Chronic Pain

By: Dr. Robert Inesta

Over 100 million Americans suffer from chronic pain, costing a total of $560 billion – $635 billion between medical expenses and cost related to disability days and lost wages, according to the Institute of Medicine of the National Academies. Those are large and disturbing numbers. So what is chronic pain and what can we do about it?

Chronic pain is different than acute pain, or the initial pain following an injury.  Acute pain usually originates from a specific incident in which a tissue is damaged, or potentially damaged, and as a defense mechanism, the brain alerts the conscious mind with a pain signal. The purpose is to prevent activities or situations that may further insult the tissue. This acute pain pattern is a healthy neurological response and necessary for survival.

Chronic pain on the other hand, lasts longer and is often due to increased sensitivity in the nervous system. This can occur without an acute incident, or it can be the result of a transition from acute pain to a chronic state. Chronic pain may be present without any actual tissue damage at all. A tissue may have been damaged or injured and then fully healed, but because the nervous system was sensitized and not treated appropriately, the pain pattern became embedded and remained. It is as if the brain were a computer and pain software was running, leading you to falsely believe that there was a problem somewhere in the hardware. The true problem is a programming glitch.

A recent study by Mansour, et al, in the journal “Pain”, showed that structural properties in certain areas of the brain can indicate whether someone is likely to have chronic pain or not and whether they are likely to transition from acute to chronic pain, or have their acute pain resolve with treatment. This is important because it demonstrates that much of the chronic pain process is truly in the brain. So, one can conclude that in order to effectively treat chronic pain, we must treat the brain. We must reprogram the computer and install different software. How do we do this?

There are different natural ways to treat, or influence the brain, or central nervous system. Among these include rehab techniques such as neurosensory training, proprioceptive training, Graded Motor Imagery, meditation and acupuncture. Often a combination of these methods is best, with a good balance of active and passive care. All of the above methods can potentially alter brain morphology and function in a positive way.

Acupuncture, which has been around for thousands of years, has been shown through much modern research to directly influence the brain. Studies using functional MRI have demonstrated that areas of the brain that play a significant role in the pain process are altered by acupuncture treatments. In addition, areas related to nervous system imbalances due to mental/emotional stress, such as the hypothalamus, medulla oblongata, midbrain and somatosensory cortex, are also directly influenced by acupuncture. Some of the ways acupuncture affects the brain are by modulating activity in sensitive areas and regulating neurotransmitter and hormone activity.

This is very promising information for those who suffer from chronic pain. Many of these patients so not know where to turn. They have spent thousands of dollars on imaging and testing that is inconclusive, and treatments that are ineffective. They bounce around to different professionals and grow overwhelmingly frustrated when their efforts remain fruitless and they are told there is nothing more that can be done. They become hopeless and depressed. This unfortunately is extremely common. But there are solutions. Successful treatment often takes work, time and diligence. It is a process of reprogramming and it may be different for everyone. With the right treatment strategies, I believe chronic pain can be overcome.

Realize Your Strength Everyday (RYSE)

By: Ann-Marie Saccaruto

Private training is the best way to achieve the results you want in the gym. However, what if money or your schedule was an issue? What if you thrive on the camaraderie of a team atmosphere? This is where group training sessions come into play. Group training allows you to get the feeling of working with your own private trainer, but it provides you with the added support and motivation of a team atmosphere. In this dynamic, everyone is working to achieve their own individual goals, yet they are all pushing each other to become better and to overcome the challenges placed before them. This builds inspiration, motivation, trust, friendship, and many other positive results. The training is not where it ends either; many strong bonds are created in this type of environment between individuals that go way beyond the gym. Something magical happens when you go through and overcome challenges together, when you push each other & lift each other up to achieve success, and when you can all celebrate your achievement with fulfillment, respect, & deep understanding because you know what you went through to get there…together.

Group training is also a great way for corporations to work on team building. It allows a brief stress relief from the office, opens doors for greater interaction, and creates stronger bonds in the work environment. As an added bonus to the corporation, it has also been proven to provide greater work production. So, with that being said… it is with great excitement that I announce the opening of RYSE Training & Performance.

I have partnered with Pure Fitness to bring this incredible concept and training experience to life. RYSE stands for Realize Your Strength Everyday, and is all about building every individual who walks in to be stronger, both physically and mentally, when they walk out. My commitment is to inspire every individual who walks in the door to achieve their goals, and to awaken the greatness that lies within them.

RYSE will offer private training, partner & semi-private training, as well as daily group training sessions that started July 1st. Whether you are just starting your journey to new strength, fitness, health, and transformation through training, or if you are the elite athlete or avid gym- goer, the training staff at RYSE will guide you on the path to achievement, success, and the results you are looking to attain.

There will be several group training session concepts that RYSE will be bringing in the near future. To kick it all off, we will be starting with our classes called: ADAPT, AMPED, & RYSE UP.

ADAPT will help to get you on the right track to building a proper foundation. In the session, we will take your body through various movement patterns and planes of motion in order to build muscle recruitment, as well as increase an understanding of movement, function, & performance throughout your body. We will also focus on providing your body with a solid foundation of core stiffness, which is vital for all actions of human performance, as well as athletic performance. Core stiffness is the limiting factor of strength, movement, function, and performance. At RYSE we want you to be LIMITLESS.

AMPED is a class designed to do exactly that, GET YOU AMPED! This is a 30-minute, high intensity, metabolic blast to your system. If you are short on time – say you don’t have time for the gym, or are looking to push yourself in your training – then you need to be here. We will combine HIIT (high intensity interval training) circuits, along with high intensity performance & strength training circuits to provide you with an incredible training experience, and increased performance, strength, & conditioning. It will turn your body into a natural fat burning inferno.

RYSE UP is an integrated, hybrid, strength & performance training session. This session will test you, push you, and inspire you to reach your Ultimate Performance Potential. We will utilize many different training dynamics, keep you progressing further each week, and motivate you to RYSE UP to the challenge.

For more details on group training sessions or private training feel free to email me at:

Is Your Negative Mindset Setting you up for Failure?

By: Alex Diaz PHD

In a recent meeting with the parents of a talented teen squash player, I learned that they were concerned about their son’s difficulty to embrace game challenges and that he was having a defeated attitude even before the game started. Despite the teen player winning the first game in a recent match, his body language suddenly changed when he encountered challenges in the second game. The young player ended up losing the next two games, and consequently, the match. When I later spoke with him, he mentioned that he was aware of the opponent’s higher seeding and, before the match even started, he was expecting to lose. Although he started by playing well, his self-prophecy eventually became a reality.

It seems more common than not that before a game or match begins, an athlete becomes overly preoccupied with factors that might negatively affect the outcome of his/her performance. The focus of attention is on the potential risks rather than on maintaining a positive outlook. Their minds begin to spin negative scenarios, and their heart rate accelerates as they already envision poor results. This pre-game routine may not necessarily stop athletes from trying hard and attempting to do their best. However, what tends to happen is that when small obstacles get in their way, these athletes are more likely to throw in the towel. Maybe the athlete is not fully aware of this, but he/she has inadvertentlyprogrammed his/her mind to quit trying. Although underperforming becomes a repeated pattern, it is often justified under the eyes of the athlete, who finds reasonable excuses for the negative outcome.

Unless we make a conscientious effort to change this expecting-to-lose mindset pattern, an athlete will become victim of his/her own mental undoing. Soon enough, the athlete will primarily look at the negative aspects of his/her performance and zero in on these outcomes as a way to justify his/her losses. Unfortunately, in order to avoid a repetition of this outcome, the athlete lowers his/her expectations only to eventually leave the sport altogether. This is a dangerous consequence where there is no upside potential.

Jack Nicklaus, regarded as the most successful golf professional and greatest winner of Major golf tournaments, noted that most golfers were intimidated by the tough golf course layout in Major championships.  He said that most golfers were primarily concerned with the fast pace of the greens or the long length of the rough. He felt he had an edge because the other golfers were focusing so much on the negatives. Nicklaus embraced the toughness of the course by setting up strategic golf course management that would give him the greatest chance to beat the course. He studied each hole meticulously; he envisioned each shot with as much detail as possible, and he constantly gave himself positive feedback. Part of his course management strategy included the study of the safest areas to err a shot, which would still give him a good chance to salvage the hole.

Just like Jack, athletes should approach their game with enthusiasm and positive energy. Each athlete devotes a lot of time and effort to get ready for his/her upcoming event. I am sure most athletes would like to spend more time improving certain parts of their technical or endurance skills. However, when the game is about to start, each athlete is facing an opponent whose mission is to beat the other. It is at this precise moment when his/her mental skill should be sharp and working on his/her favor.

In order to improve your chances to perform at your best, the following recommendations might be helpful:

1- Recognize what is out of your control:

The way the golf course has been laid out, the seeding of the opponent, the calling of a referee, the cheering of an opposing crowd, and how the opponent responds to your shots are ALL factors you have NO control over. It is a complete waste of your energy to focus on factors that are out of your control. Spend some time going over factors  that you have no control over and come to terms the fact that, no matter what happens, you have no control over them. These factors are just part of the sport you chose, and as such, embrace these obstacles rather than fight them.

2- Recognize what is within your control:

How you physically, strategically, and mentally prepare yourself to compete are all factors you DO have control over. When you see a water pond in front of a golf green, bring full attention and visualize the shot to where you want to precisely land the ball on the green. Zero in 100% of your attention on the positive outcome and trust that you will do just fine. If your tennis opponent just won four games in a row, bring your attention to what do you well. At this point of the match, it becomes a mental game. The stronger you are, the greater your chances to turn it around. And, if you lose, you will still feel much better knowing you did your best to win.

3- Have your own plan (just like Jack):

Show up to your game knowing what positive self-statements you will use throughout the competition. Maybe you say: I trust in my own game; or I am strong and will stay with it; or I have powerful legs. It does not matter what positive statement you choose. As long as you use it consistently, it will enhance your chances to perform at your best.

If you find yourself defeated before the game even started, bring the attention back to what your strengths are, embrace the positive side of you, as a person and an athlete, and plan a sound strategy and go for it.

To Juice or Not to Juice

By: Denise Groothuis RD CPT

The juice cleanse has become increasing popular as consumers strive to lose weight and detoxify their body from chemicals and processed foods.  During a juice cleanse, a person is limited to solely fresh fruit and vegetable juices and water for a period of time ranging from days to weeks.  The juices are usually freshly made and unpasteurized, and they offer an average 1000-1200 kcal per day.  While many of these juices are nutritious, a liquid juice diet may be more harmful than beneficial.

Whole fruits and vegetables are more nutritious than juices since whole foods have more fiber and antioxidants in their skin and seeds; the amount of fiber and antioxidants is decreased during the juicing process.  Because there is less fiber in the juice, the body absorbs the carbohydrates at a much faster rate, which raises blood sugar levels quickly.  Additionally, satiety is decreased when you drink beverages rather than chew food, and this fact combined with the decreased fiber in juice can leave you feeling less satisfied and less fulfilled.

A diet filled with only juices is missing many critical nutrients that your body needs to function properly, including adequate protein and fat.  Protein is the building block for tissues and muscles. It is also needed for metabolism and proper hormone and immune function. Without adequate protein, your body will break down muscle as more vital cellular processes (e.g. respiration enzymes, blood cells) recycle muscle protein for their own requirements.  Fat is necessary in the body as a source of energy and for the structural components of cell membranes. Adequate fat is necessary to regulate body temperature and help protect the heart, kidneys and liver. Additionally, fat is needed for the absorption of fat soluble vitamins which play a role in brain development, blood clotting and managing inflammation.

It is important to recognize that a juice fast can be especially dangerous for some people. Anyone with cancer, diabetes, kidney disease, or nutritional deficiencies should avoid juice cleanses. The high antioxidant level and low protein level can be dangerous for those undergoing chemotherapy, the high sugar content can increase blood sugar levels in diabetics, and the high levels of potassium and other minerals can be dangerous for those with kidney disease.  Additionally, pregnant women and those with autoimmune diseases should avoid juices cleanses because they are unpasteurized.

Despite the aforementioned issues, many people report feeling great and having more energy while on a juice cleanse. This is most likely because the daily diet of the general population consists of many processed foods and chemicals, few fruits and vegetables, and not enough water.  One of the benefits of a juice cleanse is the number of fruits and vegetables consumed in a day; you would definitely meet the recommended servings of fruits and vegetables. It can also help someone break the cycle of unhealthy eating habits.

50% of Americans Experience Activity-Limiting Foot Pain

By: Dr. Josef Geldwert DPM

These days, foot pain is just as “American” as baseball and warm apple pie. Eight in 10 Americans say they have experienced a foot problem this year. Of those with foot pain, 50% say it has negatively affected or impaired their quality of life, restricting activities like walking, exercising, working, and playing with grandchildren. Eighty-three percent of people with chronic foot pain find these activities hindered. Of the 1,000 people surveyed by the American Podiatric Medical Association, 39% said they would exercise more and 41% said they would participate in more activities if it weren’t for their foot pain

Foot Pain Remains Pervasive in American Life

When it comes down to American attitudes about feet, not much has changed since 2010, says the American Podiatric Medical Association. The survey found that the foot continues to rank low on the list of body parts that people view as important to their well-being.

“It’s not surprising to see how many people are affected by foot pain, when survey results show that we view our feet as the least important body part in terms of our overall health and well-being,” APMA President Frank Spinosa, DPM, said in a press release. “Our feet are literally and figuratively the furthest things from our minds.”

Study Finds Shoes the Main Culprit Behind Americans’ Aching Feet

The study focused on chronic generalized pain caused by shoe choice, rather than people afflicted by sports overuse or traumatic injuries. Not surprisingly, high heels were the chief offender, with 71% of all women saying these shoes hurt their feet. Even so, the average woman owns nine pairs of these torturous shoes. Half of all women say they’ll wear heels that are three inches or higher.

Rounding out the top five most painful shoe types were:

  • – Barefoot runners (27%)
  • – Boots (26%)
  • – Flip-flops (23%), and
  • – Flats (23%).

We’ve talked at great length about the perils of some of these popular shoe styles. Of course, even athletic trainers can be a real “pain in the foot” if you buy the wrong type or fit for your feet — or if you don’t change them out often enough based on the amount of physical activity you’re doing. One of the things we do at The Center for Podiatric Care and Sports Medicine is assess your footwear, as well as your gait, to help you select the best types of shoes for your lifestyle and your unique biomechanics.

Why Not Visit a NY Podiatrist to Treat Your Feet?

You would think podiatrists would be raking in the customers, given how pervasive foot pain is in America. However, most adults (60%) would sooner speak with their general practitioner or do a Web search (48%) than consider visiting a podiatrist. In fact, only a third of those surveyed said they would seek expert care from a podiatrist. The good news is that 88% of those who have visited a podiatrist said they are “extremely satisfied” with the level of care they received — much more satisfied than the 76% of people who said they were satisfied with the foot pain help they received from a primary care physician. More than a third of those surveyed said their podiatrists also helped identify another health issue they had.

“Podiatrists are physicians, surgeons, and specialists. They’re ready and able to treat diseases, injuries, and deformities of the foot and ankle, as well as the foot problems Americans experience most often: heel pain, plantar fasciitis, nail fungus, and foot odor,” said Dr. Spinosa. “They can also catch signs of diabetes, arthritis, and nerve and circulatory disorders, all of which can be detected in the feet.”

Shoulder Pain and the Rotator Cuff

By: Dr. Rick Weinstein MD

As we get older (more mature), it is very common to develop shoulder pain. Pain may be due to specific trauma, such as lifting weights or directly hitting the shoulder, but it is much more common to develop pain without a specific injury. The most common reason for shoulder pain in adults older than 30 is due to impingement. The acromion bone, which sits on top of the shoulder, can irritate the bursa and then rub against the rotator cuff, causing impingement syndrome. This causes the development of rotator cuff tendinitis or bursitis which causes pain, typically when reaching the arm overhead. If the bursitis and tendonitis persists, this may lead to a tear of the rotator cuff.

The rotator cuff consists of 4 muscles that allow us to rotate our shoulder. The most commonly torn and injured part of the rotator cuff is the supraspinatus tendon, which sits on top of the other tendons. The problem with a tear of the rotator cuff is that if there is a complete tear it will never heal. My goal as a sports medicine orthopedist is to correct the problem in the shoulder before my patients require any surgery. Almost all patients can get back to normal activities with appropriate physical therapy and avoidance of aggravating activities.

How do we prevent shoulder problems to begin with? Typically, when we work out, we stress the large muscles around the shoulder and neglect the smaller muscles. Well-defined deltoid and pecs look great, but they are only part of the shoulder that needs to be strengthened. Simple rotation exercises with the elbow at the side are extremely important to preventing rotator cuff injuries. This should be done with very light weight initially. With any shoulder workouts with weights or machines, it is best to keep the hands in front of the head and not behind the head. Shoulder presses and latissimus pulldowns should be done in front rather than behind the head.

If you develop shoulder pain or weakness of the shoulder, do not neglect this. If it persists for more than a few days, see a sports medicine specialist. It is better to identify if there is a tear or just tendonitis early on so as to prevent needing surgery. Don’t work through pain because you may be causing significant damage. It is always better to prevent an injury rather than have to fix it!