Blood Injuries in Boxing

Although a physical, high impact (and let’s face it somewhat violent) sport – boxing comes in as having the fewest blood injuries. In American Football or Rugby for example, most players will come out with cuts all over their bodies – some worse than others. The problem with boxing is, when there’s blood there’s a lot of it as there are no middle ground scrapes (usually) as found in other impact sports. Blood in boxing means that someone is going to need towel to clean up after.

When going toe-to-toe, if the head is the target – the nose is the bullseye. If you get a good swing onto the opponent’s nose there is a very high chance you’re in for a win. The same goes with the eyes which can puff up badly and bleed profusely. Without putting you off your favourite sport, let’s take a look at how you can deal with bleeding in boxing.

If someone makes it through your guard and catches you in a groggy state, there will most likely be bleeding. The quicker the blood is stopped the less likely you or others around will be exposed to potential infection. You, or your coach, should have First-Aid supplies at hand to stop the bleeding until you can get to A&E or more help can get to you.

A nosebleed can be dealt by doing the following.

·       Pinch the nose bridge and lean forward – and probably try to avoid expensive equipment. The usual thought is to tilt the head backwards, but this is not recommended as it allows blood to flow down the throat and into the stomach.

·       Plug the bloody nostril with cotton nose plugs or cotton balls to help stop the flow of blood. Replace plugs as needed if blood flow continues. Carefully remove them as large blood clots may stick to the end.

·       If the blood flow continues take a small bag of ice and place it on the nose bridge for at least five minutes. If bleeding continues, the nosebleed may be more serious and need a doctor’s care to be cauterized.

If you’re sweaty a band aid won't stick. Or if the cut is too large (laceration) it may be hard to completely cover it. Keep the cut or laceration clean. Stop bleeding by applying pressure using a towel or gauze to stop blood flow so it can be covered.

Although boxing injuries tend to heal on their own, there are instances in which the injury could become infected, or necessary to receive stitching. Please contact our switchboard at (212) 241-6321 to discuss options if your sustained injury needs looking at.

Frequent Injuries in Baseball

Most Common Injuries in Baseball

For obvious reasons, baseball isn’t considered a high-risk sport like football or ice hockey – mostly because it isn’t a collision sport. Regardless, baseball brings its own risks. You are running, jumping, sliding (sometimes) and swinging a bat at a high velocity which puts you in danger of muscle strain, especially after long practice sessions. Consequently, baseball players frequently suffer from golf and tennis elbow – their ligaments are fatigued and deteriorating over time; and we haven’t even considered the risk of falling, collisions, and the danger associated with a hard ball flying at over 99m/h (albeit a generous estimate for most).

Types of Shoulder Pain

The most commonly overused muscle in baseball is the shoulder – usually during pitching. Shoulder tendonitis is common in young athletes who use overhead throws and the windmill pitch can cause a myriad of problems, especially when combined with poor form. Torn rotator cuffs can develop in the rotator cuff tendons and older players may begin experiencing Frozen Shoulder which reduces motion and causes pain in the shoulder joint. The shoulder can become unstable when combined with long periods of overhead throwing as the motion stretches the ligaments, leading to loose joints and sometimes dislocation. Finally, and possibly all pitchers’ worst nightmare is the Shoulder Separation – which is a traumatic injury that is a result of falling or colliding with a hard object with an outstretched hand.

Pain in the Elbow

Throughout the last couple of weeks, we outlined exactly what Tennis and Golfer’s Elbow was, and top ways of curing. We will go over it quickly now, but if you want a more in-depth guide, follow the links below.

Golfers Elbow and how to treat it – Click Here

Tennis Elbow and how to treat it – Click Here

PRICE Routine to help with minor sprains – Click Here

Tennis and Golfer’s Elbow are like two sides of the same coin. When the tendons in the arm are overloaded we often experience a dull pain on the outside of the forearm. Tennis Elbow denotes a pain felt due to overuse on the outside of the arm above the elbow whereas Golfer’s elbow is in a similar location but slightly under the elbow. Follow the links above to learn more.

Overloading the Spine

The human spine is a wonderous structure – we really couldn’t function without it. It transmits information from nerve endings all over the body through the central nervous system to the brain, and if that wasn’t enough, it is also the structure that keeps us standing up straight on two legs. It’s worth looking after your spine. Baseball poses a slight risk to the spine. Although admittedly it is a small risk – because the spine is so important – it is worth covering.

Catchers are prone to back injury during baseball due to the crouched position and overhead throwing. Some pitchers may also experience back damage especially when using the windmill pitch.

The most common damage sustained to the spine is muscle strains in the upper and lower back. This is usually dealt with rather simply by a physiotherapist or a sports massage (and rest). However, there is also a risk of a herniated disk which is when a disc in the spine ruptures and pinches surrounding nerves. This can be an agonizing experience. If you believe you have suffered from a herniated disc you should seek medical attention immediately. Even if it was only a small rupture, the damage could be exponentially augmenting each time you play – eventually leading to a severe hernia. As always, prevention is the best form of treatment.

If you have suffered from anything mentioned above and believe you could benefit from a rehab plan or require medical attention, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. We’ll get you back on the field ASAP. Contact our switchboard at (212) 241-6321

Why SAD affects us in the winter

Seasonal Affective Disorder (SAD) is a state of depression that stems from the changing of the season, specifically – the summer to winter. In the winter, the days get shorter, it is cloudy and cold – but SAD isn’t a prophetic fallacy – it’s a physical reaction to a lack of vitamin D. Although there is a myriad of reasons as to how this depressive state can be triggered, none is more widely accepted than the vitamin D deficiency the body undergoes during the winter. A lack of vitamin D will create a chain reaction with other symptoms of SAD, which then feed into other depressive behaviours, in turn worsening the state of affairs. Let’s look at what vitamin D deficiency does to the human body.

Vitamin D, like all vitamins, it is a nutrient we make in our body; and most it comes from the sun. But vitamin D is unique as it is a hormone and not a nutrient like other vitamins. It works with calcium and phosphorus to create and maintain healthy bones, muscles, and teeth. Without enough vitamin D, your body will not be able to absorb calcium and other important nutrients that allow our body to function. In turn, many people with low levels of vitamin D will experience rickets, osteomalacia alongside other muscle and bone deficiencies. This leads us to be being tired, frustrated that our bodies are not functioning as it should be, and possibly lowering our immune system.

Vitamin D also has a role in maintaining stable brain hormones. Serotonin, the hormone associated with happiness, rises with the exposure to bright light – and drops in correlation with decreased sun exposure. As understood by research in medical science, people with lower vitamin D are 11 times more prone to be depressed than those with healthy does. A low level of vitamin D will cause a deficiency in serotonin, causing depressive-like behaviours to occur.

If we amalgamate these two factors, we see instantly that low vitamin D, caused by reduced sun exposure, is responsible for making us tired and unhappy. These physical deprivations feed into mental manifestations of psychological dispositions – such as bipolar – or other types of depression. It also suppresses the immune system, which can have a knock-on effect on making us ill, and then beginning the “cycle of depression”.

If you would like to learn more about how the cycle of depression works, click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.

Introducing Our Director of Brain Injury Research - Dr. Dams-O'Connor

 This week we are introducing Dr. Kristen Dams-O'Connor, the new director of the Brain Injury Research Center of Mount Sinai who specialises in traumatic brain injuries (TBI), and more specifically, the recovery process of TBI patients.

When beginning college at Colgate University, Dr. Dams-O'Connor intended to major in international relations; however, after taking an introductory course in neuroscience she was hooked, and chose instead to major in this field. Her research began in controlled laboratory experiments and she fell in love with the accuracy and certainty with which she could observe cause-and-effect relationships in her studies.

Following her undergraduate degree in neuroscience, Dr. Dams-O'Connor decided to do further studies in psychology so she could work more closely with patients who were living with neurological diseases. During her doctoral studies she worked at a clinical site for three years at the University at Albany , participating in programs that helped people with devastating brain diseases live more productive and meaningful lives.

Moving to New York, she carried out an internship in neurorehabilitation at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center. On completion of the internship she progressed to a fellowship in Clinical Neuropsychology at Mount Sinai. During this Dr. Dams-O'Connor began to focus her research more on TBI, taking an interest in the heterogeneous nature of these injuries, with no two cases being alike. This variability allowed her to apply her knowledge of empirically supported neurobehavioral interventions to unique individual cases.

Today, as well as being a director, Dr. Dams-O'Connor is also an Associate Professor in the Department of Rehabilitation Medicine at the Icahn School of Medicine, and the Director of Research. She is PI of two grants from the National Institutes of Health and Co-Project Director of the New York Traumatic Brain Injury Model System which, as well as carrying out research on brain trauma, also provides emergency medical services, acute care, rehabilitation services, and long-term outpatient care. In her career to date she has published over 60 peer-reviewed manuscripts and chapters on traumatic brain injuries, their treatments, and outcomes and her work is internationally recognised. In her current research Dr. Dams-O'Connor works primarily on studying the long-term outcomes of brain injuries including clinicopathological signatures of TBI. A key interest of hers is understanding why some patients display a full recovery after their injuries while others partially recover before regressing later in life.

You can read more about the Brain Injury Research Center here - www.tbicentral.org

The Best Exercises for Strong Bones

 With advancing age the risk of developing osteoporosis rises. This risk may be increased by having lower than normal peak bone mass, and subsequent greater than normal bone loss. The chances of this happening can be lessened by doing exercises that involve weight bearing. This is because when you do weight bearing exercises your bones adapt to the impact exerted by this extra weight and the pull of your muscles by building more cells, and thus become denser and stronger. The type of exercises that are most beneficial vary depending on age.

Children

For children, bone strengthening exercises can start before they can even walk. Crawling and active play begin the gaining of muscle mass. After they have learnt to walk unaided, activities such as climbing, walking and running, and jumping all contribute to the development of strong bones.

Teenagers and Young Adults

As children reach adolescence an active lifestyle is crucial to increasing bone mass. It is around this age that the most can be done to achieve a high peak bone mass in their early twenties. All sorts of competitive sports, from soccer to tennis to martial arts are beneficial, as are more individual exercises. Skipping, body weight exercises and high-energy activities such as aerobics and dance can strengthen muscles, while putting weight on the bones, encouraging them to increase cell production. In order to build up strong bones children should aim to undertake 60 minutes of exercise a day.

 

Adults

From your mid-thirties natural bone loss begins to occur. In order to reduce the rate of this, muscle-strengthening activities should be done at least twice a week. This can include doing some of the activities that young adults do, but also less exercise-focussed pursuits, such as brisk walking, stair climbing, carrying groceries, gardening and moderate-resistance weightlifting. These activities are less aimed at building bone mass as they are at maintaining muscle strength. Adults need less frequent exercise than children, but should aim to do at least 150 minutes of cardiovascular exercise a week, on top of muscle-focussed exercises.

Elderly

For elder individuals, or those at high risk of osteoporosis and fragile bones, it is advised to avoid particularly high impact exercises. However, maintaining a healthy, active lifestyle is beneficial. Going for a walk or doing necessary housework are both good ways of keeping active throughout the day. Swimming can improve stamina and joint flexibility in a low-weight environment, while tai chi is recommended as it is low impact but can improve balance and posture while strengthening muscles in the legs.

Until a bone is broken, there are no symptoms of osteoporosis. As the likelihood of developing it increases as you age the best preventative method is to build up strong bones at a young age and to sustain beneficial exercises throughout life.

Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.  

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.

Everything You Need to Know About Strokes

This week we tell you everything you need to know about strokes: how they are caused, how you can recognise one, and how they are treated.

Causes

Strokes are caused when the brain does not receive enough oxygen. There are two ways in which this can occur. An ishemic stroke, the more common form, is caused by clots in the blood vessels which supply the brain which stop the blood flow. The second, rarer form is the hemorrhagic stroke, which is caused by ruptured blood vessels bleeding into, or around, the brain.

Symptoms

There are various physiological indicators that a stroke has occurred. It is often signalled by a sudden numbness in the face, arm, or leg, and especially on a single side of the body. This may be accompanied by sudden confusion, and the inability to speak or understand others' speech.

Trouble seeing in one, or both, eyes can result from a stroke, as can having difficulty walking, and losing balance and coordination. The final symptom of a stroke is a sudden, and severe headache.

The sooner a stroke is identified and treated, the less permanent damage it is likely to do. This is because, the sooner treatment is administered, the more of the brain can be saved.

Cures and Therapies

Accute stroke therapies are administered to try and stop the stroke while it is happening, either to stop the bleeding or to dissolve the clot. If the cause of the stroke is ischemic aspirin is given, as this has the effect of thinning the blood, preventing further clots. With hemorrhagic strokes it it a little less straight forward as the patient must be monitored to ascertain what the cause of the bleeding is. It may be as a result of blood thinning medicines, high blood pressure, head trauma, or blood vessel malformation. Once the cause is identified tre

atment can then be tailored to the patient's need. Immediate emergency care for hemorrhagic strokes is concerned with controlling the bleeding, and medications may be given to reduce blood pressure or to slow the blood flow.

In the case of quickly identified and treated strokes there may be very little lasting damage, however, for some, there may be a need for a range of therapies to relearn certain skills. Strokes can cause paralysis or movement control problems, pain, difficulties using or understanding language, memory and thinking problems, and emotional disturbances, depending on which area of the brain is affected. Rehabilitation therapy involves the input of a range of specialists including physiotherapists, psychologists, occupational therapists, speech and language therapists, dietitians, specialist nurses and doctors, all of whom work to help patients relearn skills to make them as independent as possible.

Strokes can be damaging but the key to full recovery is knowing and recognising the signs and taking early action to get medical help.  

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.

The History of the Center of Rehabilitation Medicine, Part 2: 1959-1999

1959-1986

In January 1959, Lawrence A. Wisham, M.D., was appointed chairman of the Department of Physical Medicine. Shortly after his appointment, on March 10, 1959, the name of the department was changed to Physical Medicine and Rehabilitation (PM&R). Dr. Wisham is best known for his investigations on the clearance of sodium from human muscle, some of which did in collaboration with Rosalyn Yalow, the Nobel Prize recipient for medicine and physiology in 1977. During Dr.   Wisham’s tenure, the department primarily provided consultation services to inpatients on the acute wards of the hospital and in various outpatient clinics, but did not have an active inpatient service. In the spring of 1964, the Rehabilitation Workshop, a project of the Women Auxiliary Board, began providing paid employment in a sheltered environment for outpatients with disabilities - individuals were unable to work in a competitive commercial environment but who hoped to gain employment in the future. On July 1, 1966, the department began a three-year training program in PM&R. with eight residents and fellows who had received a federal traineeship grant from the Vocational Rehabilitation Administration.

During the early 1980s, there were five physiatrists on the faculty at Mount Sinai. Besides Dr. Wisham, these were Drs. Frances Dworecka, Danuta Janiszewski, Somchat Chiamprasert and Beatrice Kaplan. A residency training program for 24 residents was directed by Jerry Weissman, M.D., at Elmhurst Hospital. These. residents rotated through hospitals: Elmhurst City Hospital, Beth Israel Medical Center, The Bronx Veterans Affairs Medical Center (VAMC) and The Mount Sinai Hospital. There were no federally funded research programs within the department.

On the national scene during the 1950s and 1960s, a small number of academic medical centers established their own departments of PM&R which incorporated inpatient hospital beds for the rehabilitation of persons with severe physical disabilities. Teams of rehabilitation professionals were created consisting of specialists in PM&R (physiatrists) physical, occupational and speech therapists, as well as rehabilitation nurses, psychologists, social workers, vocational counsellors, recreational therapists, etc. These people worked together under the direction of the physician to reach the goals of rehabilitation medicine. The goals were defined as maximizing the function of the disabled person physically, psychologically, socially and vocationally. In 1965, the US Congress passed legislation creating Medicare and Medicaid, and through diligent advocacy of leaders in the field of PM&R, rehabilitation services for both inpatients and outpatients were included in the Medicare/Medicaid health care package. Since that time rehabilitation services have become a standard component of health care services in the United States for all persons with a new onset of physical disability. On May 20, 1968, the name of Mount Sinai's Department of Physical Medicine and Rehabilitation was changed to its current name: The Department of Rehabilitation Medicine.

1986-1999

By the mid-1980s, it was clear that both The Mount Sinai Medical Center and its Department of Rehabilitation Medicine were about to undergo major changes. A new hospital building was being planned and a search committee was established to find a new chairman for the department. When Mount Sinai applied for a certificate of need (CON) for the new hospital building, to the New York State Commissioner of Health, David AxeIrod, M.D. the CON was ultimately granted with the provision that there would be reduction in the total number of beds in the hospital, but that 50 beds would be set aside for inpatient rehabilitation.

By July 1986, when Kristian T. Ragnarsson, M.D. assumed the chairmanship, Mount Sinai had made known its new commitment to provide comprehensive rehabilitation services for people with physical disabilities and to facilitate rehabilitation research and education. Since that time remarkable growth has occurred in the various activities of the department, including expansion of inpatient and outpatient care services, educational programs and externally-funded research. This has involved a large increase in the number of faculty and staff in the department.

In December of 1986, eight inpatient rehabilitation beds were opened on the seventh floor of the old Housman Pavilion and the service grew to 17 beds in 1987. The inpatient service grew to 36 beds early in the year 1990, when if moved to the new Guggenheim Pavilion, and in 1992 it grew to 50 beds. In 1996, the inpatient rehabilitation service moved to renovated. state-of-the-art facilities on the second and third floors of the Klingenstein Care Center (KCC). Each inpatient unit of 25 beds was self-contained, with all rehabilitation services provided on the same floor as the nursing unit. One unit was primarily for patients with spinal cord disorders, while the other unit provided services for patients with disabilities caused by stroke and traumatic brain injury. In December of 1997, a third self-contained inpatient rehabilitation unit was added; it is located on the fifth floor of KCC. The unit is intended to provide services primarily for patients with physical disabilities of non-neurological causes.

Outpatient rehabilitation services have expanded both on and off the Mount Sinai campus. In 1986, outpatient rehabilitation services were provided only in the sub-basement level of 5 East 98th Street the old Guggenheim Hall but in 1996 the outpatient services moved completely to the current Facilities in the new Guggenheim Pavilion.

Working closely with Mount Sinai's Center for Corporate Health, has provided consultation services for persons with musculoskeletal disorders, as well as for sports- and work-related injuries.

There has been considerable interaction with hospitals within the Mount Sinai Health System, other than the traditional academic affiliates. One very significant development has been the close collaboration with Jersey City Medical Center and Meadowlands Hospital in New Jersey, in opening, staffing and operating the Liberty Rehabilitation Institute at Meadowlands Hospital. A 30-bed inpatient rehabilitation unit opened there in December of 1996. The department has also provided guidance and assistance to many other hospitals within the Mount Sinai Health System regarding establishment of new rehabilitation medicine services and recruitment of professional staff including medical directors. In July of 1998, 26 representatives from 12 system hospitals with rehabilitation medicine services met for the first time at Mount Sinai to discuss future collaboration and networking.

At the same time as the clinical programs have grown; federally funded rehabilitation research projects have increased significantly. In 1986 the department was funded by the National Institutes of Health (NIH) for a research project on diagnosis and treatment of post-stroke depression. In 1987, the department was designated and funded by the National Institute of Disability and Rehabilitation Research (NIDRR) for five years as a traumatic brain injury (TBI) model system of care. In 1989, the Spinal Cord Damage Research Center at the Bronx VAMC opened. In 1990, the department received a designation and federal funding as a spinal cord injury model system of care, the only such system operating in New York State at the time.