Introducing Dr Joseph E. Herrera

This month we have taken an in-depth look at how sports injuries can affect your life and highlighted preventative steps to avoid sports injuries. This week we would like to introduce you to a sports-specialist at Mount Sinai’s Department of Rehabilitative Medicine – Dr Joseph E Herrera. During sports seasons it is important that players look after themselves off the field as well as on. If you are looking at rehab to get back into shape or fighting off a hamstring tear - wherever you are on your journey to recovery (or the MBA), Dr Joseph Herrera can give you some coaching tips.

Dr Joseph E. Herrera is a Board-Certified Physician who joined Mount Sinai after the completion of an Interventional Spine and Sports Medicine Fellowship at the renown Beth Israel Medical Center, New York. He then completed his residency and served as Chief Resident in Physical Medicine and Rehabilitation through a combined program of Columbia Presbyterian Medical Center and Weill Cornel Medical Center. He finished his academic career before joining us by completing a fellowship at Beth Israel Medical Center and has been named an American Pain Scholar by the American Pain Society.

His literary works extend to authoring and editing textbooks such as the “Manual to Musculoskeletal Medicine” and “Essential Sports Medicine and he is the chief editor of the medical journal “Current Reviews in Musculoskeletal Medicine.”

He is currently researching Wii Shoulder Injuries – which are injuries obtained during using the Nintendo Wii Sports devices. His past accomplishment was in adding to the cutting edge of Lumbar Discography Study – and he anticipates beginning work in adding to the literature on Plasma Rich Protein for the Elbow.

Dr Herrera is also the New York State Athletic Commission and Chief Team Physician for USA Boxing Metro which has allowed him to regularly treat and evaluate professional athletes. His in-depth understanding of his field has awarded him the Rocky Marciano Physician of the Year Award for excellence in Sports Medicine.

Dr Herrera comes highly recommended. He was selected as one of the Best Doctors in America and has won an abundant of awards and comes highly recommended by his patients. He maintains an excellent rating on our website – averaging at 4.7/5 rating. His top-rated categories are in the following:

·        He explains in a way you understand

·        He listens carefully

·        They will recommend him to a friend

If you are looking for a sports physician that can help you through rehab or someone to create a bespoke plan of action.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan and request Dr Herrera. Contact our switchboard on: (212) 241-6321

Spinal Cord Injury. Introducing Thomas N Bryce

Recovering from spinal cord injuries is a complex process as they can be the result of serious localized trauma or lifestyle habits. That is why it is helpful to have a professional by your side while you undergo recovery. Thomas N Bryce, our leader in Spinal Cord Medicine at the Department of Rehabilitative medicine, has been a part of our team here at Mount Sinai since 1997 and could be the answer to your problem.

Dr Thomas Bryce has an impressive academic record. Prior to joining us, he completed his undergraduate degree from Albany Medical College and received speciality training at Thomas Jefferson University Hospital. He is a leader in the field, being the principal investigator of several ongoing studies in these areas and “wrote the book” (quite literally) on spinal cord injuries having authored numerous chapters and peer-reviewed articles on the subject.

Dr Bryce’s research is focused on assessing residing pain after spine damage, use of robotic exoskeletons to facilitate walking, and stem cell implantations for neurological recovery. He has been involved in several international taskforces with the aim to reduce pain after spinal cord surgery.

He is currently Governor Cuomo to the New York State Spinal Cord Research Board. Dr Bryce’s method is intersectional. He works closely with physical therapists, occupational therapists, neuropsychologists, and other surgical specialists to provide bespoke comprehensive care.

Dr Bryce understands the intricacies that are involved in recovering from spinal cord injury.

A bespoke plan can be constructed to suit anyone’s individual needs when going through this difficult period. Spine damage can be the result of hard trauma or lifestyle or a mix of both. Dr. Bryce can accommodate plans that involve difficult lifestyle changes. This includes both long-term habitual corrections, such as posture to post-surgery rehab.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard on: (212) 241-6321

Recovering from spinal cord surgery

Spinal cord injuries are the result of both accidents and lifestyle habits. We can avoid developing a weak spine by adjusting our lifestyles. Unfortunately, the same cannot be said for accidents. A car accident or slipping over can lead to tremendous long-term discomfort and pain with little we can do to prevent these damages, assuming you're wearing your seatbelt and not running on unstable surfaces. Nonetheless, there are ways we can tackle this issue using advances in medical science. Spine surgery can have incredible effects on your quality of life. Let’s investigate how you can plan your recovery after a surgery. Please note that timestamps are generalized and dependent on your health and recovery plan.

Spine surgery is one of the more common types of surgery, and most are minimally invasive.  Let’s take a look at what spine surgery can do for you.

Firstly, when you’re in the hospital, you may have one of these surgeries depending on what type of damage you have incurred.  

·       Diskectomy – surgery to remove all or part of your disk

·       Foraminotory – surgery to widen the opening in your back where nerve roots leave your spinal column

·       Laminectomy – surgery to remove the lamina, two small bones that make up a vertebra, or bone spurs in your back, to take pressure off your spinal nerves or spinal column

·       Spinal fusion – the fusing of two bones together in your back to correct problems in your spine

Your physician will give you a bespoke plan relating to your damage and recovery plan.

Depending on your surgery, recovery could take anywhere between 3 weeks to 6 months to recover. Other conditions that could affect your recovery is your lifestyle and bodily condition before the surgery.

Your bandages have a lifespan of approximately 9 days.  Check to see if the area has changed colour, swollen, or begins to open up. If this happens, contact your surgeon immediately. If there are no issues, you may begin to shower again. Wait 5 days before showering, and cover the incision with plastic wrap. Do not allow shower from the head to spray the wounded area. You should also want to avoid stairs for the first week or so.

Once a few weeks have passed, and the healing process is underway, you should be attempting to work your way into your previous routine. Before continuing your rehab, please note: do not sit still for extended periods of time, and inform yourself on proper posture by reading this. If you are supported by a brace or corset, you should be wearing it when sitting and walking, however, it would be unnecessary to wear the brace when you are sitting for short periods of time or using the bathroom at night. Finally, do not drive for the first 2 weeks.

Now is the point where, as opposed to what you should avoid, we can start looking at how you can actively help the healing process.

Around the 4 week stage, generally, you should be taking light walks to strengthen surrounding areas. Increase the speed or duration of the walk slowly. This allows the spine to heal itself within an active body and correct itself. A sedentary lifestyle will encourage previous problems to return. Continue to up your exercise slowly as your spine recovers.

Please note, you should contact your surgeon immediately if you experience any of the following:

·        Chills or a fever of 101°F (38.3°C), or higher

·        More pain where you had your surgery

·        Drainage from the wound or the drainage is green or yellow

·        Lose feeling or have a change of feeling in your arms (if you had neck surgery) or your legs and feet (if you had lower back surgery)

·        Chest pain, shortness of breath

·        Swelling

·        Calf pain

·        Your back pain worsens and does not get better with rest and/or pain medicine

·        Difficulty urinating and controlling your bowel movements

If this routine does not help, or you need medical attention, please contact us at Mount Sinai Department of Rehabilitative Medicine. A bespoke plan will be necessary if you suffer from other medical problems. Contact our switchboard on: (212) 241-6321

Changes to Your Daily Routine That Will Change Your Life

This week, with our committment to your health, we bring you ways in which you can avoid spinal cord damage and subsequent back pain. Severe spinal cord damage stems from mundane and seemingly trivial aspects in our lives. Although one of the strongest parts of the body, the lower back is incredibly susceptible to damage. Twisting, poor posture, and repetitive strain all leads to its gradual deterioration – so, with this in mind - let’s undergo a quick lower-back health workshop: how can you avoid spinal damage?

Posture

This is the easiest to fix in the short term, but one of the hardest in the long term. Before we go into why that is (and how we should sit), let’s explain why our posture can have such a strain on the spine. The spine is multiply-curved back-to-front in an S shape to allow greater weight bearing and shock resisting capacities. Slouching when sitting, and poor posture when standing puts a strain on parts of the back that were not designed to take pressure. In the long-term, this leads to deterioration of the spine and can cause severe spine pain.

This issue is addressed by sitting upright: pull your shoulders back and sit in an upright position – and you’re already on-the-mend. What makes this an awkward issue to address in the long term is that the way you sit (and stand) is habitual; and it will take consistent minor corrections to achieve good posture.

Exercising the Lower Back

Working on your core once a week will have noticeable effects on your spine’s health. Strengthening your intercostal and surrounding muscles will help balance your spine and make it easier to lessen strain on your back. This will reduce strain on the lower back. Low-impact exercise like walking can also help increase blood flow to the lower back, activating and strengthening the area. If exercising seems like an impossibility, then take to whatever you can. Do not remain idle, get yourself moving somehow.

Daily Health Routines

Drink more water. Stop smoking. Reduce alcohol intake.

For most of us, these trivial pointers are always at the back of our minds. But why should we care when it comes to spine health? The spine health’s reflects the overall health of the body. Anything you can do to improve your overall fitness and well-being will benefit you lumbar. The benefits of drinking water are lengthy, and we won’t go into that here (however it is probably more poignant to mention the disadvantages of not drinking water), smoking will reduce oxygen absorption from the surrounding muscles and reduce muscular-capacity of surrounding muscles, putting more strain on the spine, and finally, excessive alcohol consumption has a serious detrimental effect on the entire
body, including the brain, the spine, the nervous system – and everything in-between.

Our End Goal

Where possible, one should attempt a synergy of all three aspects for optimized results. Thankfully, once you have started it only gets easier. Strengthening the core and activating the lower back will make the habitual process of maintaining a good posture easier, and maintaining a good posture will make strengthening the core easier. Following our dietary tips will speed along both of these processes.

Our end goal should be as follows: our hips should be above our feet – hip above knees – shoulders above hip – head above shoulders. When this is achieved unconsciously, you will have strengthened one of the most important areas of your body.

If this routine does not help, or you need medical attention, please contact us at Mount Sinai Department of Rehabilitative Medicine. Contact our switchboard on: (212) 241-6321

Tips for a Good Night's Sleep

There is nothing better than having a good night's sleep at the end of a long work day. However, in the US, 30% of the population suffers from insomnia, with this rising to between 40% and 60% among those above 60. Often it is caused by stress or anxiety, and may be fixed as this stress is removed. However, for those suffering more long-term sleep loss other measures must be taken to improve the situation.

Developing a Sleep Schedule

One important action to take is to implement a sleep schedule. By making sure you go to bed at the same time every night and wake up at the same time every morning your body will get into a cycle, helping you to wake up feeling more rested. While regular sleep patterns are important, they will not be as effective if other factors are not taken into account. Midday naps can actually leave you feeling more tired, as they adjust the body's internal clock. If you must have a nap it should be kept to 10-30 minutes and should be had during mid-afternoon. Similarly, using electronic devices before bedtime can upset rest as the light from them resets the body's circadian rhythm by imitating daylight. In order to get the best sleep possible, all electronics should be turned off an hour before sleep. Furthermore, lights should be dimmed 2-3 hours before bed, as this will stimulate the brain to produce melatonin, the hormone that induces sleep.

Regulating Food Intake and Exercise

It is essential to cut out substances such as nicotine and caffeine before bed, as both are stimulants that will keep you awake. It is also best to avoid having a nightcap as, while alcohol will initially make you fall into a deep sleep, as it wears off you will spend less time in this deep sleep and more in the lighter REM stage of sleep resulting in waking up feeling lethargic.

While it may be a myth that eating cheese before bedtime will give you nightmares, it will definitely make it more difficult to get a good night's rest. Eating just before dinner will cause the body to release cortisol, a hormone involved in the metabolism of food, which decreases secretion of melatonin, thus making you more likely to wake up in the middle of the night. Likewise, it is best to keep late-night exercise to a minimum. Working out in the middle of the day can help to tire you out, and thus help encourage sleep. However, exercising releases energy which, if done just before bed, will keep delay sleep. Light exercise, such as stretching or yoga can be beneficial, as it relaxes the body.

See a Doctor

Often the measures mentioned above are sufficient to restore good sleep, however, occasionally symptoms can persist. If sleeplessness lasts a month or longer it may be necessary to see a doctor, who can ascertain if the cause is related to another health condition, such as acid reflux or asthma. Alternatively it could be an adverse effect of medication you are taking.

Our Tips for Reducing Back Pain

 Back pain can be debilitating and leave one feeling like they cannot do everyday activities. Before seeking surgical solutions, there are a range of activities that may help alleviate the pain, and get you back to moving as normal.

Pain Relief – As a first port of call, and as a short-term solution pain killers can reduce suffering. To counteract swelling and inflammation cold packs can be beneficial while hot packs work to lessen tension, cramping and muscle spasms.

Manual Therapy – This method involves a therapist using their hands to massage, gently move, and apply careful force to the muscles, bones and joints of the spine. This removes tension in the muscles and encourages them to relax though it will only be effective if used alongside other measures, such as those listed here.

Exercise and Stretches – Traditional thinking is that in order to fix back pain bed rest is the best option. It has since been found that it is better to remain active, to retain muscle strength and flexibility. At first avoid any heavy-duty weight bearing exercises and opt more for gentle stretches and yoga. Exercises that lengthen out back muscles, such as back-bends and the cat-and-camel move, are the best for reducing pain.

Aquatic Therapy – If exercise exacerbates back pain at first, this can be countered in aquatic therapy. This involves gentle movement in a pool. The buoyancy of the water helps to remove strain from the joints, putting less pressure on the back, while the warmth of the water can help increase blood circulation, relax the back muscles, and remove tension.

Electric Stimulation – It has been seen that mild electrical currents can reduce perception of back pain. Electric stimulation involves using a Transcutaneous Electric Nerve Stimulator (TENS) machine to send low-voltage electrical currents to the body, through electrodes placed on the back. The exact mechanisms of this therapy are unknown, but one hypothesis is that the currents work to scramble pain messages to the brain, so the brain does not process them. An alternate idea is that the electrical impulses stimulate the body to release endorphins which override the sensation of pain.

For the most effective recovery it is recommended that a combination of these techniques is used. Some, such as pain relief and manual therapy, only alleviate pain in the short term, and so it is necessary to combine them with other techniques, such as stretches, for long term improvements.  

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.