Author Archives: bbrand

Signs and Symptoms of Frozen Shoulder

Frozen ShoulderIf you’ve had a “frozen shoulder”, you know this is an extremely painful condition where you are unable to move your shoulder or lift your arm upward or backward, either on your own or with the help of someone else. It’s scary when everyday activities such as sleeping, dressing, washing dishes, combing hair, clasping and unclasping a bra, or reaching for a wallet in a back pocket can become difficult or impossible.

What is a frozen shoulder?

First, to clear up a misconception, frozen shoulder is sometimes confused with arthritis, but the two conditions are unrelated – whereas signs of a rotator cuff tear could be instead a frozen shoulder. Sometimes called “adhesive capsulitis”, a shoulder “freezing” occurs when the shoulder’s joint capsule membrane thickens. This tissue band surrounding the joint becomes stiff and tight and can also grow new adhesions making mobility even more difficult. View OrthoConnecticut’s animation from ViewMedica, which illustrates this process well. Click here.

Why does this happen?

It’s not well understood why the shoulder “freezes”, but these situations make it more likely to happen:

  • Following swelling
  • After an injury or fracture
  • After surgery
  • After shoulder immobilization – note it doesn’t take long for the frozen shoulder process to begin

Who does this most often affect:

  • People 40 years old and older
  • Females more than males – 70% of people with frozen shoulder are women.
  • People with diabetes are more prone to frozen shoulder, but these conditions can also increase the risk: stroke, over or under active thyroid, cardiovascular disease, and Parkinson’s disease

What are the symptoms and stages?

Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. The stages are fairly typical across patients:

  • Freezing stage (6-9 months):
    • Starts slowly, mild pain worsens over a few months
    • Difficulty sleeping because of the pain
  • Frozen stage (4 to 6 months):
    • Movement restricted, difficulty lifting arm or moving it backwards, pain level even or decreasing
    • A good self-test is to stand in front of a mirror and try to raise both arms in front of you and overhead. You may have difficulty raising the frozen shoulder arm just past parallel to the floor, plus you may find that your shoulder blade rises painfully toward your ear in an unnatural motion.
  • Thawing stage (6 months to 2 years)
    • Movement gets easier or returns to normal, pain may lessen or reoccur periodically

What can you do for a frozen shoulder?

See a physician for a diagnosis which may include a review of symptoms, physical exam of arms and shoulder, and x-ray or MRI to identify structural issues.

For 9 out of 10 patients, time and treatment bring relief.

Here are some options to help reduce pain and improve functionality:

  • Gentle exercises: Harvard Medical School suggests these exercises to reverse stiffness: pendulum stretch, towel stretch, finger walk, cross-body reach, armpit stretch, and strengthening rotator cuff with outward and inward rotation exercises.
  • Wait it out: frozen shoulder will resolve on its own but that can take up to three years, total time.
  • If swollen, alternate between applying hot and cold packs to reduce pain and swelling.
  • Medication: medications to reduce inflammation and can help relieve mild pain.
  • Injections: your orthopedic surgeon may consider corticosteroid injections or nerve blocks.
  • Physical therapy: including TENS electrical nerve stimulation, training and mobility exercises, and manipulation to unfreeze the adhesions and stretch the shoulder capsule.
  • Arthroscopic Surgery: if advised by your orthopedic surgeon:
    • Gentle shoulder manipulation under general anesthetic.
    • Shoulder arthroscopy to remove any scar tissue or adhesions.

Here is an interesting takeaway from OrthoInfo that reviews some of the basics of a frozen shoulder. Click here.

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you’re experiencing frozen shoulder or other mobility issues. Contact us today for a telemedicine or in person appointment and #getmovingCT.

Take precautions when cleaning and avoid orthopedic injuries

Female with back pain after dusting floor

During these unusual times, we all are busy cleaning our homes and wiping off delivered packages. Be sure to take adequate precautions to avoid musculoskeletal injury as you take care of your family and home. Here are a few tips for preventing or reducing accidents from happening:

Watch Out For Falls

Wear proper footwear. Athletic shoes or rubber soled shoes are preferred. Don’t wear sandals, open-toed shoes or shoes with slippery soles. Look for good traction. Watch out for long cords, toys, throw rugs, and other objects on the floor. Avoid wet floors and let your family members know when a floor was just mopped.

Watch Your Back

Be sure to lift packages and heavy cleaning supplies safely. Bend at the knees and not at the waist and use caution when vacuuming and mopping. Avoid overly repetitive motions that can cause injury. Use a lightweight upright vacuum if possible, with handles that are comfortable to the grip. Bend your knees and use a dustpan and brush to pick up recently swept piles.

Avoid Ladder Injuries

Use sturdy ladders that are in good condition. Don’t stand on chairs, desks, boxes or other objects in order to reach high areas. Never stand on the top rung of the ladder and don’t over-reach or lean too far to one side when standing on a ladder. Don’t use a step ladder as a straight ladder. Step ladders must be fully open with spreaders locked in place.

Following these simple tips can help minimize orthopedic injury while staying safe and clean at home. Should you have an injury or experience severe pain, our orthopedic surgeons are available for emergencies. Be safe and avoid the hospital emergency department, especially now while it is busy managing Covid-19 patients. Visit or our OrthoCare Express page for updated hours: CLICK HERE.

About OrthoConnecticut

OrthoConnecticut is the region’s premier, multi-specialty orthopedic surgery practice, helping patients regain mobility, lead active lives, and attain optimal well-being. The practice’s urgent care service, OrthoCare Express, is open 7 days a week for emergencies and is available in Danbury, Darien, New Milford, Norwalk and Westport. Telemedicine appointments, with any of the practice’s specialists, are currently available for non-urgent matters. To learn more visit or call 1.833.ORTHOCT (1.833.678.4628).

Text Neck, It’s a Real Thing!

Man experiencing Text Neck discomfort

Neck Pain? Texting too much at the wrong angle (15 to 60 degrees forward) for too long can lead to “Text Neck”.

Also called “Tech Neck”, it’s a real, modern-age issue of neck muscle pain, headaches, and potentially “dowagers” hump. Less common symptoms are numbness, weakness, balance issues, and jaw pain.

Adults have it. Children are now developing it, and worse still, it may impact how young bodies’ grow and develop – leading to prolonged neck, shoulder, curving of the spine, and low-back issues.

Holding phones and mobile devices at different angles is linked to pounds of downward pressure exerted on the neck. Studies have shown how holding the phone at different angles varies this pressure:

  • 0-degree angle (looking straight ahead) = 10-12 lbs. pressure
  • 15-degree angle = 27 lbs. pressure
  • 30-degree angle = 40 lbs. pressure
  • 45 degrees angle = 49 lbs. pressure
  • 60 degrees angle = 60 lbs. pressure

So, what can we do to prevent pain and inflammation associated with texting, or treat it if you already have it?

  • Use good posture: hold your phone at eye level and sit up straight
  • Take breaks and stretch your neck periodically by tilting your ear toward your shoulder and then arching the neck and upper back to lengthen and ease muscle pain
  • Exercise and stretch your neck as part of your overall exercise routine to increase neck strength and flexibility
  • Seek treatments such as joint mobilization, posture correction exercises, taping, braces, massage, posture reeducation, and pain creams. Yoga can be helpful also.
  • Consider calling instead of texting!

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you’re experiencing text neck or other spinal issues. Contact us today for an appointment and #getmovingCT.

Resolved to Exercise … Next Steps

Teacher and active senior women yoga class on chairs

Anytime is a perfect time to make a resolution including moving more through exercise. Make an exercise plan that includes small, achievable goals that encourage and motivate you as you succeed. It takes 90 days to build a habit, so be sure to add the critical ingredient of patience to your mix of planning and activity. And be sure to include an attitude of flexibility, and adapt and change your exercise routines to keep them fresh and motivating. Combining different types of activities, such as Pilates with running, or yoga with cycling, can help you maximize muscle strengthening while bolstering your commitment.

Here are some thoughts to consider.

  • Get cleared by your doctor first. Get the go-ahead for exercising and learn if you have any physical limitations to consider or work around to avoid orthopedic injury.
  • Make a plan and stick to it. Just starting out? New to exercise? Be patient. What do you enjoy doing? Do you want to exercise by walking more? Set an appointment on your calendar to walk and invite a friend, or listen to music, or walk a dog. Want to take up golf? Make an appointment for an introductory lesson. Call a local gym or YMCA for a tour and check out the exercise room, pool, or aerobic and yoga classes they offer. Being a loner is a preference for some, but others enjoy camaraderie while exercising.
  • Think strong muscles to support your skeletal system and aid in weight loss. If you want to build strength through a weight lifting routine, work to avoid injuries by asking for help from a trainer or manager at the gym. Learn the correct form, technique, and how to adapt an exercise for a preexisting condition, such as a knee issue or arthritis.
  • Cross train. Consider cross training so you use a variety of your muscles and don’t overuse any one muscle group.
  • Be safe.
    • Include a warm-up to get your body ready for exercise. Start slowly for 5 to 10 minutes.
    • A cool-down after exercising can help remove any lactic acid build-up in your muscles and reduce soreness.
    • Stretch after your warm-up and cool-down.
    • Go slow – ease into your new routine.
  • Drink water to stay hydrated. Sweating can dehydrate so it’s important to replenish water. Here’s a hydration calculator to help you figure out the right level of hydration for you.
  • If pain occurs at any point in exercise – stop and assess. Icing an injury can help prevent inflammation. Be proactive about getting help if you need it – and consult your orthopedic physician in a timely manner.

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you need assistance with your exercise plan, getting advice for orthopedic or musculoskeletal limitations, or if you’ve injured yourself. Contact us today for an appointment and #getmovingCT!

De-stress this holiday season with a gentle yoga practice

Group of women in a yoga class, using blocks to assist in pose.

Practicing yoga can be a great way to get exercise and stay calm during the stressful holiday season. A consistent yoga practice has so many incredible benefits, including reducing heart rate, lowering blood pressure, reducing anxiety and depressive tendencies, and easing back pain — not to mention the stretching and muscle strengthening benefits to the body.

Understanding Joint Anatomy

Yoga uses every muscle and joint of the body. One key thing to remember is that each joint functions differently. For example, the knee is a hinge joint, meaning it allows the leg to extend and bend back and forth with minimal side-to-side motion. Its motion during yoga should remain within the natural back and forth movement of this “hinge”. The hip, on the other hand, has a unique anatomy which enables it to be both extremely strong and amazingly flexible, so it can bear body weight AND allow for a wide range of movement.  The hip joint allows the leg to move back and forth (flexion and extension), out to the side (abduction) and inward toward the other leg (adduction). It also enables rotation, allowing us to point our toes inward (internal rotation) or outward (external rotation) and moving the straight leg in the direction of the toes.

OrthoConnecticut recommends a few tips to as you enjoy your yoga practice this season:

  1. Keep the natural direction of the joint’s motion in mind as you practice – this goes a long way to preventing injury and strain. Be mindful of each joint, its muscles and your skeleton as a whole and how it is designed to move and not move. Work with your skeleton and joints, and not against them, for safe alignment and motion.
  2. Use care to listen to your body to help avoid overstretching your neck, shoulders, spine or legs. Common yoga injuries include muscle strains, torn ligaments and even more serious injuries, so start slowly. The American Academy of Orthopedic Surgeons (AAOS) recommends several steps to prevent yoga-related injuries. Read more here.
  3. Engage in mindful breathing – being present and enjoying the now is restful and recuperative. Here are some breathing exercises to get you started from
  4. Learn and practice yoga at your own speed, with a good teacher. Share information with them about any injuries or illness so they can adapt your practice to your needs. Don’t be afraid to ask questions.
  5. Warm up before yoga. Wear comfortable loose clothing and hydrate! Here’s one helpful floor routine to review from Wettravel and Melina Meza.
  6. Age is not a factor. If standing or floor yoga is not for you, enjoy a class of Chair Yoga as in this routine.

OrthoConnecticut Can Help

Our physicians and physician assistants are available to help you if you’ve injured yourself this holiday season. Contact us today for an appointment and #getmovingCT.

Tips to Avoid Back Pain During Leaf Clean-Up

Fall in New England is synonymous with beautiful changing leaves, but it also a time for yard work, slippery leaves, and avoiding ticks.

Here are some tips from OrthoConnecticut to protect you during leaf season.

  1. Know where the leaves need to go and use the right tools. Are you bagging, mulching, composting, or preparing leaves for citywide leaf curbside collection? Decide upfront what is best for you based on your physical ability.
  1. Mow regularly. Chopping up deciduous leaves, or mulching, as part of regular mowing is both good for your lawn and back. During the heavy leaf falling period, you might want to mow twice a week.
    • Self-propelled or push mower posture is important. If using a push mower, the best posture for mowing is pushing with your legs and arms to reduce strain on back. A self-propelled mower lets you walk behind the mower as it mainly does the work.
    • Take a break every 15-20 minutes to rest. 
  1. Use the right equipment. Here are some ideas for the right tools.
    • Rakes: be sure your rake is the correct fit, that it is proportional to your height and size to avoid straining posture or muscles, and a padded handle.
    • Leaf blowers: save time and energy by considering lightweight gas or electric leaf blowers to blow leaves either into a pile for bagging or onto a tarp for easier moving. Some leaf blowers rest on your back and ease the need to move the blower from arm to arm.
    • Work gloves: protect your hands from blisters and ticks.
    • Good shoes: protect yourself from wet leaves, slipping, skidding and possibly falling with arch-supportive shoes and anti-slip soles.
    • Tarp: helpful for moving leaves from one spot to another for composting.
  1. Posture for raking and lifting leaves: The National University of Health Sciences recommends:
    • Warm up with stretches first
    • Rake in sections, don’t do a large yard all at once, spread out work over several days. Take breaks every 15-20 minutes.
    • Keep your back straight and avoid repetitive motions by switching arms and pulling in different directions to work out different parts of your body equally.
    • Practice proper lifting. BEND AT YOUR KNEES (not at your waist), feet shoulder-width apart. Tighten your abs when lifting, straighten your knees and keep your back straight.
    • For turning, you should avoid twisting at the waist by moving your feet instead.
  1. Avoid ticks. Put pants inside your socks to create a barrier for ticks. Complete a body check following working with leaves and grass.
  1. Drink water … stay hydrated.
  1. Cleaning gutters … ladders, slippery leaves and roofs can add up to big falls. Consider hiring a professional for this task – they’ll have the right equipment and protective gear.

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you’ve strained your muscles or back during Fall Leaf Season. Contact us today for an appointment and #getmovingCT.

Nine tips to help with Osteoarthritis

Arthritic seniors hands cutting flowers

If you’re middle-aged or older, it’s likely you have some Osteoarthritis in your hands, fingers, hips, knees, feet or spine. The most common form of arthritis, Osteoarthritis occurs when cartilage between joints and bone gradually wears away causing joint swelling, pain, stiffness, deformity, and reduced range of motion. Most often X-rays are used to diagnose and assess the amount of joint loss, or other issues that can occur like thinning bone, reduced joint space, joint fluid, or bone spurs. If you have osteoarthritis, here are some options your Orthopedist might recommend.

If you’re in pain, seek treatment and get help!

Nonsurgical treatment for joint mobility, strength and pain relief can include:

  • Lifestyle changes
    • Lose weight to reduce joint stress
    • Rest and ice when swollen
    • Include low-impact exercise such as stretching, walking, water exercise, swimming, muscle strengthening and cycling to help strengthen your muscles, joints and keep you active.
  • Medications to ease pain and swelling
    • Use oral NSAIDs (non-steroidal anti-inflammatory drugs)
    • Use corticosteroid or hyaluronan injections in the joint to provide pain relief and cushioning.
  • Walking aids as needed
    • Use supportive/assistive devices – braces, splint, elastic bandage, cane, crutches, or walker.
  • Physical therapy
    • Improve balance, flexibility, range of motion, reduce pain and strengthen the muscles supporting the joints.

OrthoConnecticut recommends you consult your orthopedist surgeon for advice on surgical options, which might include:

  • Arthroscopy
    • In some cases, can temporarily improve pain
  • Osteotomy
    • To realign and reduce joint pressure
  • Joint fusion
    • To fuse bones together and eliminate joint flexibility
  • Partial or complete joint replacement / arthroplasty
    • Resurfaces the arthritic bones with manmade components to eliminate the arthritis and substantially reduce or even eliminate pain.

OrthoConnecticut Can Help

Our physicians and physician assistants are available to diagnose and advise you on the best ways to treat your Osteoarthritis,. Contact us today for an appointment and #getmovingCT.

Girls and Sports is a Win-Win

Schoolgirl baseball team in a team huddle with their coach

Girls participating in sports is a win-win that stretches far beyond known physical aerobic benefits. Being part of a team encourages cooperation, self-reliance, confidence/self-esteem, friendships, adventure, fun, health benefits and the joy of movement and teamwork that carries into adult life.

Are there obstacles? Yes! There are fewer obstacles because of Title IX, but disincentives such as cost, access, and “throws like a girl” comments still exist. Even so, the benefits certainly outweigh them.

What are some of the benefits? According to momsTEAM, a trusted source for parents, sports benefits girls in many ways including getting through the trials of adolescence:

  • Better physical health including better self-reported health, healthier menstruation, stronger bones, and fewer chronic illnesses later in life. Even reduced cigarette/drug use and less sexual activity are linked to playing sports for girls.
  • Higher body esteem plus lower risk of obesity and sedentary lifestyle – Harvard Medical School studied girls between 5th and 12th grade and found a positive relationship between girls playing multiple sports and developing healthy eating habits with good body images.
  • Stronger grades, lower dropout rate – studies have shown higher organization in setting priorities and budgeting time, and better performance in math and science. “High school athletic participation significantly lowers the dropout rate for white females in suburban and rural schools and Latina athletes in rural schools.”
  • Deeper social networks and higher peer acceptance – team sports help develop close friendships and greater entry into the complex social hierarchies of high school. Physical activity is also linked to reduced stress, depression and teen suicides.
  • Enhanced career benefits – team sports nurtures leadership and teamwork skills, self-confidence, and broadens the ability to speak sports vernacular. Donna Lopiano, CEO of the Women’s Sports Foundation, observes, “Sports is nothing more than organizing a group for high performance. And that’s what businesses do.”

Tips to keep girls in the game as they grow into adulthood

  • Make sure she is hydrating and participating in safe muscular warm-ups, stretching, and cool downs to reduce risk of injury.
  • Pace participation and training to her body strength and stamina.
  • Help her maintain balance between athletics in her overall repertoire of activities, R&R time, and schoolwork.
  • Keep an eye on stress and seek to main balance on girls wanting to achieve a certain level of advancement – let it be fun and a natural progression to wanting to be physically active as adults.
  • Show your girls, through your activity, that aging does not mean less activity or enjoyment of sports! And if there is pain, how to rest, ice and get help.

OrthoConnecticut & OrthoCare Express Can Help

Our physicians and physician assistants are available to advise on sports safety. We know accidents happen, that’s why walk-in orthopedic specialist care is available 7-days a week at our urgent care service,  OrthoCare Express. Download our vCard so the contact information is already in your address book, should an emergency happen.

10 Tips for Managing Knee Pain When You Travel

Close up of woman leg with pain - long driving on the way.Knee pain while traveling is common, but if you’re prepared you don’t have to be sidelined. Sitting in tight, no-room-to-stretch airline seats, bouncing trains or buses, and sitting in one position in a car for too long can exacerbate pre-existing knee conditions or create knee stiffness and muscular cramping.

Whether it’s arthritis, runner’s knee, kneecap, meniscus, ligament, or other knee conditions causing you discomfort, employing these helpful strategies can reduce or eliminate knee pain while traveling.

General Strategies

  • Dress comfortably in loose or stretchy clothing, wear supportive shoes and compression socks to increase circulation and help prevent blood clots.
  • Plan breaks in your schedule so you can minimize long stretches of travel. Shorter hops mean more walking and stretching – – and the breaks can enhance your explorations at different destinations along the way.
  • Don’t sit too long, move and stretch more. Get up and walk around to avoid stiffness or cramping and to relieve pain. Slide your feet/legs forward and back while seated to stretch your muscles and knee joints – be sure to repeat often.
  • Seat location can help. Reserving an aisle seat (preferably a bulkhead) on planes, trains and buses makes it easier to stretch legs (periodically) into the aisle.
  • Know your cars cruise control. If safe, periodically use cruise control while driving to stretch your legs out. Make frequent rest stops to stretch and move.

Tips to Prepare for Travel

  • Ask your Orthopedist about preventative treatment. Would a knee brace, assistance device, compression socks, corticosteroid or hyaluronic acid injection (to reduce pain or lubricate your joint), or anti-inflammatory medication be of help for your knee condition.
  • Keep all advised medications in a handy location and in the prescription or over-the-counter bottles for easy identification and safety instructions. Ask if premedicating 30 to 45 minutes before travel is helpful.
  • Be prepared for icing or heating your knees. Why not pack a reusable hot or cold bag for relieving sore knees. Ask your doctor which is appropriate for your condition.
  • Ask your Orthopedist for knee strengthening exercises. Some examples include:
    • Pull your heels. Strengthen your hamstrings by lifting your toes with your helps on the floor until you feel tension in your hamstrings. Hold for 10 seconds.
    • Lift your legs. Do straight leg lifts if room allows to strengthen your quadriceps (or front thigh)
    • Slow and careful backward walking to strengthen hamstrings and stabilize knees over time.

Tips Post Travel

  • Keep moving, if possible, to avoid stiffness. If in pain consider applying heat or ice as appropriate, rest and elevate your knee. Does your hotel have a hot tub? Go and enjoy for stiff muscles. Most importantly, enjoy your travels.

OrthoConnecticut Can Help

Our physicians and physician assistants are available for travel consults in advance of your journey. Contact us today for an appointment and enjoy a safe and wonderful trip!

Reference: thepointsguy

Today’s Youth Sports Injuries and How to Keep Up

By Dr. Joshua B. Frank, OrthoConnecticut, Coastal Orthopedics

Lacross-girlsOver the years we have learned a tremendous amount about sports, physiology, bio-mechanics, and technique. This advancement in knowledge has allowed athletes to become faster, stronger, quicker, and more efficient.

Sports medicine has advanced concurrently, and there has been a particular focus on youth athletes. Sports injures can be thought of in two categories: acute and sub-acute, or chronic injuries.

Acute injuries can cause immediate pain, are often quite obvious. In some cases, the initial injury is not very dramatic and may not cause a person to stop playing sports. These injuries should be addressed in a timely manner, as negligence and lingering pain can cause permanent disability. Children can sustain similar injuries as adults, and we have witnessed that the diagnosis of pediatric anterior cruciate ligament (ACL) and meniscal injuries is on the rise. This may be related to increased awareness and better diagnosis of these injuries. If left untreated, these injuries may lead to further damage to the knee and even the onset of early arthritis. Acute knee injuries should be evaluated by a physician on medical professional and may require x-rays or MRI.

Sub-acute or chronic injuries can also sideline a young athlete. While sports are great and teach children excellent life skills as well as improve physical condition, there is a point where overuse of specific joints and muscles can be problematic. The threshhold may be different among different athletes and may change as a child grows.

In an effort to improve athletic ability, children and adolescents are often specializing in one sport and participating in that sport year-round. Whether it be on a team, in camp, or even in the backyard, year-round sports can lead to fatigue and injury. Overuse injuries can occur all over the body. Thee are even names to associate injuries with certain sports. For example, a chronic, over-use injury to the growth plate of the proximal humerus (shoulder) is known as “Little Leaguer’s Shoulder.”

Obviously, these types of injuries are not limited to baseball. We do not yet know how much time is too much time in gymnastics practice, or ice-skating or even playing basketball outside. We do believe that performing multiple sports over the course of a year allows for different muscles to be used and rested. Also, periods of rest and time without any major sports participation is also beneficial.

Another important recommendation is to prepare for the upcoming season well in advance. A period of limited activity followed by a sudden onset of intense training can easily lead to aggravation of growth plates, tendons, and apophyses. In general, a graduated schedule of increased activity with appropriate stretching may help prevent these conditions. Even though training camp often begins in August, young athletes should be preparing on their own, well in advance of these intense training periods.

We are delighted to see so many youth engaged in fitness and athletic activities, especially as obesity rates grow in the country. With the increased prevalence of childhood obesity, it has become even more evident that many children are not nearly active enough. With appropriate training, rest, and conditioning we hope to prevent many injuries and keep our young athletes safer.