Are You Ready to Shovel Snow?

Big snowstorms may seem far in the future, but now is the time you should be training your body for the heavy snow lifting that may to come at some point this winter.  “People commonly underestimate the physical challenge involved in clearing large amounts of snow,”  said  Dr. Alex Levchenko, a board-certified, fellowship trained physician who specializes in the non-operative treatment of spine, joint and muscle pain.  “This is especially true for people who lead inactive lives, but even someone in good shape can suffer back pain from the strain of lifting and rotating the back to toss snow in a pile.”

Dr. Levchenko advises everyone to strengthen the muscles in their core and back before starting any strenuous upper body activity. “You wouldn’t try to lift 100 pounds at the gym if you’ve never lifted that much weight before.  It’s the same with shoveling snow.  You have to build up to it,” he said.

Dr. Levchenko said the number of patients he sees with back pain increases after every large snowfall. “People tend to think of shoveling snow as a nuisance when it is really an intense form of exercise.”

When large snowfalls do occur, he recommends getting ahead of the accumulations by shoveling smaller amounts every few hours rather than waiting for inches of snow to pile up and freeze.

As with any exercise, it’s important to warm up your muscles before you head outside. Once the shoving is underway, maintaining proper posture and body mechanics will minimize stress to the weaker back muscles. That means keeping a straight back while leaning forward and having a slight bend in the knees.

It’s also important to use your core, hips and hamstrings to provide strength and stability rather than relying on your back and shoulder muscles to do the heavy lifting. Using ergonomically designed “push” shovels can also help ease lower back strain. If back pain develops during the activity, stop and rest for a while.

If the pain continues, conservative treatment using anti-inflammatory medication and ice to the area usually reduces the discomfort.  However, back pain that lasts more than a few days should be evaluated by a physician who specializes in spine conditions.

Dr. Levchenko advises people with pre-existing back conditions to avoid shoveling altogether. “It’s better to pay someone else to do it and save yourself from all the ways the increased back pain will impact your life,” he said.


Can Tiger Wood’s Surgery Help You?

Spinal fusion may not improve your golf game, but it can make it less painful.

Eighteen months ago, Tiger Woods underwent spinal fusion surgery to relieve the debilitating back pain that had forced him to drop out of the sport where he is considered one of the greatest golfers of all time.

Six months after the procedure, Woods started swinging a club.  Last Sunday, Woods took first place at the  the 2018 Tour Championship in France.  It was his first major tournament win in 5 years.

Before his lower spine fusion, Woods said his pain had gotten so intense that playing golf was the furthest thing from his mind.

“I was beyond playing. I couldn’t sit. I couldn’t walk. I couldn’t lay down without feeling the pain in my back and my leg. That was a pretty low point for a very long time,” he told senior writer Bob Harig of

Spinal fusion surgery has been around for more than 50 years; however, recent developments in minimally invasive techniques, computer navigation and robotics have made spinal fusion less invasive, safer, and more precise. Newer technology also reduces the need for repeated x-rays during surgery. This decreases radiation exposure for the patient and the attending surgical staff.  Recovery is quicker and outcomes are much better than in years past.

“Today’s technology has so many benefits for patients suffering from spinal problems,” said neurosurgeon, Scott Simon, MD, of Orthopaedic & Neurosurgery Specialists (ONS). Dr. Simon was the first in Fairfield and Westchester Counties to perform robotic assisted spinal fusion surgery using the newest state-of-the-art Globus Excelsius GPS robotic system.

Spinal fusion surgery welds together two or more vertebrae in the spine to reduce motion in the section that causes pain from arthritis, injury, disease, or degeneration. Each procedure is slightly different depending on the patient’s individual condition.  But, typically the surgeon will decompress the nerves and replace a damaged disc (discectomy) with a bone graft and a synthetic cage. This will help reestablish a normal level of space between the affected vertebrae and the nerve channels. In Tiger Wood’s case, the 5th lumbar vertebra had slid slightly over the sacrum. This is a condition known as spondylolisthesis. It was corrected by fixating and fusing the 5th lumbar vertebra to the sacrum.  In time, the vertebrae heals into one solid piece.

Most cervical (neck) fusion cases can be performed on an outpatient basis with patients recovering at home and moving about on the same day.  Thoracic and lumbar spinal fusions for the mid and lower back usually require a hospital stay of two to four days. However, it depends on the location and complexity of the condition.  In addition to spinal fusion, a neurosurgeon may also recommend a procedure known as a laminectomy, during which damaged bone or tissue is removed.

According to Dr. Simon, spinal fusion surgery is only recommended after conservative treatments, such as NSAIDs, physical therapy and injections have failed to provide lasting pain relief.  Spinal fusion may be used to treat a number of back and neck problems, including:

Depending on the nature and location of the spine disorder, neurosurgeons will use one of three approaches to perform the procedure.  The anterior approach requires a small incision to be made through the front or side of the abdomen. Surgeons do this to reach the lumbar region or through the front of the neck to reach the cervical spine.  With the posterior lumbar approach, a small incision is made in the middle of the lower back; posterior cervical fusion is performed through the back of the neck.


Patients tend to feel better in less time than it takes for the bone fusion to become solidly formed. “Post-lumbar surgical patients should avoid bending or lifting until they are cleared by their surgeon,” Dr. Simon said.  Most patients are off all pain medication by week 3 and often return to work by week 6.  Full recovery from cervical fusion can take from three to six months.  Thoracic and lumbar fusion can take longer, from six months to a year to heal completely.

If you experience prolonged back or neck pain that radiates down a limb, consult with a board certified neurosurgeon. You can learn if spinal fusion is an option for you.

ONS neurosurgery specialists are spinal fusion experts who use the latest state-of-the-art technology for the greatest precision and shorter recovery periods.

Schedule an appointment to find out if spinal fusion surgery is an option to treat your back pain.

The Myth of Laser Spine Surgery

Many people are under the impression that a laser is the main surgical tool used in the procedure advertised as laser spine surgery. That couldn’t be farther from the truth, according to back painneurosurgeon Dr. Scott Simon of Orthopaedic and Neurosurgery Specialists (ONS).

What’s more, Dr. Simon believes that use of a laser in spine surgery is more of a marketing gimmick than surgical innovation. “The laser is only used to remove the soft tissue over the spine after an incision has been made and the surgeon performs whatever minimally invasive procedure is called for,” Dr. Simon explained. “Using a laser actually creates an unnecessary step to the surgery.” If soft tissue needs to be removed from the spine, electrocautery, in which a heated needle is used, is a more effective technique, he added

Lasers are certainly not new technology. Lasers have been available for use in medicine since 1973. However, they have not been widely adopted as a tool to be used in spinal surgery. “Most neurosurgeons do not use or recommend the use of lasers for spine surgery because there are no clear benefits and there are other well-established and documented studies proving the effectiveness of more modern and established spine surgery techniques,” Dr. Simon said, adding that ONS neurosurgeons do not use or recommend laser spine surgery.

The laser is in fact just a light that burns soft tissues and is unable to remove ligaments, discs, bone or bone spurs. It is actually much less precise than the more modern surgical tools. Bone spurs that press on nerves or the spinal cord, for instance, are easily taken care of through minimally invasive spine surgery. “The outcomes are excellent and patients often go home the same day as their procedure,” Dr. Simon said.

The majority of spine conditions can be effectively treated without surgery, noted Dr. Simon. When surgery is recommended, he advises patients to carefully research the qualifications of the neurosurgeon and surgical facility. “Minimally invasive spine surgery, fusionless spine surgery and outpatient spine surgery are often advertised as the latest advances in spine care, when in fact the specialists at ONS and elsewhere have been performing and improving these procedures for nearly 20 years,” he said.

Schedule a consultation with an ONS spine specialist at our offices in Greenwich or Stamford, CT or in Harrison, NY by calling 203-869-1145 or submit this online form.


The Low Down on Low Back Pain


Did you know that 80 percent of Americans experience low back pain at some point in their lifetime? According to neurosurgeon Dr. Scott Simon of Orthopedic and Neurosurgery Specialists in Blog sizeGreenwich and Stamford, the majority of low back pain is due to a lower back muscle and ligament strain or sprain.

“This type of low back pain usually occurs as muscles tighten after exercise or other exertions,” he said, adding that stress has also been shown to make people more susceptible to episodic low back pain. Avoiding sudden lifting away from your body and stretching before or after exercise can often help prevent pain.

In most cases, back pain from strains or sprains lasts two to five days. It is best treated with heat and anti-inflammatory medication such as Naprosyn or ibuprofen. In the vast majority of cases, the pain subsides on its own without the need for additional treatment. Even as the pain dissipates, however, Dr. Simon recommends easing back into exercise. “Re-injury can occur if the muscles and ligaments are still healing,” he said.

Despite the claims of manufacturers, there is no conrete evidence supporting the use of a product to prevent or treat back pain.  “The best mattresses, pillows or chairs are the ones that are most comfortable according to the needs and prefences of the individual,” Dr. Simon explained.

Those who experience back pain that lasts longer than a week or produces leg pain, weakness, numbness or tingling sensations may have a more serious problem and should seek medical attention. Pain that radiates down one or both legs may be due to nerve irritation or pinching from either a disc herniation or arthritis. In the majority of these conditions, patients can be treated with physical therapy

Anyone should see a doctor immediately if the low back pain is a result of trauma or if the pain is accompanied by any of the following symptoms:

  • Fever and chills

  • Significant leg weakness

  • Sudden bowel and/or bladder incontinence

  • Difficulty passing urine

  • Severe continuous abdominal pain

Is Your Back and Leg Pain from Sciatica?


While most back pain is confined to a specific region of the spine, those suffering from sciatica can experience pain from their back down to their toes.Herniated Disk According to neurosurgeon Dr. Mark Camel of Orthopaedic and Neurosurgery Specialists, “There are many causes of back pain. Making a correct diagnosis is the important first step before prescribing treatment.“

Sciatica is a condition in which pain travels along the sciatic nerve. It runs from the lower back through the hips and buttocks and down each leg. The pain from sciatica is usually limited to one side of the body. It also tends to affect people between the ages of 30 to 50.

The most common causes of sciatica is a herniated disk, spinal bone spur or a narrowing of the spine called spinal stenosis. These injuries put pressure on the nerve roots in the lower back and cause inflammation and pain. Sudden pressure on the the lower spine vertebrae from an acute injury can also trigger the condition creating a sharp, leg cramp that can last for weeks.

In most cases, sciatica can be resolved with such non-surgical treatments as rest, anti-inflammatory medications, heat and cold application as well as physical therapy. However, if the pain persists or worsens, doctors may administer a cortisone injection into the spine. If those measures fail to relieve the pain, surgery may be recommended. “Sciatica is a manageable condition with the appropriate treatment,” said Dr. Camel.

Patients experiencing lower back, hip, and leg pain or develop numbness, burning, and weakening in the leg or foot should consult with a physician.

Make an appointment with an ONS spine specialist to learn if sciatica is the root of your back and leg pain.

Tips for Safe Summer Sports


Summer Sports Blog

With Memorial Day upon us, summer is a great time for outdoor sports as long as you take certain precautions to avoid injury and illness. With the increase in temperatures, proper hydration is a must. Intense exercise that causes you to sweat is usually a good reminder to drink water, but you can become dehydrated simply taking a walk or playing ball with your child during hot weather. Swimmers, who don’t notice their perspiration and tend to feel cooler because they are exercising in water, need to remember to replace fluids on a regular basis, too.

Generally, it takes the body about 10 days to adapt to the heat. Even if you’ve stayed conditioned throughout the winter, it’s important to start your outdoor exercise slowly, gradually increasing in time and intensity until your body has fully acclimated. Whenever possible, exercise in the cooler parts of the day such as morning and evening.

Similarly, if you haven’t played a sport since the fall, such as golf and tennis, don’t expect to just pick up your game where you left off. Back sprains, tennis or golfers elbow and wrist problems can pop up if you haven’t taken the time to develop the muscles that are important for your specific sport. Knee injuries such as meniscus tears and anterior cruciate ligament (ACL) ruptures are common when the knee is unstable and if there is an imbalance in the hip and leg muscles. A sudden pivot or twist while running or jumping could derail your active summer by requiring surgery and rehabilitation. Relatively short strengthening programs can have a significant impact on reducing the risk of ACL injuries and anterior knee pain.

It’s also important to protect your skin from the sun. At the very least, use a waterproof sunscreen with a minimum SPF of 30 – 45 that is designed for sports. Be sure to apply the sunscreen at least 30 minutes before you go outside, even if the day is overcast, and reapply every two to three hours.

Finishing First Following Spine Surgery


Amanda Miller has been running the 5-mile Jim Fixx Memorial Day Run in downtown Greenwich for as long as she can remember.  “That race is my annual barometer. It tells me where I am with Amanda Miller Race 3 webmy running and it kicks off my summer running season,” explained the 50 year old real estate agent and mother of three.  This year’s run was particularly triumphant.  Amanda ranked first in her age group with a 39:46 minute finish and 11th among women runners of all ages.  Her triumph, though, was the fact that she could run the race at all.  A herniated disc and subsequent back surgery in 2015 could have kept her on the sidelines indefinitely.

Amanda is married to ONS orthopedist and shoulder surgeon, Seth Miller, MD, so she didn’t have to look very far to find one of the top spine surgeons in the state.  “I give all the credit to my doctor, Paul Apostolides.  He gave me confidence that I’d be able to run again,” she said. Six months after surgery, Amanda was back on the road.

Amanda has had a lifelong passion for running distances, competing with herself to run faster or further with each race. In the fall of 2014, she achieved a personal goal by running in the New York City Marathon.  However, in many ways this year’s Memorial Day race was a sweeter accomplishment.  “By finishing the race in less than 40 minutes, I am running at nearly the same pace I was before the surgery,” she said. “I’ve always known that ONS is among the best practices in the tri-state area because of how consistently high the doctors are in the rankings, but now I’ve lived through it myself. I’m so grateful.”

ONS MDs to Discuss Chronic Pain


Maintaining quality of life while living with chronic pain is no easy feat. Two orthopedic specialists from ONS will discuss effective new treatments to help people with relentless pain return to the WavenyPain Flyer (2)activities they enjoy.  Join Demetris Delos, MD, an orthopedic surgeon who specializes in sports medicine an comprehensive knee and shoulder, and interventional pain management physiatrist, Christopher Sahler, MD for this informative talk on Wednesday, May 11 at The Inn at Waveny, 73 Oenoke Ridge in New Canaan.  Doors open at 4:00 pm for refreshments. Presentation begins at 4:30. RSVP at 203-594-5310 or [email protected]


Regenerative Medicine and Chronic Pain


In the past, most cases of damaged tissue within the body were considered irreversible, but developments in regenerative medicine hold the potential to change all that, writes Christopher Sahler, PRPMD, an interventional pain management specialist at ONS, in this week’s edition of the Greenwich Sentinel.  Although research into harnessing the body’s own healing process using amniotic fluids, blood, tissues, growth factors and stem cells is ongoing, certain biomedical therapies are in use today to help ordinary people suffering from orthopedic conditions and chronic pain.  The most common treatment, using platelet rich plasma collected from a patient’s own blood, is administered in a physician’s office using ultrasound guided injections directly into the diseased or damaged tissue to restart and increase the healing process.  Read the full article in the April 1 edition of Greenwich Sentinel.

Regenerative Medicine Benefits

Dr. Christopher Sahler
                Dr. Christopher Sahler


Does your own blood hold the key to healing your medical condition? The evolving field of regenerative medicine uses biomedical materials, often from your own body, to regenerate cells and rebuild diseased and damaged tissues. Join Dr. Christopher Sahler to learn about this exciting new medical field that uses therapies from blood, platelets and stem cells to treat pain and cure complex, often chronic conditions of the musculoskeletal system.  Healing Yourself: The Promise of Regenerative Medicine for Chronic Pain and Orthopaedic Care will take place on Thursday, March 10 at Greenwich Hospital’s Noble Auditorium.  6 – 7:30 pm. Free.  To register, call 203-863-4277 or go to

The Importance of Injury Prevention: Don’t Become a Statistic


One in two Americans over the age of 18 and nearly three out of four age 65 and older have a musculoskeletal condition costing an estimated $213 billion each year in treatment, cadolori articolari 1re and lost wages, according to a report by the United States Bone and Joint Initiative (USBJI), The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action.

The study finds that the quality of life, activity and productivity of an estimated 126.6 million American adults are affected by painful conditions and disorders affecting the bones, joints and muscles, a number which is comparable to the total percentage of Americans living with chronic lung or heart conditions. Among children, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.

The report states that arthritis and related conditions top the list of orthopedic ailments (51.8 million adults) followed by back and neck pain (75.7 million combined). With an aging population, the number of people faced with musculoskeletal discomfort can be expected to greatly increase.

Fortunately, advances in diagnostic and treatment technologies, such as those that are available from the sub-specialists at ONS, can provide patients with pain relief and a safe return to mobility. However, the report underscores the importance of injury prevention strategies for individuals of all ages and the need for prompt treatment when injuries occur and orthopedic conditions first appear. With top orthopedists, neurosurgeons, physical therapists and physiatrists, ONS is committed to finding non-surgical options as the first line of treatment. Only 10 percent of ONS patients require surgery.

ONS’s Christopher Sahler, MD, Offers Tips for Combating Chronic Pain

Sahler - icontactExercise can help people with chronic pain return to daily activities with ease and comfort, writes Dr. Christopher Sahler, interventional pain management specialist at ONS in this week’s issue of the Greenwich Sentinel.  Slowing down is wise advice if pain is caused by an injury, he said, but a growing body of research suggests people suffering from chronic pain may feel better if they keep moving.

Not only does inactivity lead to a myriad of problems from weight gain to depression, it can actually exacerbate a person’s perception of pain.  Moderate, adaptive exercise, he explains, helps alleviate unrelenting pain because it releases endorphins, brain chemicals that improve mood and act as natural painkillers. Exercise provides the additional benefits of increasing a person’s agility and range of motion and it can stregnthen muscles to prevent injury.  Read the entire article which includes tips for gradually returning to normal, daily activities with greater ease and comfort.


Tips to Prevent Back Injury from Shoveling Snow

If the local forecasts are to be believed, many of us will be doing a fair amount of snow shoveling this weekend. Before you bundle up and head out, though, Dr. Jeffery Heftler, an interventional pain Blog-shoveling show 300 pxspecialist at Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, has a few words of advice to protect your back from strain and injury.

“The most important thing is to stay ahead of the accumulation of snow. It’s much easier on your back to shovel after every few inches has fallen than to wait and lift heavier loads of snow for a longer period of time,” he advises. Waiting can make the task even harder if the snow melts and then freezes over. Dr. Heftler also recommends investing in so called “push shovels” that are specially designed for pushing the snow aside while shovels with bent handles can help ease the tension on back and shoulders.

Without a doubt, Dr. Heftler sees more patients with back pain following a large snow storm. One reason, he suggests, is that people tend to think of shoveling snow as a nuisance and chore, when in fact it is an intense and strenuous exercise. “All too often, people who are generally inactive underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting the snow and throwing it over their shoulder,”   he says.

To protect your back, it’s best to take a few moments to warm up your muscles before going out in the cold. When shoveling, maintain the correct posture and technique to minimize the pressure on your weaker back muscles. Avoid rounding your lower back, for instance. Instead, go through the motions with a straight back leaning forward and your knees slightly bent. Use your core, hips and hamstrings to provide strength and stability instead of relying on your back and shoulder muscles to do the heavy lifting.

People with pre-existing back conditions are most vulnerable to shoveling related injuries and should avoid the activity altogether. “Even if you have to hire someone to clear the snow for you, it will pay for itself in terms of avoiding pain and days lost from work and winter sports,” Heftler says.

If you do experience pain while shoveling, Dr. Heftler says to stop, go inside and rest in a comfortable position until the discomfort passes. He recommends anti-inflammatory medications such as Advil or Aleve, and using ice or heat directly on the area where the pain is most acute. If the pain is severe and persists through the next day, consult with a physician.

ONS Physical Therapist, Alicia Hirscht Discusses How to Help Avoid Neck and Back Pain in the Workplace

ONS Senior Clinical Specialist Alicia Hirsch
ONS Senior Clinical Specialist Alicia Hirsch

Let’s face it, if you don’t have a smartphone or a tablet, LTE or Wi-Fi, if you are not tweeting and networking 24/7….well, with the way we all depend on technology today, you might as well be living in a cave and drawing hieroglyphics!

We’ve come a long way from the years of the caveman, the question is, at what expense have we make this progress? From manufacturing and robotics, trading and purchasing, to filing and storage of records and data, almost everyone in the workplace uses computer technology. While computers and the internet enable workers to be more efficient and productive, our global workforce is quickly becoming more sedentary, and more painful.

Data collected from office workers reveals that 20% suffer from chronic neck pain, and 60-70% report having suffered from neck pain at some point in their career. Neck pain is highly correlated to workers who sit with a forward head for more than 5 hours per day, and is twice as likely to affect women and workers older than 40. Luckily, though, research also shows that workers who exercised regularly, reported good sleep habits and engaged in productive stress management reported a lower incidence of neck pain.

While 8 hours of sleep, regular meditation and a gym membership (that you actually use) might not fit into your busy, computer driven life, do not worry, hope is not lost. There are small steps you can take to keep yourself as pain free in the office as possible… and less irritable.

Step 1: Get up and move! We are not built to sit, we are built to MOVE. Set a timer on your computer that reminds you to change position every 20 minutes. Even if you stand for 1 minute 2 times an hour, your risk of developing neck pain reduces dramatically. While standing, engage is some basic exercises that can be done easily at your desk (see below).

Extensions: Place your hands on your waist and lean your shoulders back. Move slowly, repeat 15 times.
Extensions: Place your hands on your waist and lean your shoulders back. Move slowly, repeat 15 times.
Chin tuck: Pull your chin back towards your spine, keeping your eyes focused straight ahead. Hold for 3 seconds, relax, repeat 15 times.
Chin tuck: Pull your chin back towards your spine, keeping your eyes focused straight ahead. Hold for 3 seconds, relax, repeat 15 times.
Stand with your shoulders back and your chin tucked. Take a large step back with your right foot, allowing your left leg to bend. Sit your hips down into the stretch, hold for 20 seconds, repeat on each leg.
Stand with your shoulders back and your chin tucked. Take a large step back with your right foot, allowing your left leg to bend. Sit your hips down into the stretch, hold for 20 seconds, repeat on each leg.
Chest stretch: Reach up and back with one arm while reaching down and back with the other, open up your chest and squeeze your shoulder blades together. Keep your chin tucked, hold for 15 seconds.
Chest stretch: Reach up and back with one arm while reaching down and back with the other, open up your chest and squeeze your shoulder blades together. Keep your chin tucked, hold for 15 seconds.

Step 2: Make sure your work area is set up properly. Your desktop monitor should be even with your line of sight. Not in a corner away from you, right in front of you. If you work with a lap top or tablet, prop them up on risers so that you do not have to look down. Consider wireless/external keyboards to keep your hands in front of you and your elbows bent at 90 degree angles. Use a lumbar support to keep your spine in a neutral position, and adjust your seat height so that your hips, knees and ankles can rest at 90 degree angles. (See the picture below) Download or view our Workstation Ergonomics flyer to use as a guideline for improving your work space to help improve sitting posture and help to minimize neck and back pain.

Desktop even with your eye sight, lumbar support to keep spine in a neutral position, knees and ankles resting at 90 degree angles.

If you are experiencing neck and back pain it may be time to talk to the experts at the ONS Spine Center. ONS Spine Center physicians specialize in non-operative and operative treatments for neck and back pain. Visit the Back and Neck Pain page on our website to learn more and see our physicians. To learn about our physical therapy services visit ONS Physical Therapy.

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit or call 203.869.1145.