The above picture is not staged. It was taken of me just prior to my playing in my last Handball National Tournament when I was 56. Handball and skiing were my athletic passions. Medicine was, and still is, my professional passion. By passion, I mean that I played 5-6 days a week starting in my early 20s. I skied whenever I could, given the limitations of time and timing. However, as you can see from the above picture, injuries plagued me. This is what I needed to do every day that I played, in order to play and compete. In fact, the injury that got me into Rehabilitation Medicine occurred when I was 27 years old, playing for my Handball Club championships. I ruptured my major hip stabilizer. There was no surgical solution available, so I started wrapping my hip with Ace wraps, and fortunately, this allowed me to function at a high level, and to continue to play aggressively, for the next 30 years.
I had already had 2 shoulder separations, and some hand injuries. I have hammer-toes and medial compartment syndromes. I have had heel spurs, Osgood-Shlotters Disease of the knees, Pulmonary infarction, arthritis, and Raynaud's syndrome.
I also had Fibromyalgia (before it had a name) and just accepted that fact that if wanted to play, I had to put up with some aching and pain. I took Naprosyn and tons of Tylenol, and this approach allowed me to continue to play regularly, and aggressively.
I also had some circulation problems, but I loved skiing. I just accepted the fact that I had to dress more warmly than my other ski buddies, and I also had to wrap my knees and my shoulders when I skied. I tore my Achilles tendon on the right, both plantar muscles, playing handball, and tore the medial meniscus of my right knee twice, first when I was 42 and then again when I was 54.
When I was 55, someone did not get out of my way and I ruptured my left biceps, but was able to play. However, unfortunately, one year later, when I was 56, while skiing the bumps in Wyoming, my left ski released while I was air borne, and I hit a rock, rupturing my right shoulder rotator cuff muscles and the right biceps. I lost the ability to play the piano, but fortunately, through the efforts of my orthopedic surgeon, Dr Charles Silberstein, who performed some tendon transfers on my right shoulder, I was able to resume playing the piano. To him, I am eternally grateful.
In my 60s, I had blood clots to my lungs and missed several years of skiing. Now, at age 73, I still ski, but less intensively. I still work regularly, and with the same passion that I have had all of my life. I play golf and dance and enjoy helping people by teaching them how to help themselves - free of fear, and more empowered and excited by life.
Looking back on my life with 50 years plus experience of Playing hurt, and with an extensive 35 years of experience in dealing with injured athletes, injured workers, and disabled people, including patients with Fibromyalgia and Myofaxcial Pain and Dysfunction, and, of course, Low Back Pain, neck and shoulder pain, I can truly say that Keeping Active keeps you alive and feeling better.
- Norman B. Rosen, M.D.
Comprehensive Pain Management
One of the major services that we, at Rehabilitation and Pain Management Associates, provide is Acute and Chronic COMPREHENSIVE PAIN Management.
Pain, from any cause, is one of the more challenging and difficult problems that physicians encounter. This is due to the fact that the complaint of "Pain" can apply to a variety of conditions, ranging from a symptom that reflects no serious underlying medical or surgical problem to a sign that a more serious underlying medical, surgical and/or psychiatric condition may, in fact, be present. Fortunately, most pain complaints are not serious; the complaint subsides with time, and does not interfere with life expectations, or with "quality of life", except transiently.
However, when disability from Pain, exceeds a reasonable period of time, then, the chief complaint of "Pain" must be evaluated from a more comprehensive standpoint. When Pain interferes with work, with play, with sleep, with relationships, with escalating fear, and anxiety, then Pain clearly needs to be treated more aggressively, paying attention to all possible factors that may be contributing to the disability that is present.
Pain is now considered to be one of the most important "vital signs" (along with pulse, blood pressure, weight, breathing rate, and height), Unfortunately, precious few physicians are formally trained in the comprehensive management of Pain, and are often unwilling or unable to handle the multiple factors that cause pain to persist and to cause prolonged disability.
Although "pills" and "rest" (the most common advice that physicians give when a patient presents with what seems to be a "simple" pain problem), these recommendations may actually make the more serious potentially disabling conditions, to get worse. This is due to the fact that unnecessary time is lost, and a medical condition called "deconditioning" sets in.
Furthermore, the prescription of "pills" alone is often not adequate "pain management" in many instances, since pain is usually due to more than one problem alone. Further, the use of "pain pills" alone without using a combination approach to treatment is often inadequate, and, although effective, on a short-term basis, often sets the stage for patients losing valuable time by allowing "deconditioning" to set in. This merely prolongs the recovery process and makes restoration to wellness harder to achieve - particularly in patients who do not exercise as a matter of choice.
Similarly, the prescription of “rest” often makes the underlying problems that caused the pain in the first place to get worse.
Pain is usually not due to "overuse" but rather to inefficient "use" of tissues - particularly in patients who do not exercise regularly or properly.
There is often a great deal of confusion in the minds of many people because pain may merely be a symptom that something in the body is awry or it may be a disabling problem, in of itself.
Pain is usually due to combination of factors, including physical factors, psychological factors, social factors, multiple co-existing medical factors, and sometimes spiritual factors.
Treatment, therefore, must be multi factorial and must address all of the above factors simultaneously and be comprehensive in nature.
Pain is difficult to treat because pain is difficult to measure.
Pain is variable and is generally affected by many factors - including physical factors, emotional factors, social factors, spiritual factors, educational factors, age, sex, other disease states, level of physical and emotional "fitness", energy level, sleep, and even be of function of inadequate education about the nature of pain, and putting life goals on "hold" while waiting for pain to go away.
Time does not heal; it just makes the patient in pain suffer longer, and have less hope for a good future.
Needless to say we are not all alike. We all cope differently. We all have different life styles and different needs and goals. Some of us are fear-based; others are angry; others are depressed or sad; others magnify their disability and the amount of pain that they have; still others tend to be stoic about their pain and their disability and do more than they should be doing - too soon, too early; others may feel guilty about their pain, and believe it or not, there are even some people who enjoy having pain and who don't want to do anything about it.
Regardless of the above, we feel that merely because you have pain does not mean you cannot still have a high quality life and be able to function - despite pain. After all, for those of you that have permanent pain or disability, what choice do you really have? Your choice is one of two: suffer with your pain or try to have the highest quality of life possible - despite having persistent pain.
And once you decide that you want the highest quality of life possible, you are only faced with two decisions: How to achieve it? and Who to go to?
We obviously feel that we are the best facility to help you solve your pain problem. We have unique expertise in dealing with pain, and people with pain. We have been in practice for over 30 years and have been among the world's leaders and innovators in the fields of pain management and rehabilitation.
Under the direction of two Board-certified physiatrists (from The American Academy of Physical Medicine and Rehabilitation), Norman B. Rosen, M.D. and Howard J. Hoffberg, M.D., Rosen-Hoffberg Rehabilitation and Pain Management Associates, P.A. is a unique private practice dedicated to serving patients with acute or chronic pain, or who have any physical or stress-related disability from any cause.
Since PAIN is due to so many factors and is so variable, it has been determined that the best way to treat pain is to approach it from a multi-faceted approach. This requires a team working together to try to solve persistent symptoms and persistent disability. This means using a "multi-disciplinary team approach".
Rehabilitation and Pain Management Associates was the first private Rehabilitation practice in the Baltimore area to utilize this type of an approach.
Our multi-disciplinary team consists of physicians, nurse practitioners, physician assistants, physical therapists and social workers, all of whom are licensed and certified in their respective fields.
Our approach is holistic, with an emphasis on physical, emotional and spiritual wellness. We utilize a gradual and graduated sports medicine approach for the average person, featuring wellness through exercise, stress reduction, and improved control over life events, including physical and emotional disability.
For more information about all of the services and areas of expertise that we have, please press the "Services Provided" tab at the bottom on this screen.