Dealing with Pain: Osteopathic Manipulation Treatments

Osteopathic manipulative treatment (OMT) is hands on care, in which your physician will treat, diagnose, or prevent illness using manual palpitations. The underlying principle holds that the patient’s history of illness and physical trauma is written into the body’s structure. A Doctor of Osteopathic Medicine (DO) will gently move muscles and joints using techniques including stretching, especially with gentle pressure and resistance. 

Your physician will have been specially trained in the musculoskeletal system, which is comprised of an intricate system of muscles, nerves, and bones. Their nuanced and intricate understanding of the interconnections between all facets of the body means that a DO can locate a “blueprint” of an illness through the way the musculoskeletal system is connected. 

How Does it Work?

The aim of OMT is to relieve joint restriction by focusing on misalignment, this is done by with a focus on manually treating structural and tissue abnormalities, restoring muscle strength by promoting tissue balance, and finally – and potentially most importantly, by promoting the overall movement of blood flow throughout the body.

Just as there are many types of chronic pains, there are a multitude of treatment options from medication to the hands-on techniques detailed above. 

Our physicians’ practice in any school of medicine, but our DOs have taken the time to receive an additional 300-500 hours in the study of the body’s muscular skeletal system. Their highly developed sense of touch allows them to understand physical traumas that are written into the body’s structure by palpitating the patients living anatomy.

Who Can it Help?

As well as helping people with localized musculoskeletal damage, OMT has been clinically proven to help these other common illnesses.

·       Asthma

·       Sinus Disorders

·       Carpal Tunnel Syndrome

·       Migraines

·       Menstrual Pains

How Do I Get Referred?

Please contact us at The Mount Sinai Department of Rehabilitative Medicine and make an appointment today or to speak to one of our DO physicians.

If you have or would like to be recommended a OST and would like to do it with us at Mount Sinai, or if you are having one with us soon and would like more information, please contact us on (212) 241-6321) to see if our physicians can further help.

How Can We Deal with Being SAD?

We all feel unhappy sometimes, but depression is more than a feeling of unhappiness. It is a mental disorder that makes someone feel persistently sad for several weeks or months. Depression can be hereditary, triggered by another mental disorder such as a “low” in bi-polar disorder, a side-effect of drug abuse, but it can also be triggered by external forces, like the season. Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year, usually in the winter.

SAD manifests itself similarly to other types of depression. There is no way of accurately diagnosing depression without knowing a patient’s history and state-of-mind, as there is no “test” for SAD. Your health care provider can make a diagnosis by asking about your symptoms. There are two main ways SAD can affect your life, mentally and physically.

The mental effect of SAD can be as follows. As with all types of depression, sufferers will tend to experience a feeling of hopelessness in all facets of life and catastrophize events past and present. Due to this, sufferers of SAD will be unhappy and irritable, and may begin to withdraw themselves socially. The disorder may begin to make the patient feel the need to eat more (as weight loss is more common with other forms of depression).

SAD manifests itself physically as a need for more sleep, a loss of energy and ability to concentrate.

There is a loss of interest to the sufferer’s work, his partner and friends, and other activities (especially social activities). Their movements may become sluggish and, they will more likely than not become socially reclusive.

These symptoms are not mutually exclusive, and they usually feed into each other which make the disorder more difficult to cope with. The mental facets of SAD will reinforce the social behaviour and vice-versa.

If you, or someone you know, is suffering from a handful of these symptoms then it is worth visiting your physician. Your health care provider can make a diagnosis by asking a series of questions about your symptoms and history. They can also perform physical exam and blood tests to rules out other disorders that are similar to SAD such as chronic fatigue.

If you are struggling to make an appointment, or are unable to see a physician for whatever reason, we have some tips that will help manage your depression at home. Remember, it is always better to see your physician.

Some tips on dealing with SAD

Firstly, make sure you are getting enough sleep. A fully-grown adult should get between seven to eight hours a night – although some people may need as few as five, and some as much as ten. Know how much sleep you need, and make sure you are getting it. Oversleeping is never advised.

Make sure you are eating healthy foods. This doesn’t mean you need to eat bland food, it means you need to have a balanced diet. For example: make sure you are getting a healthy dose of vitamins and minerals every day and avoid binging on sugar and hydrogenated fats.

Do not use alcohol or illegal drugs, these often make depression worse – and have been correlated to suicidal thoughts during episodes of SAD.

Try to exercise often. Proven time and time again, exercise is a fantastic way of battling depression. Force yourself to start a social sport or activity, but most importantly – do activities that make you happy.

Learn to watch your symptoms and understand that you are dealing with a disorder. This is especially effective in the early days of SAD, it will allow you to take control of your disorder, change your routine, and book in to see your health care provider.

Finally, if you have seen your health care provider, make sure you take your medicines right away, and ensure you ask your provider how to manage any side effects. There is a multitude of ways of dealing with SAD that your health care provider can offer. Symptoms tend to get better on their own, but there is no “cure” for SAD. Tackling SAD is a matter of managing symptoms and learning to with the disorder.

Get medical attention immediately if you have thoughts of hurting yourself or anyone else.

Neurobics – Exercises to Keep the Brain Young

As we age our brain activity begins to slow down because the organ looses nerve connections and fails to form new ones. While this is a natural process there is a range of activities that can be done to somewhat reverse, or at least slow down, the mental ageing process.

Take Up a New Hobby

It has been noted that learning a new activity works to keep the brain young by keeping it active. Processing new information encourages the brain to form new connections between nerve cells and may even help to generate new cells. A new hobby can be anything from reading or taking a class to craft projects to physical exercise. New experiences trigger the release of dopamine, the neurotransmitter that stimulates motivation and perseverance in an activity and the hormone that encourages the production of new neurons.

Master the Crossword

While word and number games may just seem like a fun pass time they also have profound benefits on the neurological level. These brain exercises force various parts of the brain, such as the areas associated with language, numerical reasoning, and problem solving, to work. Over time this improves the performance of these areas and various studies have suggested that frequent work on crossword or sudoku puzzles may even delay the onset of illnesses such as dementia. This is because mental exercises force the brain to make connections and to recall information which, otherwise, can easily be forgotten as we age.

Keep Things Interesting

Just as important as taking up new activities is knowing when to stop doing an activity. If an exercise becomes habitual and routine your brain has normalized it and is no longer creating new neural connections. Much like if you do not do physical exercise the body will lose strength, without mental stimulation the brain becomes sluggish and slow. Shaking up your daily routine by adding in new elements keeps your brain sharp by constantly giving it new information to process. This can be as simple as taking a new route when you travel somewhere familiar. Instead of going into autopilot with well-established directional knowledge taking an unfamiliar route will actively engage the cortex and the hippocampus to process the new area.

It is inevitable that as the body ages the brain will lose some of the agility it had at peak age, in our mid -20s. However, keeping the brain exercised with novel activities can go a certain way to maintaining a healthy brain.

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.  

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.