or slowly, so have patience, measure progress, and stay positive. Depression is extremely common after a stroke, so monitor your loved one’s mood and behavior, and step in if you notice any signs of depression. Also, it is important that you are clued-up on medication and instructions given by the physician, especially those which relate to preventing future strokes. Encourage a healthy diet and exercise, and make sure all medication is being taken as prescribed.

Sports Injuries

Sports injuries vary enormously – from acute injuries incurred during a game to wear-and-tear injuries from repeated use. They can also affect vastly different parts of the body and take different lengths of time to heal, but there are some general rules which should help with all of them. Firstly, be sure that the injured person sees the doctor regularly throughout their rehabilitation, and that they take their advice and instructions seriously. Motivate them through difficult aspects such as physical therapy while being sure not to encourage them to get back into their sport of choice before they are ready.

Wheelchair

It is important to bear in mind that, life in a wheelchair can be extremely challenging – particularly for those who are new to it. To begin with, the crucial thing is simply to be there for your loved one, and to remind them of this sensitively, without constantly reminding them of the things they can no longer do. One of the trickiest things, our patients’ families find, is learning to tread the fine line between drawing constant attention to the wheelchair and conspicuously not mentioning it. This may take time and effort, but you will get there. Adapt your home to make it as wheelchair friendly as possible – this is something your hospital or medical center can help you with. Finally, be prepared to help them in any way they need – especially at the beginning. There may be a number of everyday activities they find difficult to do on their own – from bathing to dressing – and it is imperative that you lay any reluctance to one side and do what is necessary. Over time, they may well learn to do these things without you.

Spinal Injuries

Experiencing a Spinal Cord Injury can profoundly change the way in which someone interacts with the world. As a caregiver, it is crucial that you make this transition as painless as possible. Sufferers often experience high levels of guilt, frustration, and depression – as well as physical pain – so it is your role to help prevent this, whenever possible, and never to let your loved one feel like a burden. Be prepared to face these emotions, and try to communicate openly and often with your loved one about them. On the whole, it is good to interact with them as you normally would. One of the best things to do is to work out early on which tasks the patient can complete independently and which tasks could use your assistance. Keep the whole family or household involved and be sure to nurture healthy, positive relationships – providing your loved one with as much contact with the outside world as possible.

When it comes to rehabilitation for any serious condition, your role is vital. Your love, care, and support can be the difference between a patient recovering, and them not recovering. It is a role which is exceedingly challenging, but which can be hugely rewarding and, whatever the condition of your loved one, it is always important to remember: you are doing a good job.