Wednesday, September 23, 2009

Running injury treatment in NYC

Running injury treatment in NYC

I have been treating runners injuries for over 15 year in my Manhattan Chiropractic practice.
I was never a huge fan of running I was more a bike rider,
but as more and more patients told me how much they loved it,I decided to give it a try.
I put on my Running shoes and stretched out and started slow.
I live in Downtown NYC and some of the granite sidewalks are a little uneven, and BAM not even 2 minutes into it I sprained my right ankle.
Of course I iced it right away for the first day or two.
The next day in the office I had the Physical therapist use cold laser and I had a Chiropractic extremity adjustment of my right talus by a friend that practices in Midtown.
I also had my associate use Kinesio tape using the fan method followed by stabilization applied up the outside of my leg.
I think this protocol really helped me get functional pretty quick.
I will continue treatment with the Physical therapist and we will probally add the Graston technique by next week.

I posted some information below about some traditional ways of treating a lateral ankle sprain. This information comes from Dr. Pribut's in Washington DC.

Running Injury
Topic: Lateral Ankle Pain

Question I just twisted my ankle what immediate care should I give it? And by the way please tell me a bit more about ankle sprains.

Amswer: Ankle sprains are more common in athletes participating in sports with side to side movement than that with straight ahead motion.Court sports such as Basketball, Tennis and Raquetball all create a fair share of ankle sprains. Running on level ground does not often result in an ankle sprain but cross country running, trail running and stepping in a pot hole (or uneven sidewalks) all could potentially lead to an ankle sprain.

The most frequent ankle sprain is an inversion ankle sprain. This can injure the outer structures of the ankle.

Anatomy: The ankle includes the Talus or ankle bone and the ankle mortise created by the lower Tibia (inner ankle bone, leg bone) and fibula (outer ankle, leg bone). There are three main outer ankle ligaments. The anterior talo-fibular ligament, the calcaneo-fibular ligament and the posterior talo-fibular ligament. Other structures in this area which your doctor will want to examine which can also be injured in an inversion injury include the peroneal tendons (which can sublux or move out of place), the calcaneo-cuboid ligament, and the base of the 5th metatarsal (which can break).

Most Common Injury:

The most common injury resulting from an inversion ankle injury is a partial tear of the anterior talo-fibular ligament. This ligament may also tear completely. The next most frequently injured ligament is the calcaneo-fibular ligament and least injured is the posterior talo-fibular ligament. On occasion the fibula itself may be fractured or the talar dome is injured.

As already mentioned, the other structures on the lateral side of the ankle should always be carefully examined to make sure they are not injured.(I had a Grade 2)

The grading of ankle sprains is officially done on an inadequate 3 point scale. Grade 1 is a mild "stretch" of the ligaments, Grade 3 is a complete tear of the ligament and Grade 2 is everything in between. In my office I use a subjective 10 point scale to finer grade the ligament injury for the benefit of the patient.

Treatment For Minor Sprain:

If you have doubts or your ankle swells very rapidly you should head for the emergency room. Immediate treatment should consist of R.I.C.E.:

Compression - gentle

The ice should be applied for about 15 minutes at a time and then off for about the same. Avoid damaging your skin with the chemical bags you can place in your freezer. Frozen corn or peas works just fine.

If the ankle does not respond quickly to this treatment, it is probably best to visit your sports physician for an evaluation and treatment. This way you'll avoid having your sprain be worse than a break.

Frequently for Grade 2 sprains, I'll recommend a plastic splint such as that made by Air Cast - Air Splint. This holds the ankle quiet as it heals and prevents most inversion and eversion. On occasion crutch walking for a few days (or longer) is needed. The first exercise I recommend after the ankle is starting to feel better is dorsiflexion - plantarflexion or just plain moving the ankle up and down. After more improvement small circles, painting the alphabet with your toes and other exercises can be done. Later still a theraband or other elastic band can be used to strengthen the muscles that help hold the ankle stable. Beam balance exercises and figure 8 running are also possible exercises later in recovery.

I recommend avoiding forcing your ankle to move in pain too soon. I also recommend avoiding weight bearing or walking in pain early in the course of an ankle sprain. There is no reason to start testing your ankle until it has had time to heal. Slow and easy gets more gain than rushing into painful exercises.

A Sports Podiatrist or Orthopedist and Physical Therapist can team together to make sure you have a speedy recovery.

Tuesday, September 22, 2009

Hand Wrist pain treatments using the Graston technique in NYC

Wrist Pain

Txt Messaging Creates Hand, Wrist and Arm Ailments
By Julianne Lessard OTR/L, CHT, Springfield, MA
In this age of handheld electronics like cell phones, the iPod® and the PSP (PlayStation®Portable), it is easy to see how a new crop of hand injuries has developed. Age is not a factor here – from the 10-year-olds playing video games to the teenagers text messaging up to the young business professional with the Blackberry® – no one is safe.
As devices get smaller and more compact, the technology improves. Some phones come with a full keyboard – no wonder there has to be a special language, it would be too hard to type a full sentence!
In 2005 the American Society of Hand Therapists ( issued a National Consumer Alert. “Handheld electronics may require prolonged grips, repetitive motion on small buttons and awkward wrist movements. This combination can lead to hand, wrist and arm ailments such as Carpal Tunnel Syndrome and Tendinitis,” said ASHT President Donna Breger Stanton, MA,OTR/L,CHT FAOTA. ( 2005 ).
The following are some guidelines from ASHT for healthier use of handheld devices:
• Use a neutral grip when holding the device. A neutral grip is when the wrist is straight, not bent in either direction (not strong or weak). It will allow for wrist motion in a plane where more motion is available in the wrist.
• Take a break every hour or switch to another activity. Overuse of repetitive motions, such as pressing buttons, can cause tendinitis of the elbow or lead to Carpal Tunnel Syndrome (tendon or nerve irritation).
• If possible, place pillows in your lap and rest arms on pillows. This will allow you to keep your head in a more upright position and therefore decrease neck strain. The pillows will help support the arms so they do not have to be held up in the air.
• Sit in an appropriate chair that allows you to comfortably put your feet on the floor and also provides good back support.
• Switch hands frequently. This will allow the one hand to rest and reduce fatigue.
• Frequently focus on a distant object (away from the screen) to help reduce eye fatigue.
The best advice for patients is to tell them to listen to their bodies. No matter what they’re doing, if their arms and hands become sore, uncomfortable, achy or numb, then change their routine. Add tendon gliding exercises throughout their day. Simple changes can make a big difference in preventing tendinitis.
When treating patients with tendinitis, try using GT6 with a sweeping motion over the TM joint and J stroke to the hypothenar and thenar group. Also, use GT3 with strumming and a J stroke to the thenar and along the volar metacarpal heads. After only a few visits, the muscles are more pliable and have improved endurance and function. Stretching exercises will follow to re-align the fibers.
Tendon Gliding Exercises
These exercises glide the tendons gently through the carpal tunnel to minimize microscopic adhesions, reduce congestion and improve lubrication in the tendons.
Hook fist – touch your fingers to the top of your palm. The large knuckles should be pulled back as much as possible.
Full fist – touch your fingers to the middle of your palm. All three finger joints should be bent.
Straight fist – touch your fingers to the bottom of your palm. The tips of the fingers should be straight.
Thumb flexion – Start with your thumb pulled back from your palm as if you are hitch-hiking, then move your thumb across your palm and try to touch the tip of the thumb to the bottom of the small finger.
To learn more about the Graston technique to treat hand or wrist pain in NYC visit Dr. Steven Shoshany's website at
Graston tchnique, Cold laser terapy, Kinesio taping

Monday, September 14, 2009

Best treatment for tennis elbow? NYC

Best treatment for tennis elbow? NYC
I have been treating patient in my NYC practice for years with "Tennis elbow".
Bing,the new search engine had a nice ad on top of NYC cabs,

Best treatment for tennis elbow, Heat or Ice? Bing you decide.

Some of my insight.

What exactly is Tennis elbow?

So by defintion "Tennis elbow" is Lateral Epicondlyitis ,Tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow.

This can happen from any repetitive motion, My father had it years ago and he never even picked up a tennis raquet!!! My father hammered nails all day. But calling it lateral epicondylitis doesn't sound as good.

I will always go with ice. ICE brings down the inflamation and helps to reduce pain.
When I treat patients for this chronic condition treatment usually involves Graston technique,to break up the adhesions-more on Graston technique below.

Tennis elbow treatment NYC
The Technique:

* Separates and breaks down collagen cross-links, and splays and stretches connective tissue and muscle fibers
* Increases skin temperature
* Facilitates reflex changes in the chronic muscle holding pattern
* Alters spinal reflux activity (facilitated segment)
* Increases the rate and amount of blood flow to and from the area
* Increases cellular activity in the region, including fibroblasts and mast cells
* Increases histamine response secondary to mast cell activity

I also like to use Cold laser therapy with the Erchonia 635 NM. laser to decrease pain and inflamation.
I like to use Kinesio tape over and around muscles in order to assist and give support or to prevent over-contraction.
If your elbow is bothering you in NYC visit

Tuesday, September 08, 2009

Herniated disc NYC, New York City Herniated disc treatment, DRX 9000

Herniated disc NYC, New York City Herniated disc treatment, DRX 9000
Herniated disc NYC

Do you have back pain?

Do you have Sciatica? or even worse have you been diagnosed with a herniated disc?

I have a relationship with a excellent diagnostic center here in New York City, when a patient is diagnosed with a herniated disc they need information to make the right decision. Information is crucial because if a patient does not understand their condition they may be guided into a treatment that they cannot undue like a back surgery.
A conservative approach would be to recommend Physical therapy for 6weeks.
Chiropractic care should be included in management of the patient with the herniated disc.
In our NYC Multi-disciplinary office we utilize a integrated approach to treat and correct herniated disc problems with a combination of Physical therapy, Chiropractic care, Spinal decompression, acupuncture and advanced Core strengthening techniques.
We offer the most Comprehensive treatment in NYC for back Pain and the herniated disc.
The intervertebral disc has been estimated to be responsible for 26-40% of low back symptoms.
Disc Herniations are defined as displacement of disc material beyond the limits of the intervertebral disc space, involving less than 50% of the disc circumference and rarely occur without concomitant or pre-existing mechanical, degenerative, or muscular deconditioning.
Non-surgical spinal decompression using the DRX 9000,Core strengthening using the Spine Force.
Rehabilitation for patients with Herniated discs-NYC
Rehabilitation of the patient with a herniated disc consits of improving their strength and flexibility while, at the same time, addressing their posture and habits.
If you live or work in Manhattan,NYC and suffer with back consider a Comprehensive approach to not only get rid of your pain but solve the problem.
Have your MRI,NCV,EMG test's evaluated to see if you can benefit from our combined approach. Visit Dr. Steven Shoshany's website @ to send your reports or learn more about methods.
Or visit to learn more about our Comprehensive disc herniation treatment methods.