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Physician Articles

By Brian A. Bast, D.O.

Maintaining core-strength has been a huge focus in the sports and fitness world for the last decade. As the term “core” implies, this part of our bodies is central to most activities we perform, particularly any sports activity. Keeping the muscles at our core strong is important for achieving peak performance as well as avoiding injury. In this article, I will review what core exercises are and why they are important.

Core-strength refers to the spine and the major muscle groups neighboring the spine. These muscle groups include the front thighs, the buttocks, the abdominals, and the layers of muscles surrounding the spine. The interplay among these central muscles groups is essential for any physical activity. For example, think about the various body parts a baseball pitcher engages to throw a ball 100 m.p.h. Central to his pitching ability is the strength and flexibility of the musculature in his lower back and upper thighs, transmitting his leg power up the spine to the shoulders, and ultimately to the hand where the ball is released at blazing speed. Without the core musculature, our limbs are separate objects, unable to work in a coordinated fashion with the rest of our body.

Core exercise has changed over time with a growing awareness to a few key principles. In the past, core strengthening generally meant sit-ups, and a multitude of them. Other exercises like push-ups, pull-ups and jumping jacks also represented core work, but sit-ups and abdominal exercises were often what people spent the majority of their time doing. Today, maintaining core strength is a more dynamic process involving exercises that develop balance, flexibility and strength as well as paying particular attention to injury prevention. Yoga and martial arts, like Tai Chi, are often incorporated into core strengthening programs to enhance flexibility and balance.

Injury prevention is paramount in core strength development. Bad or incorrect form can lead to back injuries, one of the most common reasons people seek medical care. Developing core strength may be the goal of many exercises, but without proper form, back and neck injuries may result. Recently there has been a trend away from sit-ups, given the extra strain on the low back that occurs with the repetitive rocking motion on the lower segments of the spine. In an effort to limit this repetitive stress, neutral spine exercises are favored. These exercises engage the core musculature against gravity in which the spine is held relatively straight or neutral, unlike the repetitive motion common with sit-ups. Examples of some excellent core exercises can be found at:

Developing a core strength program, either through your gym, yoga class or with a health care provider, can help prevent injury while enhancing your athletic performance. Try and refine your program to fit your schedule and borrow from other disciplines to keep it interesting.


By Randolph J. Sealey, M.D.

Many people think of a bunion as a bump or a growth, on their big toe, as their shoes get tighter and more painful to wear, with time. Really a bunion is caused by deformity around the big toe. The big toe gradually angles outward towards the second toe, while the next bone back, the first metatarsal, starts angling inward and away from the 2nd metatarsal. So, what seems like a growth that is enlarging is really a splaying or spreading out of the front of the foot. The more accurate medical term for the deformity is Hallux Valgus. Hallux refers to the big toe, and valgus refers to the outward angulation of the toe.

Hallux valgus can not only cause a prominence that rubs against the shoe and causes pain, but it also can affect the surrounding toes and alter how the foot meets the ground. With the deformity, pressure is often transferred to the second and sometimes third toe. The second toe is often overpowered and can become a progressively painful hammertoe.

There are a number of factors that lead to the formation of the hallux valgus deformity. Genetics plays a part, but shoe wear plays an equally large part. Although, even shoeless societies in the desert are known to develop these deformities, they are far more common where restrictive shoe wear is worn. It is thought that women have a higher rate of hallux valgus, as they tend to favor tighter shoes with higher heals which tend to crowd the toes together. Whatever starts the deformity, they tend to progress as the muscles and tendons that move the joints of the toes slip out of their original positions and becoming deforming forces. Nobody goes to bed with a bunion or a hammertoe and wakes up with straight toes.

The goal of treatment for hallux valgus and for hammertoes is to relieve pain and improve function. Many of these deformities are painless and therefore do not need immediate treatment. Shoes that are wider and roomier in the front and lower in the heel will often relieve painful pressure. Often expensive custom orthotics are prescribed. These will not reverse the deformity and only occasionally relieve pain in patients who have an especially flat foot. If a trial of orthotics is considered, I often recommend an inexpensive but good quality over the counter model.

When shoe modification fails to relieve pain, I will often recommend a bunionectomy. A bunionectomy is really a deformity correction and requires both bone cuts and soft tissue balancing. In planning a case, care must be taken not to perform procedures that are unnecessary, however, it is equally important to perform all of the necessary procedures in order to get good balance to the foot. The alignment of the entire leg and the patients other orthopedic and medical issues need to be carefully considered.

Although, there are a lot of people in the community who do bunion and hammertoe surgery, Lapidus Bunionectomy procedures should never be taken lightly, as a poorly performed operation can lead to ongoing pain and difficulty walking, which can last a lifetime. Not every foot and ankle specialist has been equally trained. Choose your surgeon wisely, and make sure that he or she has the training and expertise necessary to give you the relief that you need.

OrthoConnecticut is the region’s premier, multi-specialty orthopedic practice, helping patients regain mobility, lead active lives, and attain optimal well-being. It is the combined practice of Danbury Orthopedics, New Milford Orthopedics, Coastal Orthopedics and CT Pain Care. 27 fellowship-trained, board-certified physicians offer patient care at 9 offices in Danbury, Darien, Litchfield, New Milford, Norwalk, Ridgefield, Sharon, Southbury and Westport. The practice’s urgent care service, OrthoCare Express, is open 7 days a week for emergencies and is available in Danbury, New Milford and Norwalk. To make an appointment with any of the practice’s specialists, or to learn more visit myorthoct.com or call 1.833.ORTHOCT (1.833.678.4628).


By Mark J. Fletcher, M.D.

Exercise is important. The benefits from regular exercise are well known: improved cardiovascular health; prevention or improvement of osteoporosis; weight loss; increased muscle mass; and mental health benefits of improving mood and confidence. Exercise is good for everyone, regardless of age and health status. Our bodies are designed to exercise and will improve with proper activity.

The principles of training and conditioning are the same for all of us – from beginners all the way up to Olympic and professional level athletes. It is much easier to pick an activity that is fun when starting any exercise program. Having fun while exercising will keep you coming back, even on days that find you tired or stressed.

Most experts recommend that 30 minutes of moderate exercise 5 times a week is appropriate for general health, 45 minutes is even better.

For patients with osteoporosis – walking as little as 3-5miles per week has been shown to prevent osteoporosis and helps to maintain the bone mass you have while other activities such as hiking, dancing, and stair climbing can be as effective. Strength training will also strengthen bone as well as muscles. Examples of strength training are weight lifting, resistance tubing exercises, and even water exercise.

For patients with arthritis – Exercise has been shown to ease the pain of arthritis and decrease stiffness. Short walks, bicycling, and water exercise are great way to start if the thought of exercise with painful joints is overwhelming.

Injury is another problem faced by people trying to start exercise and the “weekend warriors” among us. When beginning any new exercise program it is important to gradually increase the volume or intensity of any exercise program to allow the body to acclimate and avoid injury. A good fitness base of moderate aerobic and strength training is essential if you plan to participate in some of the more aggressive fitness activities that are popular today.

Try to add variety by doing different exercises every other time you work out. If you are doing an aerobic exercise 2- 3 days per week, try to add weight training and stretching on other days. If you belong to a gym, a registered trainer can be a useful resource to guide you when you start. Remember to check with your primary care physician prior to starting any new exercise program if you have any significant active medical problems. There is no better time to start than right now, what are you waiting for?

Coastal Orthopaedics surgeons provide complete orthopedic treatments from head to toe in four conveniently located offices: Norwalk, Westport, Darien, and New Canaan. A new walk-in urgent care facility known as Coastal Ortho Express is now opened extended hours Monday – Saturday for sprains, injuries and pain at 761 Main Avenue in Norwalk where patients can be treated without an appointment.

Statewide doctors voted our surgeons “Top Docs Orthopedic Surgery” in CT Magazine since 2009.


By Mark J. Fletcher M.D.

Total hip arthroplasty (THA) continues to be one of the most successful and cost-effective procedures in medicine. THA can relieve pain, restore function, and improve quality of life for patients experiencing hip pain from a multitude of conditions. Over 400,000 total hip procedures are performed annually in the US! The amount of THA will continue to increase due to the amount of individuals wishing to remain active while they age as well as the increased number of obese individuals. Both THA and TKA (total knee arthroplasty) are commonly performed at Coastal Orthopaedics at Norwalk Hospital’s Center for Joint Care.

A THA surgery replaces the diseased hip joint surfaces with synthetic materials to alleviate pain and improve function. Surgery is usually considered as an option once all non-operative methods of pain control have been exhausted. A THA can be life changing with improvements in pain, function, and life quality for patients with severe hip disease. Conventional THA surgery has shown excellent long term survival of the implants.

Significant effort continues to be spent in research to improve THA. Improvements in materials over the past 10 years have yielded a bearing surface, highly crossed linked high molecular weight polyethylene (CL- HMWPE), which wears 90% less than previous versions. This one change may extend the functional life span of a THA by decades. The improvements of the femoral components, with the introduction of newer and tougher ceramics, along with CL-HMWPE have provided a very durable and long lasting implant combination for most patients. The use of CL-HMWPE and ceramics together maximize the benefits of both materials while minimizing the drawbacks of ceramic only implants (size options, fracture risk, joint squeeking), or metal on metal components (pseudotumor formation, pain, high revision rate from wear debris).

The approach to pain management has been revolutionized over the past 5 years. Preemptive use of non-narcotic medications, along with spinal anesthesia, can minimize the generation of pain from surgery even before the procedure begins. After surgery a combination of traditional and newer non-narcotic medications are used along with a minimal amount of oral narcotic medication. This multimodal pain control method allows the patient excellent pain control while avoid side effects caused by injections of narcotic medications. The side effects of narcotic medications (nausea, vomiting, itching, dizziness, constipation) are typically the reason that patients need to stay in bed and prolong recovery from surgery. Multimodal pain control methods, along with less invasive surgical techniques and aggressive physical therapy protocols have significantly lessened the hospital stay for all total joint replacement patients. These combined improvements have even made it possible for some patients to go home the day after, and even the day of, surgery. At the Norwalk Hospital joint replacement center the average hospital stay after joint replacement – for all patients – is only 2 days.

Surgical approaches have continued to be developed to decrease soft tissue injury at the time of surgery as well as minimizing pain after surgery while allowing more aggressive rehabilitation. The direct anterior approach (DAA) and direct superior approach (DSA) to THA have recently been developed as methods of minimizing soft tissue trauma during surgery. It is thought that both approaches allow earlier and less painful walking after surgery by avoiding the detaching of muscles required in more traditional approaches. These newer approaches, along with multimodal pain control, provide the following advantages:

  • Less soft tissue damage (muscle/tendon)
  • No need for hip precautions after surgery
  • Shorter hospital stay
  • Lower dislocation rate
  • Less pain after surgery
  • Minimal narcotic medication needs after surgery
  • Less blood loss
  • Smaller incision size

The physicians at Coastal Orthopaedics have been performing total hip arthroplasty for over 40 years. Both the direct anterior approach (DAA) and the direct superior approach (DSA) are currently performed by Coastal Orthopaedics surgeons working at Norwalk Hospital Joint replacement Center. Coastal Orthopaedics continues to be involved in the implementation of advanced techniques and methods into the care of patients with hip pain. Do not hesitate to schedule an appointment to discuss joint pain with one of our surgeons. We are happy to determine a diagnosis and create a plan of care with you to best address your problem.