Dec
09

The truth about vitamins: Part 1 of 2

Robin Tanner, MD3

Guest Author: Robin Tanner MD3

3rd Year Medical Students at Geisinger Commonwealth School of Medicine (GCSOM)

Robin Tanner MD3 is a third year medical student at Geisinger Commonwealth School of Medicine. Originally from Danville, Pennsylvania, Robin received her bachelor’s degree from Auburn University in Auburn, Alabama. Aside from studying medicine, she enjoys learning about World War II, politics, classical literature and new languages. She volunteers with different pediatric organizations including the Make-A-Wish Foundation and Camp Victory. She hopes to pursue a career that incorporates medical education, pediatrics and global health. 

We have all seen that one aisle at the grocery store, pharmacy or health food store that overwhelms us …the aisle with hundreds of little bottles with tiny font and colorful pills. It’s the vitamin aisle.  It is full of pills reaching from the floor to ceiling, all of which claim to improve your health in some aspect. Which do you pick? One says that it will improve your energy. Others claim to make your hair grow faster. Is this all too good to be true?  This one aisle is just a small piece of a $30 billion industry in the United States. How did this happen? Is it money well-spent?

What is a vitamin?

What is a vitamin? In a general sense, it is a substance which is used by the body for processes needed for growth and development.   They assist in the building of proteins and the breakdown of products to create energy for a cell. Many vitamins are consumed in our everyday meals such as vitamin C, found in lemons, and vitamin A, found in carrots.  Many studies have focused on the amount of each vitamin that is required to stay healthy. These studies have lead to a recommend daily intake of each vitamin in the diet, which can be found on the FDA’s website.

History

Scientists have studied vitamins for many years. In 1913, Thomas Osborne discovered vitamin A.  In 1922, Edward Mellanby discovered vitamin D. Many of these discoveries where guided by research focusing on a specific disease where the underlying cause of disease was a lack of the specific vitamin. Many current scientists believe this may have led to the beginning of vitamin supplementation: to avoid the diseases caused by a deficiency.

All throughout the 1900’s vitamins were advertised to improve energy and job performance, as alternative to healthy food choices, and as a way to have more fun in general.  Advertisements like these can lead to confusion regarding the purpose of vitamins and when to use them. Even today, vitamins are still advertised to increase energy and avoid unwanted illnesses. 

Do you need a vitamin?

So, do you need vitamin supplementation? Many research trials have failed to demonstrate a significant benefit from vitamin supplementation in preventing diseases which are not caused primarily from lack of a specific vitamin itself.  This is especially true in individuals who eat a well-balanced diet, because many of the vitamins needed for the body to work properly are already present in the food we eat. Moreover, taking a vitamin supplement does not provide an alternative to a healthy diet.  

Some research has shown that there is even a potential for harm when ingesting a vitamin level higher than the recommend intake.  For example, Vitamin E and folic acid may lead to increased risk hemorrhagic shock, a condition where bodily organs do not receive enough blood and oxygen.  Vitamin supplementation also has a potential risk for harm when mixed with certain medications. Therefore, it is important to tell a medical provider all medications along with supplementations one is taking.  

Although tempting, vitamin supplementation may not be the most beneficial method for achieving good health.  Maintaining a healthy diet and participating in regular exercise is the most important step to living a healthier life and to help in the prevention disease.  Although vitamin supplementation is nonessential for most, there are specific individuals and diseases which may benefit from vitamins. Please read next week’s article to review those who can benefit and those who can be harmed from vitamin supplements. 

Sources: 

National Institutes of Health (NIH) – Office of Dietary Supplements (ODS) – Fact Sheet for Health Professionals

Blumberg, J., Frei, B., Fulgoni, V., Weaver, C., & Zeisel, S. (2017). Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in US adults. Nutrients, 9(8), 849.

Medical Reviewer: James W. Joseph, MD, Geisinger Family Practice, Elysburg, PA and GCSOM Family Medicine Practice Clerkship Director

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: The Truth About Vitamins Part II of II 

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

Dec
02

Prevention of ski injuries

Like many in NEPA, I enjoy winter in great part due to my love for downhill and cross-country skiing. However, with age and wisdom, I have become much more aware of the need for safety through the use of proper equipment, good technique and preseason conditioning. Every November 1st I begin my preseason ski conditioning program and while watching my routine, a local ski enthusiast and patient asked me if I would offer some tips for preseason conditioning for skiing. The following is an updated version of the program.  

The following exercises will target the essential stability, agility, and eccentric training requirements for the prevention of skiing injuries. A BosuR Ball is a useful tool to challenge your balance and strength for skiing and other sports. It is flat on the bottom and round on the top. (www.bosu.com $70 – $110.) However, standing on one or two pillows can work.

PRE-SEASON SKI EXERCISES

Traditional exercise such as weight training for quads, hams, gluts etc are valuable. Also, elliptical and stepper equipment and exercise bikes are important. However, the following exercises are specific to the needs of the downhill and cross-country skier. 

Monster Walk Out & In (PHOTOS 1A, 1B)

  • Monster Walk-Out: Walk side-to-side while keeping your legs apart and maintaining pressure against the resistance band (Photo 1A).
  • Monster Walk-In: Walk side-to-side while keeping your legs together and maintaining pressure against a ball or pillow (Photo 1B).

Ski BosuR Squat (PHOTO 2)

  • Stand in ski position on the BosuR Ball with ski poles in hands.
  • Squat and lower yourself 45 degrees (advanced skiers can lower body until your thigh is horizontal).
  • Raise yourself back up to the starting position but do not lock knees – perform slowly and feel the quads burn.
  • Repeat for 30 – 60 seconds.
  • Advance to 5 minutes.
  • Advance to simulation of pole plant and turning while on ball performing squats.

Ski BosuR Step Down (PHOTO 3)

  • Stand in ski position on the BosuR Ball with ski poles in hands.
  • Step down on one leg to the floor while one leg remains on the ball. 
  • Raise yourself back up to the starting position but do not lock knees – perform slowly and feel the quad burn on the leg which remains on the ball.
  • Repeat Same Leg for 30 – 60 seconds.
  • Advance to 5 minutes.
  • Advance to alternate legs.
  • Advance to simulation of pole plant and turning.

Ski Pole Lunge (PHOTO 4)

  • Hold ski poles in front of trunk.
  • Perform lunges slowly and hold for 5-10 seconds each repetition.
  • Repeat and advance 10-15-20 times.
  • Advance by performing more slowly and lower to floor.

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is an associate professor of clinical medicine at GCSOM.

Nov
25

Exercise Can Improve Quality of Life for Those with COPD

Part 2 of 2

Dr. Mackarey's Health & Exercise Forum

November is National Chronic Obstructive Pulmonary Disease (COPD) month. COPD is the fourth leading cause of death in the United States, according to the Centers for Disease Control and Prevention. This problem refers to a group of lung diseases that causes damage to the airways and air sacs in the lungs.  People with COPD suffer from diminished airflow and difficulty breathing. Emphysema and chronic bronchitis are two of the most common types of COPD. The damage can’t be reversed, so treatment includes medications and lifestyle changes designed to control symptoms and minimize further damage, according to the Mayo Clinic.

Exercise is an important part of life for those with COPD because it improves the overall strength and endurance of respiratory muscles. When you exercise, muscles adapt and use oxygen more efficiently so your lungs don’t have to work so hard. Also, in addition to improvement in breathing, exercise boosts mental health, helps maintain a healthy weight and blood pressure, and improves circulation. Most importantly, exercise will improve your quality of life with COPD.

Before you begin an exercise program, see your family physician or pulmonologist for approval. Then, see a physical therapist to design a program specific for your needs. Always begin slowly and rest if you get short of breath, have chest pain, feel dizzy or sick to your stomach.

TOP EXERCISES FOR THOSE WITH LUNG DISEASE

1. ENDURANCE EXERCISES

While not all of these endurance exercises may be appropriate for you, one or two of these may offer a good starting point.

A. Walk Around the House: Start walking around the house for 1-2 minutes nonstop. Every 1-2 hours. Then, add 1-2 minutes every week.

B. Static Marching: hold onto the countertop or back of chair and march in place for 30 seconds. Rest 1-2 minutes and repeat. Do 5 cycles. Add 5-10 seconds every week.

C. Climb the Steps: If you can do so safely, use the steps for exercise 1-2 times per day. Then, add 1-2 times per day.

D. Walk the Mall/Treadmill: If you are able to get out of the house and can tolerate more extensive endurance exercises, get out and walk the malls or use a treadmill.

E. Recumbent Bike: If balance is a problem, but you can tolerate more extensive endurance exercise, use a recumbent bike (a bike with a backrest)

Walking is free exercise and can be done in some form by almost everyone…even with an assistive device such as a cane or walker. For those with COPD who are active and fit – walk 4-5 days per week for 30 to 45 minutes. Less fit individuals can walk for 15 to 20 minutes. For those with COPD who are in poor condition and have significant SOB – walk for 2-3 minutes (to the bathroom or around the house) every 30 to 45 minutes. Try not to sit for 60 minutes without getting up and walking around.

2. POSTURAL EXERCISES: Perform 5 repetitions each, 3-5 times per day.

Posture exercises are designed to keep your body more upright and prevent rounded shoulders and forward head/neck. More erect posture promotes better breathing.

A. Row-The-Boat – Pinch shoulder blades together as if you are rowing a boat.

B. I-Don’t-Know – Shrug shoulders up toward the ears as you do when you say “I don’t know.”

C. Chin Tucks – Bring your head back over your shoulders and tuck your chin in

3. ARM EXERCISES: 5-10 times

A. Bicep Curls – sit in chair and bend your elbows up and down with a can of peas in your hands

B. Wrist Curls – as above but bend your wrists up and down

C. Chair Push-ups – Push up with your arms to get out of a chair

D. Saw Wood – pull a light resistance band (yellow) back from a door knob as if you were sawing wood.

4. LEG EXERCISES: 5-10 times

A. Hip Hikes – Sit in chair and march by hiking your hip and lifting up your heel 4-6 inches off the floor

B. Leg Kicks – Sit in chair and kick your knee out straight – then bend it down to the floor

C. Hips Out and In – Sit in chair and bring your knees in and out against a resistance band

D. Toe Raise/Heel Raise – Sit in chair and raise your toes up – then raise your heels up

5. BREATHING EXERCISES

A. Diaphragmatic Breathing – The diaphragm muscle is essential for breathing. While sitting or lying down, put one hand on your abdomen and the other on your chest. Slowly inhale through your nose and try to separate the hand your stomach from the hand on your chest. Then, slowly exhale through pursed lips.

B. Pursed Lipped Breathing – breathe in through your nose slowly for 3- 5 seconds. Then, purse your lips as though you’re going to whistle. Lastly, exhale slowing through the pursed lips over 5 to 10 seconds.

More Information: “Better Breathers Club,” in conjunction with the American Lung Association, offers a free local support group to help patients and their families suffering from COPD and chronic lung disease. www.lung.org

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton, PA and is an associate professor of clinical medicine at GCSOM.

Nov
18

Lung disease and COPD

LUNG DISEASE

Part 1 of 2

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

GCSOM GUEST AUTHOR: Nicholas Czelatka, MD1

Nicholas is a currently a first-year medical student Geisinger Commonwealth School of Medicine. He is a graduate of Stony Brook University and Islip High School. Nicholas grew up in Long Island and enjoys the outdoors with activities ranging from golfing to surfing to skiing.  

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) has become the fourth leading cause of death and is one of the only major chronic diseases which have seen an increase in mortality rates.  COPD includes emphysema, chronic bronchitis and asthma.

Patients with COPD suffer from progressive shortness of breath, cough, wheeze, and sputum production.  Most patients with emphysema have been cigarette smokers. 

Patients with emphysema develop obstruction to airflow as a result of narrowing of bronchial tubes due to excess mucous, smooth muscle constriction, and destruction of lung tissue.  Eventually, the lungs become over distended, which leads to overexpansion of the chest itself.  This process leads to the so-called ”barrel chest” appearance of patients with advanced COPD. 

The most common symptom of COPD is shortness of breath.  Initially, the patient complains of shortness of breath only with exertion, but symptoms progress over time to include difficulty breathing, even at rest.  Eventually the disease worsens to the point that oxygen is required and the patient may become severely disabled.  

Treatment of COPD starts with smoking cessation, and, when symptomatic, patients are started on inhaled bronchodilator medications.  Some of these medications include albuterol, ipratropium, titotropium, and inhaled steroids. Long-acting bronchodilators such as formoterol or salmeterol and theophylline medications may be added.  Oxygen is added when the patient’s own oxygen level falls to a certain point.  In fact, oxygen is the only therapy that has been shown to prolong the life of patients with COPD. 

Over time, patients with COPD decrease their level of activity due to the sensation of shortness of breath.  This downhill slide eventually leads to a very sedentary existence.  Recent studies have shown that COPD not only affects the lungs, but is a condition which affects the diaphragm and the peripheral muscles. Patients with COPD have been shown to have abnormal limb muscles as a result of deconditioning and systemic inflammation.  Exercise is the best treatment to delay or prevent deconditioning.

Studies have shown that several factors can actually worsen the symptoms associated with COPD. For example, stress can negatively impact breathing patterns and lead to anxiety which worsens shortness of breath. The weather can also aggravate symptoms, such as season climate and high humidity changes. Irritants, like smoke (first or second hand), as well as cooking smoke, cleaning aerosols and perfumes should be avoided. Overexertion, not to be confused with a necessary and appropriate exercise program, can lead to shortness of breath and other symptoms. Noncompliance, such as not using oxygen, taking medications and performing a home exercise program as directed, will aggravate symptoms.

Pulmonary rehabilitation has been shown in numerous studies to decrease the shortness of breath associated with COPD.  Exercises to strengthen the arms are helpful to assist patients in performing activities of daily living such as combing hair, cooking, and reaching objects above their heads.  Walking and riding a stationary bike are helpful to exercise the leg muscles, especially the large thigh muscles. Despite the fact that exercise programs may not improve lung function, the patients overall level of function are almost always improved. It is recommended that a pulmonologist and physical therapist should be consulted to establish an appropriate and individualized exercise program (to be discussed in next week’s column on COPD). 

SIGNS OF TROUBLE – in more advanced stages of COPD

  • CANDLE BLOWING –  be a sign of distress
  • NECK AND CHEST MUSCLE BREATHING – visible contraction of the neck, chest and shoulder muscles
  • TRIPOD POSITION –when a person with COPD leans forward in a chair and places their hands on their knees to improve breathing
  • LOUD AND HEAVY BREATHING OR GASPING – abnormal with inactivity
  • CONFUSION, LIGHT-HEADEDNESS

EMERGENCY MANAGEMENT

  • CALL 911 – until help arrives …
  • USE INHALER  (albuterol, levalbuterol, ipratropium, prednisone)
  • USE HOME OXYGEN (be sure nasal cannula or oxygen mask is properly placed on patient and turn flowmeter up to 6 LPM for nasal or 15 LPM for mask)
  • CPR – if the patient is unresponsive and has no pulse

Sources: www.cdc.gov

               www.ncbi.nlm.nih.gov

               www.cdc.gov/nchs/fastats

Medical Reviewer: Dr. Gregory Cali, DO – is a pulmonologist (lung doctor) in Dunmore, PA.

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” COPD Part 2 – Exercise with COPD. 

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton, PA and is an associate professor of clinical medicine GCSOM.

Nov
11

Prevention of Lower Back Pain: Part 3 of 3

Part 3 of 3

Dr. Paul Mackarey, DPT

GUEST COLUMNIST: Paul Mackarey, Jr. DPT

Lower back pain (LBP) is one of the most common problems in our society as well over 85-90% of all Americans will suffer from it at least once in their lives. It affects productivity in the workplace and lifestyles at home. The medical costs of treatment including; medication, physical therapy, alternative medicine, and surgery are staggering. It is generally agreed that prevention is the best treatment for LBP.

TOP TIPS FOR THE PREVENTION OF LOWER BACK PAIN

  • Maintain Fitness Level:As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well and exercise regularly.
  • Aerobic Exercise:Aerobic exercise will help prevent weight gain and stiffness for a healthier lower back. Perform mild aerobic exercise such as walking 3-5 times per week for 30-45 minutes. Keep joint compression and pounding to a minimum. For example, run 2-3 days a week, not 6-7 and cross-train on off days; elliptical, bike, swim, kayak.
  • Core Exercises:Core stabilization exercises designed to strengthen the abdominal and lower back muscles will help prevent injury. Some examples of core exercises are:
    • Pelvic Tilt – lying on your back and performing a pelvic tilt as you flatten you lower back into the floor.
    • Pelvic Tilt and Heel Slide- lying on your back, hold a pelvic tilt as you slide your one heel up and down and repeat with the other heel.
    • Core on Ball (Photo 1) perform arm exercises such as biceps and triceps with light weight while sitting on a therapeutic ball while simultaneously trying to hold an isometric contraction of your abdominal and lower back muscles.
    • Avoid sit-ups! Limit repeated flexion and torque on the lower back by using core stabilization techniques to strengthen abdominal muscles instead of a sit up unless you are at a higher fitness level.
  • Do Not Smoke: Smoking affects natural healing because it constricts the small blood vessels. Smokers have a much higher incidence of LBP and failure from lower back surgery.
  • Practice Good Posture & Body Mechanics:Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.
  • Perform postural exercises throughout the day. Most of us spend much of the day sitting, standing and reaching forwards and flexing your spine. Postural exercises are designed to stretch your back in the opposite direction of flexion by extending or arching. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
    • Chin Tucks – tuck your chin back to bring head over shoulders.
    • Shoulder Blade Pinch – (Photo 2) pinch your shoulder blades together.
    • Standing Arch – (Photo 3) while standing, put your hands behind back, extend lower back 10-20 degrees.
  • Ergonomics
    • Sitting – When sitting, use an ergonomic chair and work station with a lumbar support and adjustable heights. Get close to your keyboard and monitor. Stand up and perform above postural exercises every 45-60 minutes.
    • Driving – If you drive long distances, use a lumbar support to keep an arch, sit close to your steering wheel to prevent bending forward and stop to stretch using the above postural exercises every 45-60 minutes.
    • Lifting – Think twice. Be mindful of the weight, size and shape of the object. Also, consider the height of the object, handles or grips, location to place object and foot traction prior to the lift. First bend your knees and arch your back. Then, brace your abdominal muscles. Bend your spine forward as little as possible to pick up the load. Use legs, turn with feet, and do not twist spine with load in hands. When possible, get help to lift very heavy loads and push rather than pull. Immediately following the lift, stand up straight and stretch lower back into extension.
  • Clothing – If you walk or stand most of the day, wear good shoes. Avoid high heels and shoes without adequate support like sandals. Tight pants, belt and oversized wallet in the back pocket can all contribute to LBP.

GUEST COLUMNIST: Paul Mackarey, Jr. DPT is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC where he specializes in the prevention and treatment of neck and LBP.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at GCSOM.

Visit your doctor regularly and listen to your body.     

Nov
04

Your back has preferences: Part 2 of 3

Part 2 of 3

Paul Mackarey, DPT

GUEST COLUMNIST: Paul Mackarey, Jr. DPT

Lower back pain (LBP) is one of the most common problems in our society. In fact, over 85-90% of all Americans will suffer from back pain at least once in their lives. It affects productivity in the workplace and lifestyles at home. The medical costs of treatment including; medication, physical therapy, alternative medicine, and surgery are staggering. It is generally agreed that prevention is the best treatment for LBP.

Last week, we discussed the importance of early intervention, controlled movement and proper exercise as a very important part of minimizing the lasting effects felt from a new or recurring exacerbation of back pain. However, it is important to have an understanding of what is the “best” type of movement and exercise for your back. This differs from person to person. Often your spine has a “directional preference” or a specific direction that fosters the healing process. Moreover, this preference will also limit movement in the wrong direction which may delay healing. The two most common and easily assessed directional preferences are flexion directional preference (FDP) or bending forward and extension directional preference (EDP) or bending backward.

Flexion Directional Preference: FDP occurs in people with back pain who experience little to no pain when bending forward or sitting down. Due to the fact that the back undergoes normal and natural changes as we age, the position we are most comfortable in also changes. Typically, this change occurs around the age of 50 – 60 years old; however, it can begin earlier depending on the individual. If you find that sitting or bending forward is a position of comfort and eases your back pain than you have FDP and your back can heal faster when selecting exercises that focus on repeated bending. Exercises such as single knee to chest, double knee to chest or child pose may be the best for you. (See Photos 1-3 below)

Extension Directional Preference: EDP occurs in people with back pain who experience little to no pain when standing, walking and/or bending backwards at the hips. This is best assessed when lying prone (on your belly) and bending backwards by propping up on your elbows/forearms. If this position is pain free than you may have EDP. Commonly, individuals that fall in this category range from the age of 45 years old and younger. Exercises that focus on the direction of extension are best. Selecting exercises such as prone on elbows, prone press up, open books and modified planks are best. (See Photos 4-7 below)

Always consult with your physician or physical therapist before beginning a new exercise program. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day. Do not continue the exercises if symptoms worsen.

PHOTO 1: Single Knee to Chest (best for FDP) While lying on your back grab the back of the one knee and pull the knee toward your chest. Alternate knees.

PHOTO 2: Double Knee to Chest (best for FDP) While lying on your back grab the back of the both knees and pull knees toward your chest

PHOTO 3: Child’s Pose (best for FDP) Begin in quadruped position (on hands and knees) and bend at the hips as your butt moves toward your heels.

PHOTO 4: Prone on Elbows: (best for EDP) While lying on your belly, prop up on your forearms to extend your lower back.

PHOTO 5: Prone Press Up: (best for EDP) While lying on your belly, prop up on your forearms, then straighten your elbows to further extend your lower back.

PHOTO 6: Open Book: (best for EDP) While lying on your side with the bottom knee straight and top knee bent, rotate by opening the arms and reaching behind you. Relax the back and let gravity give you the stretch. Then, alternate sides.

GUEST COLUMNIST: Paul Mackarey, Jr. DPT is the clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC where he specializes in the prevention and treatment of neck and LBP.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week – LBP Part 3 of 3

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at GCSOM.Visit your physician regularly and listen to your body

Oct
28

The truth about lower back pain: Part 1 of 3

…THE MORE YOU KNOW

Dr. Paul Mackarey, DPT

Part 1 of 3

GUEST COLUMNIST: Paul Mackarey, Jr. DPT

One of the most common problems people come to our office with is lower back pain (LBP). Studies show that 80-90% of adults in the USA will experience lower back pain at one or more times in their lives. It is the second most reported reason for work absences and is so common that one might even describe it as “normal.” The good news is that 80 percent of those with LBP get better within three months! However, it is important to know “the truth about lower back pain” to ensure that you do NOT become one of the twenty percent! For example, when treatment is delayed and/or mismanaged, the problem may become chronic. In fact, LBP is a commonly associated with opioid abuse. 

Management of LBP has become a financial burden as 86 billion dollars (25% of healthcare costs) are spent on the problem each year. It is the equivalent of the money spent on cancer treatment and much of it is spent on unnecessary tests and ineffective treatment. The purpose of this column will be to address the myths associated with LBP and educate consumers in order to make more informed decisions related to this problem.

There are two types of LBP, acute and chronic. Acute LBP is back pain that has devlpoed recently (within the last 3 months). Acute LBP is the leading cause of disability in the US among individuals younger than 45 years old. Chronic LBP is associated with pain that lasts more than three months. Traditional treatments include: nonsteroidal anti-inflammatory drugs, opioids, injections, manipulation and physical therapy, massage therapy, and, when all else fails, surgery. While many of these treatments can help, the efficacy of one approach over another is limited. However, what is clear, according to current research, is that early intervention is critically important to promote early healing, prevent further damage and limit the likelihood that the problem will become chronic.

The spine consists of 24 moving vertebrae, a fused sacrum and tailbone, and shock absorbing discs between each moving segment. The spine is designed to provide support and protect the spinal cord while remaining flexible for movement and function. Spinal nerves exit the spinal cord at each segment to deliver messages from your brain to your extremities. Pressure on one of these nerves can cause pain, numbness, tingling, or weakness. Muscles can also become weak and imbalanced and lead to wear and tear on the spine. 

LBP can occur from many causes. Some of these include: muscle strain, disc degeneration, arthritis, scoliosis or curvature of the spine, instability from trauma or degeneration, acute trauma from a motor vehicle accident account or a fall. Many workers are also at high risk for lower back pain. But remember, regardless of the cause, 80% of those with LBP will get better within 3 months…if managed properly. And, the best treatment for LBP is prevention, which will be discussed in LBP-Part II.

MYTH 1: I need to get an MRI before I begin my treatment for LBP.

NOT TRUE. You may know someone who has been told that they have to receive 6 weeks of physical therapy before their insurance will approve an MRI. This is for good reason. First, the insurance company knows that recent research shows that most people with LBP will be better in 6 weeks with proper management, like physical therapy. Second, it is also well-known in the medical community, that 30% of all MRI’s find problems in the spine in people without LBP (false positive). MRI’s are necessary when certain “red flags” are present such as: pain below the knee associated with weakness in the leg, history of cancer, recent trauma and others.

MYTH 2: I need to see a spine surgeon before I can begin treatment for LBP.

NOT TRUE. While spine surgeons (orthopedic or neurosurgeon) are critically important in some cases of LBP, they are rarely seen as a first visit. However, this is not a reason to delay treatment because time is of the essence. Current research associates better outcomes with early intervention. So, advocate for yourself and notify or visit your primary care physician to ask about early conservative treatments such as physical therapy.

MYTH 3: When I get LBP I need pain medication.

NOT TRUE. You cannot read a newspaper today without finding an article about the opioid crisis in our country. Over prescription of opioids has contributed to this problem and LBP was the number one reason only a few years ago. The US, representing only 5% of the world’s population, consumes 99% of global hydrocodone use. As a result, in 2016, the CDC recommends ‘non-drug approaches” to LBP management such as physical therapy, acupuncture, massage and others.

MYTH 4: If I have LBP I should stop moving: bending, walking, and exercising to prevent further damage.

NOT TRUE/TRUE. While it is important to limit certain movements and exercises that may contribute or worsen the problem, avoid all movement and activity may, in fact, contribute to the problem. For example, lifting heavy objects from the floor, sitting too long, running, jumping, performing sit ups, toe touches etc. should be avoided in the early stages of recovery. However, movement in relatively pain free positions is encouraged. For example, slow walking (10-15 minutes) intermittently throughout the day (2-3 times) is better than sitting all day. If you sit at work most of the day, it is advisable to alternate between sitting (20-30 minutes) and standing (10-15 minutes) at a standing desk. Avoiding a vigorous exercise routine is advisable until you consult with your physical therapist or physician.

MYTH 5: If I still have LBP in 6 months, than I need to have surgery.

NOT TRUE. Just because you have LBP does not mean you require surgery, even if it lasts for 6 months. Surgery is rarely performed for LBP alone and is usually limited to those with pain below the knee associated with weakness and for those with other neurologic signs. Remember, we all heal and recover at differently and while most recover from LBP in 3 months, others may require 9 – 12 months. Be sure you exhaust all conservative options and seek reputable medical advice: primary care physician, physical therapist (specializing in spine), physiatrist, and spine surgeon.  

GUEST COLUMNIST: Paul Mackarey, Jr. DPT is clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC where he specializes in the prevention and treatment of neck and LBP.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week – LBP Part 2 of 3

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at GCSOM.Visit your doctor regularly and listen to your body.     

Oct
21

Hunters and Heart Attacks: the Dangers of Buck Fever

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

Branston Allen

Guest author: Branston Allen

Branson is a currently a 4th year medical student at the Geisinger Commonwealth School of Medicine. He is a graduate of Lock Haven University and Shippensburg Area High School.   Branson grew up in Shippensburg as an avid outdoorsman and enjoys activities ranging from hunting to fishing to camping.  

As the temperature drops and the leaves fall, nearly one million Pennsylvanians take up their trusty deer rifles and plunge into the woods with hopes of dragging out a prized white-tailed deer.  Historically, rifle season commences on the first Monday after Thanksgiving, however, this year, for the first time it will begin the Saturday after Thanksgiving and archery season has been active since October 5th.  Hunters and loved ones often worry about potentially fatal misfortunates that can occur while secluded in the forest.  These concerns range from stray bullets to tree stand falls.  However, according to many experts, a heart attack is up to three times more likely to claim a hunter’s life than an errant bullet or arrow. 

One Man’s Story

As a third year medical student, I’ve actually already encountered a local gentleman whose heart carries the scar of a heart attack he experienced while hunting.  To protect his identity, I’ll refer to him as John.  John – “November was always my favorite month of the year.  Thanksgiving is a nice holiday and it’s great to see family.  But the best part about it is deer season”.  John is a 68 year old, recent retiree who was born and raised in Luzerne County.  Like a lot of NEPA residents, he probably eats a few too many pierogis and drinks a few too many beers, but otherwise is pretty healthy.    He worked most of his life in a local warehouse, and always requested off for the first 3 days of deer season.  Last deer season was almost John’s last.  “It was the second day of the season and I finally managed to get a clean shot at a nice sized doe.  I was dragging her out whenever I got this massive pain across my chest.  I was sweating like crazy and it felt like an elephant was sitting on my chest.  After I few minutes, I got really nervous and called my wife.  She told me to call 911” – John.  Fortunately for John, his story had a happy ending.  “The doc told me I had about a 99% block of a vessel in my heart that is called ‘the widow-maker’ and that I experienced a mild heart attack. Thankfully, they were able to fix me up with surgery, and I feel like lucky to still be here today”.

Risk Factors

 Most people know a man like John and these are the type of people who we worry most about having heart attacks while they are hunting.  The American Heart Association has identified men over the age of 45 and females above the age of 55 as the population most likely to suffer from cardiovascular disease.   According to the Pennsylvania Game Commission, the majority of hunters are males of the age of 45, and these individuals are often overweight and don’t get much exercise throughout the year.  When deer season comes, they’re putting strain on their muscles and heart in a way that their body isn’t used to dealing with.  This increased demand on their hearts causes their heart rates to soar and can produce some of the tell-tale signs of heart disease.  These include chest pain, arm pain or numbness, and shortness of breath.  Additional risk factors such as high blood pressure, high cholesterol, obesity, and a sedentary lifestyle also increase one’s chances of suffering a heart attack.

What makes hunting especially scary is it stresses your body in ways everyday life doesn’t.  Hunters must contend with the elements and temperatures associated with late November in Pennsylvania, the adrenaline surges associated with spotting a deer, and the daunting physical task of dragging 120+ pound deer out of woods if they shoot true.  Any of these situations individually is capable of sending heart rates soaring. Complicating the hike into the woods on uneven terrain is the added weight of a gun, ammunition and other supplies. Also, trekking through mud or snow increases the physical demands exponentially. A research study out of Beaumont Hospital in Michigan found that the majority of hunters experience circumstances in which their heart rates exceed 85% of their maximum heart for sustained periods of time, which greatly increases the risk of a sedentary, unfit individual of sustaining a heart attack.  Furthermore, hunters were more likely to demonstrate heart ischemia and arrhythmias during hunting than they were during a usual stress test with a treadmill.  Arrhythmias are usually the cause of death when somebody experiences a heart attack, which makes these findings especially troublesome.

Prevention

So what can you do to keep yourself or your loved one safe during hunting season?  First and foremost, if you experience any chest pain or shortness of breath on exertion, see your doctor immediately.  Secondly, if you are a man over the age of 45 and have risk factors for heart disease such as hypertension, high cholesterol, diabetes, obesity, and/or live a sedentary lifestyle, talk to your doctor before you head out into the woods this year to make sure your heart can take all of the stress associated with hunting.  Make sure that somebody knows where you’re at and can call for help if they don’t hear from you.  If you have trouble walking or have risk factors for a heart attack, carry a cell phone with you and try to hunt near a place with vehicle access.  Finally, just be smart and exercise caution while hunting.  Listen to your body.   Take as many breaks as you need while you are hiking into or out of your favorite hunting spot.  If you manage to harvest a deer, take your time dragging it out of the woods.  Drag, rest, and drag again.  Better yet, call in backup and get some help with the drag, especially if you are a more seasoned hunter.  You have earned the right to relax and employ the help of younger hunters to assist you.  By doing this, you can ensure that this year’s deer won’t be your last.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Oct
14

Women’s purses and back pain

Dr. Mackarey's Health & Exercise Forum

Recently, a young woman came to my office with complaints of severe middle and lower back pain. On her first visit, I carried her purse (big bag), to the treatment room to assess its weight. Then, I asked her permission to weight the bag and discovered that it weighed 8 pounds. While 8 pounds does not seem excessive, the woman weighed 120 pounds and, based on the research, would be advised to carry a 2.5 to 3.5 pound bag, (2-3% of her body weight).

A recent study shows that the average weight of a woman’s purse has increased by 38% and now exceeds 6 pounds. In spite of technological advances, women have not found a way to simplify their lives, or at least what they think they need in their lives. High tech gadgets have only added weight to a purse already filled to the brim.

On a whim, I decided to ask permission to examine the contents of some of my patient’s purses. A typical purse includes the following: hairbrush, cosmetic bag, mirror, feminine products, keys, and sunglasses, reading glasses, checkbook, wallet, coupons, water bottle, and medications. Additionally, I discovered heavy high tech products such as cellular phones, MP3 players, digital cameras, Bluetooth earpieces, and rechargers. Lastly, some women add the weight of a book or Kindle to the bag. Studies also show that the larger the bag and stronger the straps, the more items are stuffed in, resulting in a very heavy purse.

It is a pervasive attitude that a woman should never be stranded without her purse full of essentials. So, where is the problem? The problem is that carrying a heavy bag, usually on one side of the body, forces the body to tilt forward and in the opposite direction to compensate. Overtime, this change in posture leads to neck, middle and lower back pain.

SIGNS THAT YOUR PURSE IS TOO HEAVY:

  • Change in posture when carrying the purse: the weight forces you to tip forward or to the opposite side to compensate.
  • Struggling when putting on or taking off the purse due to a purse that is too heavy or straps that don’t fit properly.
  • Pain when carrying or after carrying the purse: due to the fact that it is too heavy or straps that don’t fit properly.
  • Neck, middle and lower back pain, headaches and muscle spasms:
  • Shoulder or arm pain can also be associated with a heavy bag.
  • Tingling or numbness – in the arms or hands
  • Red marks –  on the shoulder

Consider the following suggestions to promote healthy use of a purse and prevent injury.

SUGGESTIONS TO PREVENT INJURY:      

  1. Limit Weight of Purse to 2% of Body Weight.(135 lb person = 2.7 lb purse). Get on a scale without your purse, and then get on with your purse to see the difference.
  2. Clean It Out:Makeup, keys, planner, date book, address book, brush, cell phone, recharger, MP3 player, etc. Clean it out! Get rid of heavy coins. Use technology and consider getting a cellular phone that is also an MP3 player with a calendar and contact list. Recharge your phone in the car. Use a separate purse for some nonessential items and leave it in the car.
  3. Buy a Small Purse: Weigh your purse when it is completely empty. Some purses are too heavy, even without contents. Buy a small and light weight purse.
  4. Ergonomic Bags: Padded Adjustable Shoulder Straps – Messenger Bag Style. If carrying a big bag, use a strap that is long enough to distribute weight evenly across the side your hip like a messenger bag.
  5. Purse Weight Distributed to Small of Back/Hips – using adjustable straps (not all the weight on shoulders and upper back).
  6. Remove The Purse When Possible:While waiting for bus, etc
  7. Change Shoulders:Every 15 -20 minutes, change the purse strap from one shoulder to the other to balance out the stress on the spine.
  8. Stand Erect and Arch Small of Back:The correct posture while carrying heavy items is to make a hollow or arch the small of your back
  9. Perform Posture/Stretching Exercises : Pinch shoulder blades together and extend and arch your spine backwards intermittently throughout the day – especially every time you take your pack off.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Oct
07

Only smokers die earlier and at higher rates than couch potatoes!

Dr. Mackarey's Health & Exercise Forum

A recent study in the European Journal of Preventive Cardiology found that only smokers died early at higher rates than couch potatoes! The study was the longest of its kind as researchers followed approximately 800 men for 50 years and concluded with this powerful message: poor physical fitness may be almost as bad for you as smoking…so make exercise a lifesaving priority.

Is there a secret to a long and healthy life? Do genes control our destiny? How does lifestyle impact our health? According to the National Institutes of Health (NIH), while genes play and important role, lifestyle plays the biggest role on how healthy you are and how long you live. The food you eat, what you drink, if you smoke, how active you are and how you handle stress are critical factors that determine your longevity. The NIH research has found that smoking, physical inactivity, and poor eating habits are the leading causes of death, in that order.

Physical activity is one of the most important factors in improving a lifestyle in a positive way. A minimum of 30 minutes of physical activity, 5 days per week can greatly contribute to longevity. Most experts agree that moderation is important. If you overindulge with exercise you will be at greater risk for musculoskeletal injuries. This is especially true for those who are newcomers. The goal is to gradually work into a fitness program and maintain it for life. 

Researchers have found that the benefits of regular physical activity are numerous. Some of the more important benefits are:

  • Loss or Maintained Body Weight
  • Reduces LDL /Raises HDL Cholesterol
  • Improves Circulation and Blood Pressure
  • Reduces Risk of Heart Disease
  • Prevents Bone Loss
  • Reduces Stress/Muscle Tension
  • Lowers Risk of Depression
  • Improves Sleep Pattern
  • Improves Strength and Flexibility
  • Improves Balance/Reduces Risk of Falls
  • Improves Immune System
  • Improves Pain Threshold

     Some simple suggestions for beginning an exercise program are:

  • Get your physician’s approval
  • Consult with a physical therapist to set up a program for your needs
  • AEROBIC EXERCISE:
    • Buy good running sneakers – not walking shoes
    • Plan to exercise 3-5 times per week for 30-35 minutes
    • Walk for aerobic fitness
    • Begin 5-10 minutes and add 1-2 minutes each session
    • Walk in a mall if it is too hot or too cold
  • WEIGHT TRAINING:
    • Use light dumbbells, sandbag weights and resisted bands
    • Begin with 5-10 repetitions and add 1-2 reps each session
    • Alternate weight training days with walking days

     Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Sep
30

Healthy mom, healthy baby: Part 2 of 2

Finding Time for Fitness as a New Mom

Guest Columnist: Catherine Udomsak Heimrich, DPT

Catherine Udomsak Heimrich, DPT

Getting back into shape after having a baby is a priority for many new moms. However, with little sleep and lots of new responsibilities this goal can often fall to the wayside. Taking the time to ease into an exercise program is key to success as well as giving yourself some grace. After all, you did just bring a new life into this world!

As per the American College of Obstetrician and Gynecologists, postpartum exercise has several benefits. These include stress relief, boosts energy, promotes better sleep, strengthens and tones abdominal muscles, helps manage weight, and may help prevent postpartum depression. If you have a healthy pregnancy and normal vaginal delivery you may begin exercise a few days after giving birth. However, it is recommended to wait until you feel you are ready which for many women may mean a few weeks after delivery. If you have a cesarean birth, or any medical complications during delivery it is best to discuss with your OB-GYN when it is safe to begin exercising.

Similar to pregnancy, 150 minutes of activity per week is recommended starting with 20-30 minutes a day. One should ease into working out and stop if it produces any pain. Walking is a great way to begin aerobic activity post-partum and something you can easily do with your newborn in his or her stroller. Joining other moms on these walks or partaking in a group fitness class is another great way to get motivated and commit to getting fit. If you are restricted to staying home with the baby, there are countless postpartum workout videos offered for free on YouTube and several apps targeted at new moms. Some even show you how to incorporate your baby into your workout.

In addition to aerobic activity, strength training, specifically targeting core muscles is essential to a new mom’s fitness routine. Our abdominal muscles typically become weak during pregnancy due to stretching and hormonal changes which prepare our bodies for delivery. After delivery, many moms find themselves bending over and lifting to care for their newborn which puts great stress on the low back. Our abdominal muscles are what provide support for our lumbar spine and stabilize our pelvis. By incorporating core strengthening into one’s fitness routine you can help reduce the development of low back pain. Post pregnancy, some women may even suffer from a condition referred to as diastasis recti. This condition is a structural separation of the two large bands of abdominal muscle that meet at midline. It can occasionally be corrected through core exercise but at times can require surgery depending on severity.

Some simple ways you can get started strengthening your core postpartum include:

Pelvic Tilts – Lying on your back with your knees bent and feet flat on floor, gently tighten your abdominal muscles drawing your belly button toward your spine and flattening you back to the floor.

Pelvic tilt with alternating heel slides – Perform a pelvic tilt. While maintaining back flat to floor gently slide heel down and straighten leg. Alternate legs.

Pelvic tilt with heel taps – Hold a pelvic tilt and lift both legs up keeping knees bent. Then slowly tap one heel down. Alternate legs and keep back flat to floor.

Double Leg Lifts – While lying flat on back extend your legs up straight toward the ceiling. Slowly lower both legs down to the floor and then slowly raise them back up. Maintain pelvic tilt while performing. If this is too difficult lower one leg at a time.

Forearm Plank – Begin lying on your stomach with your forearms flat on floor. Engage your core and raise your body up off the floor. Keep your body in a straight line from your head to your feet. Keep abdominals engaged.

Bridges – Lying on your back with knees bent and feet hip distance apart squeeze gluteal muscles and lift your hips toward the ceiling then slowly lower. Keep core muscles activated.

Single leg bridge – Perform a bridge while keeping one foot planted on floor and other leg lifted towards the ceiling. Keep core muscles activated.

In addition to your core, it is important to tone the muscles of your pelvic floor which often become weak with pregnancy. A simple way to do this is to perform Kegel exercises in which you contract your pelvic muscles as if you are stopping the flow of urine midstream. You can so this sitting or standing and even with movement.

Tips for postpartum exercise:

• Drink plenty of water, especially if you are nursing which can be dehydrating.
• Feed your baby or express milk prior to exercise if nursing to avoid any discomfort or engorgement.
• Wear loose clothing to keep cool and supportive foot wear.
• Make sure to warm up before and cool down after exercise to avoid injury.

If I have learned anything from my own experience and conversations with other mothers, it’s that every baby and every pregnancy is different. Don’t compare yourself to others! Everyone’s physical fitness journey is unique and only you know what is best for you and your baby.

Guest Columnist: Catherine Udomsak Heimrich, DPT is a doctor of physical therapy and is an associate at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton, where she works with outpatient orthopedic and neurological patients. She has a special interest in vestibular and balance problems. She is also a new mom!

Model: Sarah Singer, PTA is a physical therapist assistant at Mackarey & Mackarey Physical Therapy and is also a relatively new mom!

Read Dr. Mackarey’s Health & Exercise Forum – Every Monday.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Sep
23

Healthy mom, healthy baby!

Part 1 of 2

Guest Columnist: Catherine Udomsak Heimrich, PT, DPT

Catherine Udomsak Heimrich, PT, DPT

For many women, expecting a baby can be one of the happiest times in their lives. Pregnancy comes with much joy and excitement as one prepares to bring a new life into this world. While much of the preparation is focused on the baby, it is imperative for pregnant women to take some time to focus on their personal health. Your body goes through immense physical changes during pregnancy and it is easy to avoid staying physically active. However, prioritizing fitness is important for women as research confirms exercise during pregnancy has benefits for both mom and baby.

Why Exercise?

Currently, there is strong evidence that maintaining moderate exercise during pregnancy is safe and advantageous for women. Some of the benefits include prevention of excessive weight gain and a lower risk for gestational diabetes, pre-eclampsia (development of high blood pressure), low back pain, cesarean section, pelvic pain and urinary incontinence, and fetal macrosomia (a baby with a birthweight of greater than eight pounds). Furthermore, it increases your overall general fitness and strengthens one’s heart and blood vessels. As long as there are no medical or obstetric contraindications to physical activity, exercise does not pose as a risk for premature birth or fetal distress in pregnant women.

What kind of exercise?

When it comes to the type of exercise, The American College of Obstetricians and Gynecologists recommends combining both aerobic and strength training. It also recommends 150 minutes of exercise per week which can be spread out through several 20 to 30 minute sessions. Intensity should always be moderate which is the equivalent of brisk walking. One should be able to still hold a conversation comfortably but be unable to sing. Activities considered safe for pregnant women include but are not limited to swimming, stationary cycling, modified yoga, modified pilates, walking, strength training, and low impact aerobics. Activities that may need to be avoided include contact sports and activities with high risk of falling such as downhill skiing, horseback riding, and off-road cycling. Furthermore, pregnant women should avoid spending prolonged time lying flat on their backs and avoid using weights that strain the lower back.

What if I’m not in shape?

Pregnancy is an ideal time to adopt a healthy lifestyle even for those who don’t consider themselves active or “in good shape”. Women who are sedentary prior to pregnancy can begin an exercise program and reap all the benefits of physical activity. It is recommended that those who are not active prior to pregnancy have a more gradual progression toward exercise. This could mean going for 10-minute walks most days of the week and gradually working up to 150 minutes of brisk walking. Both active and sedentary women should consult their doctor prior to beginning or continuing an exercise program to ensure wellbeing for both mom and baby. If you are someone who regularly participates in high intensity exercises, such as running or aerobics, it may be possible to continue these activities. Currently, there is no upper level of safe exercise established and response to exercise can differ for every woman. One’s joints are more lax during pregnancy, so ankle sprains and other injuries can occur more easily. Avoiding rocky terrain or uneven ground when running, cycling, etc. is advisable. Again, it is always best to get clearance from your doctor and be sure to listen to your body.

Precautions

While most women with an uncomplicated pregnancy will have no problems with exercising it is important to be aware of any abnormal response to activity. Some warning signs to discontinue exercise include vaginal bleeding, regular painful contractions, amniotic fluid leakage, dizziness, headache, chest pain, calf pain and swelling. If you experience any of these symptoms it is advisable to stop your current exercise program consult your OB-GYN before resuming your workout.

Next Week: Healthy Mom, Healthy Baby…Postpartum Exercises Part 2

Guest Columnist: Catherine Udomsak Heimrich, DPT is a doctor of physical therapy and is an associate at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton, where she works with outpatient orthopedic and neurological patients. She has a special interest in vestibular and balance problems.

Read Dr. Mackarey’s Health & Exercise Forum – Every Monday. Next Week: Healthy Mom – Part 2

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Sep
16

Exercise Bulimia

By Mary M. Pelkowski, MD2

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month! 

Mary Pelkowski, MD2

GCSOM Guest Author: Mary Pelkowski, MD2 is a student in the Geisinger Commonwealth School of Medicine MD Class of 2022. She grew up in Sayre, PA and graduated from Notre Dame High School. She received her undergraduate degree in biology with a minor in chemistry from Saint John Fisher College in Rochester, NY.

Back to school also means back to sports. Countless students are participating in tennis, soccer, cross country running, gymnastics, and other sports. These student athletes and others who engage in recreational sports and exercise can be vulnerable to excessive training for all the right and wrong reasons. Parents, family members, coaches, teachers, athletic trainers, friends and health providers must be aware of potential for exercise abuse…as part of the “fitspiration” movement.

It takes only a cursory glance through social media to become aware of the “fitspiration” movement. This catchy term may accompany posts of workout videos, pictures depicting physical activity, or pictures of individuals showing off the muscular bodies they obtained through dedication to rigorous exercise regimens. In a sense, exercise and fitness have become trendy in our society, with more strenuous exercise routines being perceived as more impressive. Cars boast bumper stickers with numbers such as “13.1,” “26.2,” or even “50,” referring to the distances so proudly conquered by runners. When we hear a friend has decided to commit to a rigid training schedule to complete a marathon, we are often in awe of their self-control and motivation, wishing we were that dedicated. But can exercise be a bad thing? The answer is complicated. Exercise is one of the best things we can do for our health. I have heard physicians say that if all the benefits of exercise could be bottled up into a pill; pharmaceutical companies would be fighting for the chance to sell it. However, it can get complicated when one’s reasons for exercising stem from a potentially destructive place, rather than a pursuit of health. 

Exercise Bulimia/Anorexia Nervosa

Exercise bulimia is a term used to refer to the excessive use of exercise to burn calories or try to keep a low body weight. It is not a medical diagnosis in and of itself, but the notion of using exercise to make up for excessive calorie consumption or maintain an unhealthily low body weight can occur in both anorexia nervosa and bulimia nervosa. Moreover, when excessive exercise occurs in combination with a significantly low body weight, an intense fear of gaining weight, a disturbed body image, undue influence of body shape on self-worth, or a failure to recognize the seriousness of the condition, an individual would meet the criteria for anorexia nervosa.

Anorexia nervosa can cause serious complications in all body systems. Some examples include disrupted functioning of the heart, reduced lung capacity, hormonal imbalance, amenorrhea, (loss of the menstrual period in women), changes in brain structure, and in severe cases, difficulty with memory. The hormonal changes associated with amenorrhea, especially when coupled with extreme exercise, can lead to reduced bone density and can put women at high risk of stress fractures. Stress fractures are breaks in the bone that occur from overuse through large amounts of exercise rather than the traumatic bone breaks we typically think of where an obvious event results in a broken bone.

Warning Signs

Because exercise bulimia can be a part of an eating disorder with potentially life-threatening consequences, it is important to be aware of the warning signs that someone’s exercise routine might be part of an eating disorder. Signs of exercise bulimia may include:

  • Exercising in excessive amounts
  • Refusing to take days off from exercise
  • Being overly concerned with tracking how many calories one burns
  • Becoming defensive if someone suggests the person is exercising too much
  • Being very anxious if the person is not able to do his or her usual form of exercise
  • Sticking to a rigid exercise routine at the expense of missing social activities, work or school 
  • Feeling guilty when unable to exercise
  • Refusing to eat if unable to exercise
  • Having exercise performance significantly tied to self-worth 

Not Clear Cut

While the definition of exercise bulimia implies a voluntary engagement in excessive exercise for weight loss, my experience from being on female track and cross country teams in high school and college has shown me that anorexia nervosa does not always fit the mental picture we may have of someone who refuses to eat at all or even of exercise bulimia where an individual compulsively engages in excessive exercise. During cross country, the mileage we ran likely would have been considered excessive by the average person. Our team often trained 7 days a week with run-length ranging from 5-12 miles. Most runs were at least 7 miles, and some of my teammates had long runs in excess of 12 miles. The men on our team ran even farther. In hindsight, one of my teammates may have met the criteria for a diagnosis of anorexia nervosa. Her weight was significantly below normal, she feared weight gain, did not eat sufficient calories to replenish what she burned on runs, and despite knowing she was thin, did not fully recognize the potential health consequences due to her low weight. However, it was not a clear cut problem. She was not an obvious candidate for an eating disorder because she was not pursuing the excessive exercise; she was simply following her coach’s training plan. If she did not exercise to the extent she did, the amount of food she ate would have been considered normal, so seeing her eating habits alone did not trigger any red flags. Finally, cross country runners are known for being lean, often even emaciated; it was a common side effect of the sport often not given a second thought. Thankfully, this runner never fell victim to the dangerous downward spiral that is sometimes seen in patients with anorexia nervosa. However, it is important to be aware of the unsuspecting ways in which an eating disorder can sometimes present. 

Treatment

Treatment of eating disorders typically involves a multi-pronged approach with nutritional counseling, psychotherapy, and general medical care playing a role. The nutritional counseling aims to help the patient restore a healthy diet to attain a healthy weight, the psychotherapy aims at getting to the root of the issues that may have contributed to the onset of the eating disorder, and general medical care may be necessary to manage any complications from the eating disorder depending on its seriousness. Educational programs about eating disorders and risk factors have also been shown to be successful in helping to prevent eating disorders.

It can sometimes be a fine line between a healthy passion for exercising and eating well and the start of an eating disorder. Especially in athletes where extreme exercise is part of the sport and putting in extra training is rewarded, it is valuable to be aware of the signs and symptoms of exercise bulimia to help prevent a loved one from crossing over that line. Though serious health consequences are possible in the setting of an eating disorder, treatment and recovery are very possible. 

For More Information: www.nationaleatingdisorders.org

Visit your doctor regularly and listen to your body.      

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Sep
09

GROIN STRAIN – Best Treatment is Prevention!

Dr. Mackarey's Health & Exercise Forum

 High school fall sports have begun! This includes; football, soccer, golf, cheerleading, women’s tennis, etc. Unfortunately, even well-conditioned, healthy, young athletes are vulnerable to a variety of injuries, including a pulled muscle on the inside of the thigh called a groin strain. Groin strains are common in the pre and early season but with a few additions to an exercise and training program, prevention is possible.

Groin Strain

A groin strain is a tear of the muscle fibers of the groin muscle. The groin muscle is group of muscles (adductor muscles) that run from the hip (inner pelvis) and attach to the thigh bone (femur). The adductor muscles work to stabilize the hip during weight bearing activities, such as running. They are very active when an athlete changes direction, especially side to side such as guarding an opponent with a defensive slide. This injury, like others, varies in intensity. Severe groin strain occurs when many muscle fibers are torn. In very severe cases, the boney attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.

The Most Common Causes of a Groin Strain

  • Overuse – every time the foot hits the ground the hip adductor muscles must contract to keep the hip and leg from wobbling side to side or turning in and out. If there is not adequate time allowed for rest between workouts or competition, then the muscles may be fatigued and become vulnerable to injury. Also, overuse of the same muscles without rest may make them irritated and inflamed.
  • Inadequate Warm-up – a warm muscle stretches like a piece of gum warmed up in your mouth. When you pull the warm gum, it stretches. However, if you drink an ice cold drink with gum in your mouth and then stretch the gum, it will tear instead of stretch. A good warm-up will prevent tearing and prepare the nervous system for sudden movements and changes in direction.
  • Sudden Movement – quick sprint, sudden change in direction, quick turn with an unexpected force or slip.
  • Poor Body Mechanics – especially when moving or lifting a heavy load away from your center of gravity.
  • Forceful Contact or Loss of Traction – when a leg is forced away from the body by an outside force (tackle in football) or slip on grass or ice.

Symptoms of a Groin Strain

  • Pain – usually occurs gradually. However, a sudden onset can occur, especially associated with a sudden twist or fall. Movement of the hip or change in direction reproduces pain in the groin. Touching the groin area and inside thigh reproduces pain.
  • Swelling/Discoloration – swelling and black and blue coloration can occur in the inner thigh after increase activity at the end of the day.
  • Stiffness – in the hip and thigh is more noticeable in the morning and improves with movement.
  • However, overuse can create more pain and swelling and lead to stiffness also.
  • Weakness – associated with groin/hip pain and can lead to occasional buckling of the hip when walking or climbing steps or getting in or out of a car.               
  • Loss of Function- is associated with groin pain, swelling, weakness and stiffness, which limit walking, stair climbing and participation in sports activities.

Diagnosis

Your family physician will examine your hip and groin to determine if you have groin strain. In more advanced cases you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if you problem if minor, moderate or severe.

Treatment for Groin Strain

There are many conservative options. You and your family physician or orthopedic surgeon will decide which choices are best.

  • Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling. 
  • Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range of motion exercises, strengthening exercises, and supportive compression strapping.
  • Activity Modifications: if it is not the week of the big game, rest, avoid running or stretching/stressing of the thigh muscles.
  • Supportive Devices: such as thigh wraps or sleeves, compression shorts (like those worn under basketball shorts) can provide compression and relief.

Prevent Groin Strains

  • Warm -Up: a pre-activity slow jog or exercise bike and/or massage to the area to warm up the muscles prior to play.
  • Stretching: Indian sit stretch, Hurdler stretch, Lying hamstring wall stretch 
  • Strengthening Exercises: weight training for legs, including inside and outside leg muscles, slide drill and cross kick against resistance tubing (Photo A & B)
    • Photo A – Hip Squeeze Walk – place ball between legs and walk sideways without allowing the ball to drop – 3 X 10
    • Photo B – Hip Spread Walk – place band around knees and walk sideways while pushing into the band – 3 X 10
  • Agility Drills: figure 8, cross-over, tire or disc running
  • Compression Shorts: like those worn under basketball shorts or baseball pants
  • Cool Down:  use ice to the effected area after exercise or sport

SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons

 MODEL: Sarah Singer, Physical Therapist Assistant, Mackarey Physical Therapy

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine GCSOM.

Sep
02

Happy, healthy Labor Day!

Dr. Mackarey's Health & Exercise Forum

 Since 1894 Labor Day has been designated as the national holiday that pays tribute to the contributions and achievements of American workers. Research supports the notion that healthier employees are happier and more productive. When employers encourage healthy behavior and safety at work, they benefit in many ways. For example, in addition to improving job satisfaction and productivity, healthy employees save money by using less sick time, worker’s compensation benefits and health benefits. For example, according to the Centers for Disease Control and Prevention, approximately 75 percent of employers” health care costs are related to chronic medical problems such as obesity, diabetes, high blood pressure, and high cholesterol. Deconditioned, overweight employees are more likely to suffer from these preventable conditions and are at greater risk for injury. Employers, please consider using this holiday as an opportunity to start a health promotion program at your workplace…have a health fair, offer healthy snacks, encourage walking, smoking cessation, exercising at lunch, and offer fitness club stipends.   

Lower back pain, one of the most costly illnesses to employers, is one example of a problem which can be prevented with a good health and safety program. It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics are essential in the prevention of LBP. At our clinic, significant time and effort is spent emphasizing the importance of these concepts to our patients, employees and the businesses we work with through industrial medicine programs. A comprehensive approach can produce significant reductions in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonomics. 

Prevention of Lower Back Pain

  • Maintain Fitness Level

As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.

  • Practice Good Posture & Body Mechanics

Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.P

Photo 1 – Proper Sitting

Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.

Chin Tuck: Tuck your chin back to bring your head over shoulders.

Shoulder Blade Pinch: Pinch your shoulder blades together.

Standing Extension: While standing, put your hands behind back and  extend lower back 10-20 degrees.

Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the surface resistance of the floor. Does it require two people to lift? Can I safely lift that high or bend that low?

Photo 2: Proper Lifting

When bending to lift an object think about safety:

  • Spread Legs Apart Shoulder Width
  • Bend at the Knees and Limit Forward Bending the Spine
  • Arch Lower Back Slightly
  • Get and Maintain a Firm Grip
  • Contract and Hold Abdominal (stomach) Muscles
  • Lift With Legs (not back)
  • Do Not Pivot or Rotate Spine With Load (use feet and step turn)
  • Lift Slowly and Carefully (don’t hurry)
  • Take Time to Perform Back Extension Stretches After the Lift
  • Remember, Pushing is Better Than Pulling a Heavy Load

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Aug
26

No Homework promotes healthy back

Dr. Mackarey's Health & Exercise Forum

The government of India recently announced a ban on homework! Can you imagine…a ban on homework? In an effort to promote student health and address recent surges in the incidence of back pain in the young, there will be no homework for students in grades one and two.

It was estimated that the majority of students ages 7 – 13 in India were carrying almost half their body weight. Not surprisingly, medical practitioners noticed a dramatic increase in reported cases of back pain among this group and decided to take action. In addition to the homework ban for grades one and two, Indian authorities have also implemented a limit of 10% of the student’s bodyweight.

Back pain in students is not unique to India. Each year, as students in the United States prepare to return to school from summer vacation, the subject of backpacks arises. The good news is, when compared to purses, messenger bags, or shoulder bags, backpacks are the best option to prevent lower back pain. The bad news is, most of the 40 million students in the USA using backpacks, are doing so incorrectly.

Studies have found more than 33% of children had LBP that caused them to miss school, visit a doctor, or abstain from activity. Also, 55% of children surveyed carried backpacks heavier than the 10-15% of their bodyweight, which is the maximum weight recommended by experts. Additionally, the study noted that early onset of LBP leads to greater likelihood of recurrent or chronic problems. Backpacks that are too heavy are particularly harmful to the development of the musculoskeletal system of growing youngsters. It can lead to poor posture that may lead to chronic problems.

The following information on backpack safely is based, in part, by guidelines from The American Physical Therapy Association. Parents and teachers would be wise to observe the following warning signs of an overloaded and unsafe backpack:

WARNING SIGNS:

A. Change in posture when wearing the backpack
The weight of the pack forces the child to tip forward to compensate.
Weak or poorly fitted straps force the child to tip to the side to compensate

B. Struggling when putting on or taking off the backpack.
Due to a pack that is too heavy or straps that don’t fit properly.

C. Pain when wearing or after wearing the backpack
Due to a that is too heavy or straps that don’t fit properly

D. Tingling or numbness – in the arms or hands

E. Red marks – under the armpits or on the back

Consider the following suggestions to promote backpack safely and prevent back injury:

10 SUGGESTIONS:

A. Limit Weight of Pack to 10-15% of Body Weight
(100lb child = 10-15lb pack)

B. Padded Adjustable Shoulder Straps
Use both straps to distribute weight evenly. Using one strap may look cool but it will lead to back pain.

C. Waist Belt
An adjustable waist belt will distribute pack weight from back to hips and legs

D. Pack Weight Distributed to Small of Back/Hips – using adjustable straps
Not all the weight on shoulders and upper back

E. Wheeled Backpack – if unable to make above adjustments
This is an option for some children; however, you may have problems carrying/lifting it on the bus etc.

F. Purchase Extra Set of Books And Use Your Locker
Get list from teachers and use the internet to buy extra books to leave at home. Teachers and students might consider downloading text books on the iPads or electronic tablets.
Also, put unnecessary books in your locker between classes

G. Remove Pack When Possible
While waiting for bus, hanging out between class, etc

H. Put Pack On/Off From Chair/Table/Bench – Not Floor
It is much easier to lift a pack up from a table and put it on your back than bending over to get it from the floor

I. Stand Erect and Arch Small of Back
The correct posture while carrying heavy items is to make a hollow or arch the small of your back

J. Perform Posture/Stretching Exercises
Pinch shoulder blades together and extend and arch your spine backwards intermittently throughout the day – especially every time you take your pack off

K. Consider a pack with multiple compartments
Use several compartments to carefully load your backpack and distribute the weight more evenly

L. Use a back with reflective material to enhance visibility.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Aug
19

Your skin and you — how to stay protected

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Guest Columnist: Brandon Eilberg, MD2 GCSOM

Brandon Eilberg, MD2

Brandon Eilberg, MD2, GCSOM Class of 2022 – grew up in Bucks County, PA and is currently doing research with Northeast Regional Cancer Center (NROC) on radiation therapy for non-melanoma skin cancers. As a long time beach goer with a family history of skin cancer, he is very interested in this topic.

Summer is in full swing, and we are spending more time outdoors – fishing at the lake, walking in the park, relaxing at the beach, or enjoying a host of other fun activities. We remember to bring music, drinks, and friends, but one key ingredient is usually missing from the recipe for a perfect afternoon – skin protection. Preventing skin damage is just as important as other healthy habits – like exercising regularly and maintaining a nutritious diet. Repeated sun damage can result in sunburned skin that over time can appear dry, wrinkled, leathery, and discolored. Sometimes, these consequences may not appear until years after we get sunburned. The most serious concern of repeated sun damage is skin cancer, which is now the most common of all cancers in the Unites States. However, it is also one of the most preventable. By making just a few simple additions to your daily routine, you can greatly protect your skin and reduce your chances of developing skin cancer.

How to Stay Protected

Below are some suggestions that physicians and cancer organizations recommend to improve the health of your skin:

• When going outside, use a broad spectrum (UVA/UVB), water-resistant sunscreen with an SPF of 30 or higher. Sunscreen acts like a shield for our skin that defends against UVA and UVB rays from the sun, which penetrate the skin and cause redness, burns, and long-term sun damage. Sunscreen is important for all skin types, even if you don’t burn easily. SPF stands for sun protection factor – the higher the SPF number, the greater amount of protection. Apply it on your skin every day when you know you will be outside and make it a habit, like brushing your teeth. Wearing sunscreen will keep you looking young!
• Apply at least 1 ounce (2 tablespoons) of sunscreen to your entire body. Be generous and apply 20-30 minutes before you go outside. Reapply every 2 hours, after swimming, or excessive sweating, even if the product is labeled as “all-day”. Make sure to cover all areas of your skin not protected by clothes!
• Avoid the sun in the middle of the day, from around 10am to 4pm. The sun’s UV rays are strongest at this time, and you may be more likely to burn during this time period. Apply more sunscreen if you want – better safe than sorry!
• Cover up. If you don’t have sunscreen readily available, seek shaded areas and wear protective clothing, such as long-sleeved shirts, pants, shoes, UV-protective sunglasses, and broad-brimmed hats.
• Keep newborns out of the sun. Infants under 6 months of age should be kept out of the sun because their skin is too sensitive for sunscreen and pigments in their skin, hair, eyes, are still developing. This means that they are especially susceptible to the sun’s damaging effects. After the age of 6 months, sunscreen is safe to apply to babies.
• Avoid tanning and never use UV tanning beds. There is no “safe” amount of tanning. The cumulative damage caused by UV rays can cause premature skin aging and skin cancers. Tanning is the body’s defense mechanism that begins after damage has been done by adding extra melanin, a pigment in the skin that acts as a natural sunscreen.
• Examine your whole body, head to toe, every month. Warning signs include changes in size, shape or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn’t heal. If you have over 50 moles or burn easily, you may want to check more frequently.
• See a dermatologist for a professional skin exam. If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, make an appointment with a board-certified dermatologist. Based on your skin type, history of sun exposure, and family history, a dermatologist may recommend more frequent skin examinations.

Risk Factors:

Some people may be at a higher risk for developing premature skin aging, sunburns, and skin cancer than others. Possible risk factors may include:

• Increased or excessive exposure to natural and artificial UV light
• History of blistering sunburns during childhood or adolescence
• Exposure to tanning beds, especially in women 45 and younger
• A weakened immune system (due to a medical condition)
• People with a personal or family history of skin cancer
• People who tend to burn easily, or people with blond or red hair (you may naturally produce less melanin)
• People with more than 50 moles, atypical moles, or large moles

I hope you remember these short tidbits on skin health and how to be vigilant about protecting yourself from harmful UV rays. These tips are not meant to be single-use suggestions, they are lifestyle modifications to work into your daily routine. With this knowledge, you can greatly reduce your chances of developing skin-related issues like premature aging or skin cancer. So while you’re outside enjoying your summer and beyond, remember to safeguard your body from the sun. Your skin will thank you.

Sources:
https://www.skincancer.org/prevention/sun-protection/prevention-guidelines
https://my.clevelandclinic.org/health/articles/5240-sun-damage-protecting-yourself
https://www.aad.org/media/stats/conditions/skin-cancer

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Aug
12

Prevention of Heatstroke for football, soccer, and fall sports

Dr. Mackarey's Health & Exercise Forum

Summer football training camps and practice sessions are in full swing in Northeastern Pennsylvania. A few years ago, the Pennsylvania Interscholastic Athletic Association (PIAA) implemented “Preseason Heat-Acclimatization Guidelines” This policy is slightly updated for starting dates each year (www.piaa.org).

At this time each year, I receive several emails from concerned parents regarding heat stroke in football players and hopefully this column will serve to educate coaches, players and parents about the importance of heatstroke prevention.

Most medical professionals agree that the amount of protective equipment worn by football players makes them more susceptible to heat stroke than athletes in other sports. It is also well-accepted that prevention is the best treatment for heat stroke. They feel that overweight and poorly conditioned players should be monitored closely by weighing in before and after practice. A player who loses more than 3% body weight is at risk for heat stroke. These players should be required to take more breaks, with more fluid intake before, during and after practice. Heat stroke one of the most serious heat-related illnesses. Heat stroke is caused by long term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible as are athletes wearing full gear and protective equipment. It can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heatstroke is unclear. Prevention is the best treatment because it can strike suddenly and without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals or back yard activities. The American Academy of Pediatrics and The American College of Sports Medicine has the following recommendations:

Signs of Heatstroke:

Heat Exhaustion – can be a precursor to heat stroke

  • Signs: cramps, weakness, fatigue, nausea
    • Treatment: rest in shade, cool down with cool (not cold) towels, and drink plenty of fluids.
  • Core Body Temperature above 105 degrees Fahrenheit
  • Hot, dry skin – flushed but not sweaty
  • Lack of sweating **NOTE: athletes often have external heatstroke and they can sweat even with an increase core temperature
  • Very rapid pulse
  • Mental confusion, disorientation or hallucinations
  • Physical clumsiness, sluggishness or fatigue
  • Seizure
  • Dizziness

Treatment of Heatstroke:

  • CALL 911 – Remember this may be life-threatening
  • Relocate Athlete – to a cool shady place or air-conditioned indoors and lie down with slight elevation of feet
  • Undress – Remove outer garments and roll onto side to expose as much skin as possible to the air
  • Cool Down – spray or sponge with cool water (not cold) and fan athlete
  • Ice – place ice packs to the groin, neck and armpits to cool down large blood vessels. No ice bath.
  • Core Temperature – is the only accurate measurement so medical personnel may take rectal temp if necessary. Must get core temp to 102 degrees Fahrenheit ASAP.
  • Begin CPR – if breathing stops
  • No Aspirin or Acetaminophen – to decrease temp
  • Administer Fluids – if person is alert enough to swallow give 32 to 64 oz over 1-2 hours

Prevention of Heatstroke:

Gradual Acclimatization to Heat – REFER TO PIAA HEAT-ACCLIMATIZATION Source: www.piaa.org

  • Get used to the heat gradually. Begin short conditioning sessions in early summer. Have shorter and less intense practices for the first 7-10 days. If athlete recently had the flu or an illness with a temperature, keep them home for a while and gradually introduce the heat and humidity with short periods of exercise. They are at increased risk for heat stroke.
  • Humidity Index (RI) – Be very aware of the temperature (T) and the relative humidity (RH). RI = T + RH. If the sum of the temperature and relative humidity are greater than or equal to 160, take serious precautions (short sessions in early morning or evening, shorts and half pads, plenty of water and sports drinks etc). If the sum of T and RH are greater than 180, practice and/or games should be canceled.
  • Take Frequent Breaks – 15 minutes after each hour if T & RH is equal to or greater than 160. Rest in shaded areas, helmets off, jerseys loosened or off.
  • Unlimited Cold Water – should be available at all times. Mandatory scheduled water breaks every 15-20 minutes. Break in a shaded area and water down your head, neck etc to cool down. Guidelines: 16 oz 2 hours prior to activity, ½ water bottle every break, after practice continue drinking 1 cup per hour for 4-5 hours, avoid caffeine drinks (can dehydrate), avoid carbonated drinks (bloating will limit water intake) and avoid alcohol.
  • Electrolyte Sports Drinks – are very helpful to replace electrolyte loss. DO NOT USE SALT TABLETS. Generously season food and use sports drinks instead.
  • Dress For Heat – use drytecR type material under your pads to wick sweat away from body and change shirts at break. Wear light colors. Use fishnet jerseys over your pads to keep cool. Remove helmets often in hot weather.
  • Medical Files – keep an index of individual athletes with medical problems or history for problems, especially those at risk for heat related problems. Certain medications may put an athlete at risk for heat stroke. Pay special attention to those players.
  • Keep Alert – coaches, parents, players must be on the lookout for signs of a problem in themselves and their teammates such as fatigue, lethargy, inattention, stupor, and loss of coordination. Remove the athlete from the field, cool down in shade with cool (not cold) damp towel/blanket, seek medical attention.

DO NOT IGNORE SIGNS OF PLAYER DISTRESS OR POOR PRACTICE MANAGEMENT – YOU MAY SAVE A LIFE! – If you witness signs of a player in distress or signs of poor practice management that may jeopardize the health of an athlete, diplomatically speak up. Use references to educate those in charge to recognize there mistakes and improve conditions. Problems occur not because of malice, but usually because of ignorance.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Aug
05

Total Hip Replacement Updates: Anterior vs Posterior. Part 2 of 2.

Matt Miraglia, DPT

Guest Author: Matt Miraglia, DPT

Matthew Miraglia – received a Doctor of Physical Therapy degree from Temple University in May of 2019 and interned at Mackarey Physical Therapy. He grew up in Plains, PA and graduated from Coughlin High School in Wilkes-Barre. Prior to PT school, he received a bachelor of science in kinesiology from Temple University. Matthew plans to graduate with his doctoral degree in May and work in an outpatient physical therapy clinic in the Wilkes-Barre/Scranton Area.

As discussed last week in Hip Replacement Updates – Part 1, there are a wide variety of reasons for why a total hip arthroplasty (THA), or replacement, may be needed, as well as steps that lead to requiring a total hip replacement. Those that do eventually require a THA should be well prepared for their rehab journey going forward, both before and after the surgical procedure. This article will discuss potential precautions after surgery, as well as a few exercises that will serve as a foundation for the rehabilitation process going forward.

Your surgeon should have discussed with you the type of approach that he/she will be performing, and post-operative precautions that you should be aware of. Depending on the procedure approach, it is critical that recommended precautions are followed in order to protect the integrity of the joint replacement, and allow for proper healing.

  • These positions put the healing joint replacement in its most vulnerable position. Your surgeon may recommend additional precautions that are specific to you and your replacement. It is important that these precautions are followed as prescribed by your surgeon and that you feel comfortable and capable following all precautions.
  • Anterior approach – Patients receiving the anterior (front) approach have less post operative precautions. In fact, depending on surgeon preference, often there are no precautions after surgery. The lack of precautions and restrictions is due to the relatively small amount of soft tissue and musculature that must be cut during the procedure. Sparing of the tissue helps keep the replacement much more stable, and decreases risk for dislocation. The most common precaution for anterior approaches is to avoid hip extension, or moving your thigh backwards. Hip extension is most often seen while walking, and when propping oneself up on elbows while lying on stomach.
  • Posterior approach – Patients receiving the posterior (back) approach must follow more precautions and restrictions compared to the anterior approach. This is due to the fact that a much larger amount of soft tissue is cut during the procedure. With more soft tissue involved, the stabilizers of the hip are disrupted, requiring increased caution to protect the replacement for the first 6 weeks following the procedure.
    • The most common posterior precautions are: (See photos)
  1.  No bending hip past 90 degrees – i.e. bending over to pick up objects off the floor, and sitting in a low chair or toilet; (Photo A – Correct Sitting with knee below hip and Photo B-Incorrect sitting with hip below knee and Photo C 1- Incorrect bending at hips to pick up object from floor)
  2. No crossing legs (Photo C2 – Do Not Cross Legs)
  3.  No rolling leg or knees inward – i.e. toes should not be pointing inward when standing or laying down. (Photo D – Do Not Turn Hip or Knee In)

By following these precautions, your hip will be allowed to heal without putting additional strain on the replacement

  • Modifications to daily movements and positions to help you follow these rules include:
    • To Avoid Bending Hip Past 90 degrees– Utilize a grabbing device to pick objects up off floor, and kick affected leg out straight to prevent putting hip past 90 degrees when sitting
    • To Avoid Crossing Legs – put a pillow between your legs when sitting or lying
    • To Avoid Rolling or Turning Legs In – Lay or sleep with 1-2 pillows between your legs to prevent inward rotation of your hip

In addition to precautions, your surgeon should also discuss your ability to bear weight on the affected limb. Most patients are weight bearing as tolerated after surgery, meaning they can put as much weight as they are able to through the leg, but depending age, body type, and if there were any potential surgical complications, weight bearing status may be different. Often a walker is need for a short time after surgery and then advanced to a cane.

Prior to surgery and immediately after surgery there are a few simple exercises that will either maintain (prior to) or help restore (afterwards) hip strength and mobility regardless of the surgical approach utilized. These exercises include: (See Photos)

  • Ankle pumps – (move ankle up and down as if working a gas pedal) – assist with blood return and swelling
  • Quad sets (squeezing muscles in the front of your thigh) – assist with strengthening (Photo E – Quad Set)
  • Glute sets (squeezing muscles of the buttocks) – assist with strengthening
  • Front straight leg raise – (while lying on your back, lift leg up with knee straight) – assist with strengthening (may be performed in a protect range of movement) (Photo F – Straight Leg Raise)
  • Heel slides – (while lying on your back, slide your heel up and down) –  assist with regaining mobility of the hip and knee
  • Hip abduction and adduction (squeezing knees together against a pillow and pushing knees out against a resistance band) – assist with strengthening
  • Short/long arc quads (while sitting in a chair, kick knee out straight) – assist with strengthening. (Photo G – Long Arc Quads)

These exercises will serve as a base for strength and mobility of the hip until pain levels begin to decrease and you are able to tolerate and participate in exercises that require greater mobility in order to complete. Eventually, after a strong base has been formed with strength and mobility of the hip, functional activities will be reintroduced in order to make daily activities easier and more comfortable (walking, climbing stairs, sitting to standing, etc.)

Often, it is recommended that a patient see a doctor of physical therapy before surgery to review the procedure, prepare the home environment for safety and to begin a pre operative exercise program.

In summary, hip replacements have been shown to be one of the most stable of all joint replacements with good outcomes. This article highlights surgical precautions and gives a brief overview of the initial rehabilitation process after surgery. If you have further questions about your specific condition and your surgical treatment plan, you should consult your orthopedic surgeon or physical therapist to help guide you through the process.

For more information visit: American Academy of Orthopedic Surgeons at www.aaos.com

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

Jul
29

Total Hip Replacement Updates: Anterior vs. Posterior. Part 1 of 2

Matthew Miraglia, DPT

Matthew Miraglia – received his Doctor of Physical Therapy degree from Temple University in May of 2019 and an interned at Mackarey Physical Therapy. He grew up in Plains, PA and graduated from Coughlin High School in Wilkes-Barre. Prior to PT school, he received a bachelor of science in kinesiology from Temple University. Matthew plans to graduate with his doctoral degree in May and work in an outpatient physical therapy clinic in the Wilkes-Barre/Scranton Area.

Nearly one million total joint replacement surgeries are performed every year across the United States. A total hip arthroplasty (THA), or hip replacement, is considered to be one of the most successful of all the joint replaced in the body. Moreover, the procedure is considered to be one of the most successful orthopedic interventions of its generation. The procedure has been attempted since the late 19th century, with the modern prosthesis (replacement) seen today being designed in the 1960’s. The modern prosthesis consists of a metal ball and stem, inserted into a plastic cup and secured with acrylic bone cement, technology borrowed from dentists. These mechanical components are referred to as the “low friction arthroplasty”, as it reduces wear and tear of the hip joint. We are currently in the 6th decade of modern THA’s and it is estimated that over 300,000 THA’s are performed each year in the United States alone.

There are many different problems a person might have that may lead a person to undergo a total hip replacement but the most common is severe pain which contributes to loss of mobility and function. Some of the most common reasons for hip pain are: Osteoarthritis – a condition caused by the normal human aging process of joint degeneration; Traumatic Arthritis – when an accident or trauma accelerates the rate of degenerative arthritis; Rheumatoid Arthritis – an autoimmune disorder causing damage to joints throughout the body, including the hip; Hip Fractures – when a hip fracture includes damage to the hip joint; Avascular Necrosis – a condition in which the femoral head does not receive necessary blood supply causing the bone to breakdown; Childhood Hip Diseases – when children are born with certain hip problems, it can lead to early onset of joint damage.  Overall, most implants are performed on patients between ages 50-80. However, if you are within this age group and have one of these conditions, this does not necessarily require a hip replacement. In most cases, hip replacements should be considered only after attempting more conservative treatment such as physical therapy, anti-inflammatory drugs, and walking supports or assistive devices in an effort to decrease pain, increase strength of the hip, and normalize daily functions. Hip replacements may be warranted if: conservative treatments have failed; hip pain limits everyday activities such as walking, bending, stair navigation, and sitting; hip pain is unrelenting even with rest; and stiffness that limits ability to move or lift the leg. If you suffer from these problems, you may consider having a conversation with your physician about potential risks and benefits of undergoing a total hip procedure and you may be referred to an orthopedic surgeon for an examination and consultation. The orthopedic surgeon may discuss potential surgical approaches that may be utilized. Anterior (from the front of the hip) and posterior (from the back of the hip) are the two most commonly utilized procedures when performing THA’s. It is important to keep in mind that studies clearly demonstrate that those with significant pain, loss of motion, strength and function become very unhealthy overtime. Due to inactivity they often gain weight, develop high blood pressure and adult onset diabetes. With this in mind, a new hip might be a very wise decision to improve, not only hip function, but overall health.

Posterior Hip Replacement – the posterior approach has been the gold standard in hip replacement since the 1960’s. Its success has been tested over time and is strongly supported in the literature. When using the posterior approach, the surgeon enters from the back of the hip, where the surgeon has a clearer view of the hip joint. In order to achieve this clear view of the hip, the surgeon must cut through various muscles big and small that are key in maintaining the stability of the hip joint and preventing dislocation. While the ease of surgery may be greater with the posterior approach, more soft tissue is compromised which may lead to a longer recovery time, and come with over a month of hip precautions that include no bending, lifting the leg past a certain point (a 90 degree right angle) and crossing legs.

Anterior Hip Replacement – when using an anterior surgical approach, the surgeon is able to work between the muscles in the front of the hip with minimal or no cutting of muscles, leading to a potentially quicker recovery, less pain after surgery, and decreased risk of dislocation, with few or no hip precautions. While the anterior approach is able to avoid disrupting muscles in the front of the hip, the surgeon has a more limited view of the hip joint during surgery and requires navigation through a bundle of nerves that innervate many of the muscles throughout the leg, therefore requiring a skillful and experienced surgeon who consistently performs the anterior approach.

Patients often ask, “Ok, so which one is better?”. The answer to that question though, really has nothing to do with the approach, but has everything to do with the experience of the surgeon. A study from 2016 found that as long as a surgeon is experienced in the technique he/she will perform, there is no significant difference in outcomes between posterior and anterior approaches. Therefore, you should consult with your surgeon to discuss which approach is best for you based on your body type (thin vs heavy), your mental capacity (are willing and able to follow specific approach based precautions) and most importantly,  your surgeons preference and experience with a particular approach (how many THA’s and which approach do they perform each year?).

In summary, the purpose of this article is to provide a basic overview of the history of total hip replacements, who may need them and for what conditions, and differences in two of the most common surgical hip replacement approaches, anterior and posterior. In order to know what type of medical management is most appropriate for you, you should consult with an orthopedic and a physical therapist and undergo a comprehensive physical examination that will rule out other sources of pain, and provide you more definitive answers about what is causing you pain at your hip.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Read Hip Replacement Part 2

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).

Jul
22

Use of Exoskeleton Suits for Gait Training

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Mary M. Pelkowski, Joseph Hornak, & Cecelia Allison

Mary Pelkowski, MD2 is a student in the Geisinger Commonwealth School of Medicine MD Class of 2022. She grew up in Sayre, PA and graduated from Notre Dame High School. She received her undergraduate degree in biology with a minor in chemistry from Saint John Fisher College in Rochester, NY.

Joseph Hornak, MD received his Doctor of Medicine from GCSOM in May 2019. He grew up in Hazelton, PA. and will train as a resident in Physical Medicine & Rehabilitation at University of California, Davis in Sacramento, CA. Following residency, he plans to pursue fellowship training in pediatric physiatry. Currently, he resides in Allentown, PA, where he is completing his internship year at Lehigh Valley Cedar Crest Hospital.

Cecelia Allison, MD2 medical student at Geisinger Commonwealth School of Medicine. Cecelia grew up in the South Hills of Pittsburgh and graduated from the University of Notre Dame with majors in Neuroscience and Spanish. In her free time, she enjoys practicing yoga and traveling to new places.

Military exoskeleton suits are reality’s version of Marvel’s Iron Man suit. Just as Tony Stark used his suit’s superpowers to fight evil, the military Raytheon XOS 2 exoskeleton suit uses high pressure hydraulics to enhance the wearer’s strength, agility, and endurance. In fact, one soldier in this suit can perform the same amount of work as three army personnel. This has allowed soldiers in the U.S. army to achieve extra-human functions and prevent injuries and strain on their bodies. Industrial exoskeletons use the same design to prevent work related injuries, enhance employee productivity, and extend employees’ time in the workforce. Now, exoskeleton suits have become a groundbreaking medical intervention to help patients who have suffered from spinal cord injuries or strokes.

The preliminary design for exoskeleton suits came from General Electric in the late 1960s. General Electric’s “Hardiman Suit” enhanced the user’s strength, allowing one to lift extremely heavy objects. Researchers soon saw the opportunity for Hardiman technology to restore lost function in people suffering from musculoskeletal problems. In the early 1970s, the Hardiman Suit evolved its first medical use as an exoskeleton, after the work by researchers at the Mihajlo Pupin Institute in Serbia and the University of Wisconsin-Madison in the early 1970s. Since then, exoskeleton suits have focused on teaching or re-teaching users how to walk. The Lokomat (made by the company Hocoma in Switzerland ) was one of the first designs to improve walking abilities of patients who had suffered spinal, cerebral, neurogenic, osseous, and neurogenic injuries. This novel machine is a combination of a treadmill and body weight support, and it allows guided movements and repetition of gait movements to facilitate motoric learning. However, body weight supported treadmill training (BWSTT), like the Lokomat, has not been shown to have any superiority over traditional physical therapy.

Modern, non- BWSTT exoskeleton suits assist patients in achieving over-ground walking in their natural gait pattern (hip extension and full loading of lower limbs) while at the same time promoting active involvement of the patient. The suit, worn over the legs and upper body, contains an intricate network of technology to help its users ambulate. Sensors in the lower limbs capture any postural cue or movement that is initiated by the user. A computer, located in either a backpack or the suit’s torso, will then process this information to activate movements such as sitting, standing, walking, or turning. The exact function depends on the setting that is controlled by a remote worn on the user’s wrist or operated by a licensed therapist. Depending on the extent of the user’s injuries and remaining function, the exoskeleton can be set to completely move the individual’s legs or to assist with the movement, allowing the user to contribute to their own movement however much they are able. While these suits weigh between 50 and 65 pounds, users are still required to use crutches, canes, or walkers to help stabilize their upper bodies and keep the user safe. In the event of a malfunction, the different suits are programmed with failsafe features that lock or slowly collapse the lower limbs.

Currently, the most prominent use for exoskeletons is to help retrain a patient’s gait following an injury or stroke as part of a rehabilitative program with the hope of helping the patient to ultimately regain the ability to walk independently. However, recent FDA approval of the ReWalk exoskeleton for personal use outside of the clinic can provide individuals with a permanent means of maneuvering independently as the exoskeleton can be used at home and in the community. This could impart greater opportunities for freedom and social engagement to the user.Important additional physical benefits of exoskeleton use include increasing physical activity and energy expenditure through the assisted movement of muscles, which may help combat the development of a sedentary lifestyle and obesity. This allows the user to spend less time sitting and more time in an upright position, which may decrease the risks of heart disease and cancer. Furthermore, by helping to support the patient’s weight and movement during rehabilitative exercises, exoskeletons can reduce the physical burden placed on physical therapists in helping patients to execute rehabilitative exercises. Doing so can allow for more effective and efficient utilization of the therapist’s attention to patients. If you are interested in learning more about exoskeletons and their use, rewalk.com and eksobionics.com provide information about their respective suits.

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Jul
15

Spend Time Outdoors: Part 2 of 2

SPEND TIME OUTDOORS – IT’S HEALTHY!

Part 2 of 2

Dr. Mackarey's Health & Exercise Forum

GET THE HECK OUTSIDE! Research shows that spending time outdoors has many positive effects on your health. While there are many year round activity options, in Northeastern Pennsylvania our short-lived summer is the inspiration to “suck the marrow out of a sunny day!”  Summer in NEPA can be enjoyed in many ways such as; walking, running, hiking, biking, horseback riding, boating, kayaking, and swimming. Studies show that even less vigorous activities such as; fishing, picnicking camping, barbequing or reading a good book on the porch are healthier than being indoors. 

Dr. Paul and Esther Mackarey, hiking in Alaska. June 2019.

It is reported that Americans spend 90% of their lives indoors and that number increases with age. Worse yet, for some, venturing outdoors is considered risky behavior with fear of the sun, ticks, wind, mosquitoes and other creatures of God. Well, the truth of the matter is the risk of being one with nature is far less than the ill effects of a life stuck indoors. Please consider the following benefits of spending time outdoors.

  • Nature’s Vitamin D – Current research suggests that Vitamin D (The Sunshine Vitamin), may offer significant disease prevention and healing powers for osteoporosis, some forms of cancer and heart disease. Of all the methods of getting an adequate amount of Vitamin D, none is more fun than spending time outdoors in the sunlight. It seems that the health concerns of ultraviolet light, sun burn and skin cancer have created an overreaction to the point of Vitamin D deficiency in many. Balance and common sense go a long way. One can attain normal levels of Vitamin D by being outdoors in the sun and exposing their arms and legs for 10 -15 minutes a few times per week. Additional time in the sun warrants sunscreen and Vitamin D supplements can be used if necessary.
  • Increase Activity Level – While exercising indoors in a gym is valuable, research shows that time spent indoors is associated with being sedentary and being sedentary is associated with obesity, especially in children. Some studies show that children in the United States spend an average of 6 ½ hours per day with electronic devices such as computers, video games and television. It is also reported that a child’s activity level more than doubles when they are outdoors. So, get out of the office, house and gym as often as possible. Consider weight training at the gym and doing cardio by walking, biking or running outdoors.    
  • Improved Mental Health – It is well documented that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health. Furthermore, studies show that exercising outdoors in the presence of nature, even for as little as 5- 10 minutes has additional mental health benefits. For those less active, read or listen to music in a hammock or lying in the grass.
  • Improved Concentration – Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term is supported by research that found children with ADHD focus better when outdoors. Furthermore, it was discovered that these children scored higher on concentration tests following a walk in the park than they did after a walk in their residential neighborhoods or downtown areas, showing the benefit of the “green outdoors.”
  • Improved Health and Healing – Researchers at the University of Pittsburgh found that patients recovering from surgery recovered faster with less pain and shorter hospital stays when they were exposed to natural light. Next time you’re recovering from an illness, discuss this with your physician. 
  • Improved Breathing – In general, breathing fresh air is good for you. Some exceptions might be those with severe allergy problems when the pollen count is high. In spite of this, it may be better to take allergy medicine and enjoy the benefits of being outdoors than to be stuck inside. Many pulmonologists believe people with pulmonary problems would benefit from outdoor activities such as a 10-15 minute walk because they are prone to osteoporosis and Vitamin D deficiency.  Local pulmonologist, Dr. Gregory Cali, DO, agrees and also adds that studies do not show that high humidity is dangerous for respiratory patients but it may be uncomfortable. In cold temperatures, those with pulmonary problems must avoid directly breathing cold air by covering up their mouths when walking outdoors. Overall, the benefits far outweigh the risks.

Read “Health & Exercise Forum” – Every Monday.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. 

Jul
08

Spend Time Outdoors: Part 1 of 2

Dr. Mackarey's Health & Exercise Forum

RESEARCH SAYS IT’S HEALTHY!

It is summertime! So, make time to enjoy the great outdoors because research shows that it is good for your health! 

Daphne Miller, MD, is a physician, author, hiker and associate clinical professor at The University of California, San Francisco. She is an advocate of the National Park Service’s “Healthy Parks, Healthy People” program. She was featured in NationalParks Magazine for prescribing outdoor activities for the health and well-being of her patients. 

Denali National Park Wonder Lake, June 2019.
Photo by Dr. Greg Cali

Dr. Miller is strong proponent of the spending time in the great outdoors for medicinal purposes. Studies strongly support the fact that exposure to green space has a positive impact on our health and well-being. Consequently, when taking a patient history, she is just a likely to ask a patient how much time they spend in nature, as she is how much they smoke and drink alcohol. 

Kayaking at Lackawanna State Park.
Dr. Paul Mackarey, PT, DPT

Hundreds of studies support the fact that getting off the couch, away from the television and video games to increase physical activity, is only one of the many reasons people benefit from green space. One study demonstrated that children with attention-deficit hyperactivity disorder (ADHD) functioned with more focus when placed in a natural setting. Other studies found that children demonstrated lower risk for asthma and elderly improved their longevity, when they lived in greener spaces. Most impressive, was a study published in the British medical journal, Lancet, which found that health disparities between wealthy and poor were neutralized when both groups lived in greener spaces.    

According to the article in NationalParks, a “nature prescription” written by Dr. Miller might look like this: 

Drug: Exercise in Glen Canyon Park

Dose: 45 Minutes of Hiking, Walking, or Running

Directions: Take 3-4 Times per Week (M,W,F,S) at 7 AM or 7 PM

Refill: Unlimited

As many of readers who know me are aware, I am a card carrying member and passionate supporter of the National Park Conservation Association (NPCA). I have not only visited, but camped, explored, and hiked, in many of our National Parks and enjoyed all four seasons in several of these special places. As you may recall from the Ken Burn’s documentary, “The National Parks – America’s Best Idea” these sanctuaries are often described as much for their natural beauty, as they are for the emotion they evoke…spiritual, divine, ethereal, holy, calming, tranquil, mesmerizing, inspirational, illuminating and other countless words of peaceful wisdom. For me, they are this planets version of “heaven!” 

WHAT IS YOUR FAVORITE NATIONAL PARK?

People often ask, “What is your favorite National Park?” I tell them, “It is impossible for me to pick just one.” They all have their own special beauty and each exudes a unique feeling. For example, The Grand Canyon in Arizona is an overwhelming beautiful place that must be seen before you leave the planet. For most, it is admired by looking down into a “special version of heaven.” At the same time, Yosemite National Park in California stirs emotion while looking up at the granite rock formed into art by nature with names like Half-Dome and El Capitan. However, more than 500 geysers, including “Old Faithful” and many other thermal features produced over millions of years, have mesmerized visitors in Yellowstone National Park like no other natural feature. And, I will forget how the breathtaking view of Denali Mountain inspires me! (Attached photo by Dr. Greg Cali). So, you can quickly see the dilemma in choosing one favorite over fifty-eight special versions of heaven on earth!

PLENTY OF GREEN SPACE IN NEPA!

Keep in mind, living in NEPA offers plenty of options for healthy green space. You do not have to travel far to get our city or state parks. Nay Aug Park and Lackawanna State Park (attached photo of Dr. Paul Mackarey Jr Kayaking at LSP) are two good LOCAL examples. A short drive will take you to Ricketts Glen State Park for a beautiful hike along the waterfalls. If you don’t mind a little longer drive, The Pennsylvania Grand Canyon will bring you closer to a healthy mind, body and spirit.   


Read “Health & Exercise Forum” – Every Monday.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Jun
24

Control Menopause through Exercise!

Dr. Mackarey's Health & Exercise Forum

According to the North American Menopause Society (NAMS), 1.5 million American women reach menopause each year. The median age is 52, but some women will reach menopause as early as 40 or as late as 58. Recent research revealed that menopausal women who engaged in three hours of exercise per week for one full year reported improved mental and physical health.

Menopause begins when women’s ovaries are depleted of healthy eggs. Typically, women are born with 1-3 million eggs which are lost over the course of a women’s life through ovulation and other natural means. Under normal conditions, a reproductive hormone called follicle-stimulating hormone, (FSH) stimulates the growth of the eggs during the first half of the menstrual cycle. As a woman approaches menopause, the eggs become more resistant to FSH. Additionally, the ovaries produce significantly less estrogen, a hormone that affects the blood vessels, heart, bone, breasts, uterus, skin and brain. Many of the symptoms associated with menopause are due to the loss of estrogen. These symptoms include: hot flashes, irregular or skipped periods, insomnia, mood swings, fatigue, depression, irritability, racing heart, headaches, joint and muscle pain, decrease sex drive, vaginal dryness, and loss of bladder control. While not all women get these symptoms. Most women experience various degrees of some of these symptoms.

Exercise and Menopause:

Several studies support the fact that women who engage in regular exercise report less menopausal symptoms than those who are inactive. One particular study in the Journal of Advanced Nursing, found that women who engaged in 3 hours of exercise per week for one full year reported improvement in mental and physical health as compared to the control group. The program consisted of cardiovascular, stretching, strengthening, and relaxation exercises.

In another study published in the Annals of Behavioral Medicine, researchers found that women who walked or performed yoga reported improvements in quality of life with less anxiety and stress related to their menopause symptoms. It is believed that exercise stimulates a release of endorphins in the brain and this is the primary mechanism by which exercise relieves symptoms associated with menopause. 

How to Begin an Exercise Program:

Consult with your family physician before you begin an exercise program, especially if you have health issues. Consider a consultation with an orthopedic or sports physical therapist for professional advice to begin an exercise program best for you. Wear comfortable exercise clothing and sneakers. Exercise to control menopause symptoms does not have to be extreme. A simple increase in daily activity for 15 minutes 2 times per day or 30 minutes 1 time per day is adequate to control your symptoms. This can be simply accomplished by walking, swimming, biking, and playing golf or tennis. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes 4-5 days per week with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for 5-10 minutes, 2-3 times per day. Then, add 1-2 minutes each week until you attain a 30-45 minute goal. Keep in mind, weight bearing exercises such as: walking, hiking, and light weight training are important for improving the loss of bone density associated with menopause.  

A Comprehensive Healthy Lifestyle Includes:

  • Exercise – as described above is an essential component of controlling menopause symptoms and overall wellness.
  • Diet & Nutrition – limit high-fat foods especially from animal sources. Limit red meat and dairy. A diet consisting of fish, fruit and vegetables is valuable. Some researchers theorize that brussel sprouts, broccoli, and cabbage may trigger a chemical process to turn on a gene to suppress tumors. Sunlight and vitamin D are thought to be important too. 
  • Lifestyle & Personal Habits– avoiding smoking and excessive alcohol use increases health and wellness. Controlling stress and anxiety can also be helpful.

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Jun
17

Walk with a Doc

National Program Comes to NEPA by way of GCSOM

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Cecelia Strauch, MD2

Cecelia Strauch, MD2 of Factoryville is a member of GCSOM’s MD Class of 2021. She is a member of GCSOM’s Family Medicine Interest Group (FMIG), and served as co-president in 2017-18.  She attended Lackawanna Trail High School in Factoryville, and received her undergraduate education at the University of Scranton from which she graduated with majors in biology and philosophy and a minor in Spanish Language.

Geisinger Commonwealth School of Medicine (GCSOM) is teaming up with The Wright Center for Community Health to encourage Scranton residents to take a step toward better health with Walk with a Future Doc, a health program that brings medical students, doctors and patients together to walk every fourth Saturday monthly at 9 a.m. at one of two partner sites: Lackawanna River Heritage Trail at West Olive Street or Backcourt Hoops at 5 West Olive Plaza.

The initiative is led by GCSOM medical student, Cecelia Strauch of Factoryville, a member of the Class of 2021.

Walk with a Doc is a national nonprofit organization whose mission is to encourage healthy physical activity in people of all ages and reverse the consequences of a sedentary lifestyle in order to improve the health and well-being of the country.

“This program has had tremendous participation and success in hundreds of cities around the country,” said Jennifer Joyce, MD, professor of family medicine at GCSOM. “I’m very pleased to bring this exciting and simple program to Scranton because it has shown such improved health results for countless people around the country.”

The walk is open to the community and each walk will feature a short educational talk about a health topic of interest to participants. Participation is free and pre-registration is not required. Walkers will enjoy a refreshing and rejuvenating walk with medical students and healthcare professionals from GCSOM and The Wright Center for Community Health, who will provide support to participants and answer questions during the walk.

“Walk with a Doc is honored to team up with the Geisinger Commonwealth School of Medicine. By incorporating this program into the practice, GCSOM is demonstrating an exceptional level of care and commitment to their community,” said Dr. David Sabgir, founder of Walk with a Doc.

Scranton joins a growing list of communities nationwide that have started local Walk with a Doc (WWAD) programs. WWAD was created by Dr. David Sabgir, a cardiologist with Mount Carmel Health Systems in Columbus, Ohio.  He has walked with patients and community members every weekend since 2005.

Learn more about Walk with a Doc at www.walkwithadoc.org.

Benefits of Walking

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.”

According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

  • Improve blood pressure and blood sugar levels
  • Help maintain a healthy body weight and lower the risk of obesity
  • Enhance mental well-being
  • Reduce the risk of osteoporosis

Use Efficient Technique

Proper walking technique

Like everything, there is a right way of doing something, even walking. For efficiency and safety, walking with proper stride is important. A fitness stride requires good posture and purposeful movements. Ideally, here’s how you’ll look when you’re walking:

  • Head up, look forward – glance at the ground but don’t stare down.
  • Relax your neck, shoulders and back – avoid a rigid upright posture.
  • Swing your arms freely with a slight bend in your elbows.
  • Keep your stomach muscles are slightly tightened (work the core) with a straight back.
  • Walking smoothly – rolling your foot from heel to toe.

Plan Ahead

  • Gear Up – but don’t go overboard. Good running shoes with proper arch support and shock absorption. Wear weather appropriate dry tech clothing with bright, reflective visible colors.
  • Select the Best Path – begin on level surfaces like a “rails to trails.” In inclement weather consider walking in a shopping mall.
  • Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.
  • Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.
  • Stretch. After you cool down, gently stretch your muscles. If you want to stretch before you walk, remember to warm up first.

Set Realistic Goals

Anything is better than nothing! However, for most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity. The guidelines suggest that you spread out this exercise during the course of a week. Also aim to do strength training exercises of all major muscle groups at least two times a week.

As a general goal, aim for at least 30 minutes of physical activity a day. If you can’t set aside that much time, try several short sessions of activity throughout the day. Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefit.

Remember it’s OK to start slowly — especially if you haven’t been exercising regularly. You might start with five minutes a day the first week, and then increase your time by five minutes each week until you reach at least 30 minutes.

For even more health benefits, aim for at least 60 minutes of physical activity most days of the week.

Track Your Progress

Keeping a record of how many steps you take, the distance you walk and how long it takes can help you see where you started from and serve as a source of inspiration. Record these numbers in a walking journal or log them in a spreadsheet or a physical activity app. Another option is to use an electronic device such as a pedometer or fitness tracker to calculate steps and distance

Source: Mayo Clinic

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Jun
10

Preventing Softball Pitching Injuries

Dr. Mackarey's Health & Exercise Forum

High school softball season is over; however, many young women will continue their sport throughout the summer. Unfortunately, female athletes are often forgotten when it comes to injury prevention. It is the purpose of this column to raise the level of awareness regarding prevention of pitching injuries in softball.

Pitching injuries in softball are very similar to the pitching injuries in baseball.  Bursitis, rotator cuff injury, impingement syndrome, little league shoulder, little league elbow are all common to the softball player/pitcher.  Sherry Werner, Coordinator of the Human Performance Laboratory at the Tulane Institute of Sports Medicine, says that 80 percent of college softball pitchers miss some playing time because of arm pain.  Equally startling is that the same problems exist for players in the 12 – 18 age groups.  The focus of this article is preventing arm injuries in the softball pitches.

Gerald Warner, a Colorado pitching coach, identified 10 injury-causing softball pitching problems:

  1. Overuse – As with baseball pitching, the most common cause of injury in softball pitching is overuse.  While there presently is no sanctioned pitch count in softball, one must be careful that a pitcher does not throw too many pitches and has adequate recovery between games.  It has been suggested that 12 year olds throw no more than 60 pitches, 13-18 year olds no more than 60 pitches and no more than 100 pitches for athletes 15 years old and over. 
  2. Inadequate warm-up – Muscles must be warmed up and stretched prior to demands of pitching.  Jogging for 3-5 minutes followed by a stretching program (never stretch a cold muscle) is essential before the first underhand pitch.
  3. Bending at the waist – Young pitchers have a tendency to bend at the waist during the final portion of their pitching motion.  At the time of release, bending forward causes a slower pitch and often can lead to back injuries. 
  4. “Snapping” the release – Some young players get into the habit of stopping their arm motion as soon as the ball leaves their hand which is known as “snapping the release”  Continued snapping the release rather than a controlled follow through may result in elbow and forearm injuries.  
  5. “Chicken-winging” – “Chicken-winging” is when a pitcher’s elbow flies out during the pitching motion.  This is not a natural part of a pitch release or follow-through which can lead to elbow and shoulder problems.  The pitcher should try to keep the elbow close to their side at the release to avoid undo stress.
  6. Practicing breaking pitches before you are ready – As with baseball, breaking pitches place undue demand on developing skeletons.  Although they may have the knowledge and ability to throw breaking pitches, they do not have the bone structure to weather the stress.  Growth plates are at risk and future pitching in advanced leagues may be compromised due to permanent shoulder injury.
  7. Pitching from the “Open” position –   Some pitchers are taught to “keep your body open (sideways to the catcher) when you release the ball”.  Unfortunately, many who are taught with this method develop a problem of bending at the waist during the final downswing and through the release of the pitch.  This additional torque can put severe pressure on the pitcher’s back. 
  8. Improper landing of the stride foot – Since the majority of female fastpitch pitchers use the “leap and drag” style of pitching, it is important that the stride leg drives out fast and far.  Ideally, the knee will be slightly bent at landing and the stride foot will land at an angle of between 20 and 30 degrees.  If the pitcher’s foot is pointing more directly toward the catcher, it can cause the bent knee to “buckle” and lead to injury.  If the foot lands at more of an angle, more than 45 degrees, it is too far sideways, and the “blocking” or pushback against the landing foot can cause an ankle, calf, and/or knee problem.
  9. “Jerking” the shoulders or head back at the release of the pitch – Although rare, some pitcher can develop a body “jerk” as they whip their arm down through the release point.  Although this “arm whip” is essential for maximizing the speed of the pitch, it should not involve any snapping of the upper back, neck, or head which may result in injury.
  10.  Not pitching like a girl – Many young female athletes are taught fastpitch basics from male instructors.  Unfortunately, there is a tendency by many male instructors to tell girl softball pitchers to “do it the way I do it” regardless of the girl’s age, size, physical and emotional development, athletic ability, etc. All pitches need to be adjusted to the abilities, needs and comfort-level of the pitcher.

CONTRIBUTOR: GARY E. MATTINGLY, PT, PhD, Professor Emeritus, University of Scranton, Dept. of Physical Therapy

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

May
06

Studies Show That Sitting Time in USA Rises and That Sitting is Unhealthy!

Dr. Mackarey's Health & Exercise Forum

Get Off Your Butt!

A recent study published in the Journal of the American Medical Association (JAMA) found that the average daily sitting time in the USA has increased by almost an hour over the past decade. This translates to approximately 8 hours of sitting for teenagers and 6 ½ hours for adults in this country. The study found that more than 50% of kids and adults spend more than one hour of LEISURE time per day on a computer. Surprisingly, the greatest increase in sitting time was found among the “oldest” adults. These findings are particularly concerning when one considers the many other studies that have demonstrated the risks of prolonged sitting.

Research has repeatedly correlated the amount of sitting time per day to health problems. In fact, one study found a relationship between the amount of time an individual watches television to a decrease in their average life expectancy. Seriously, watching television and sitting is literally killing us. The Heart and Diabetes Institute of Australia conducted extensive research on sedentary behavior, including a review of almost one million people. They used actuary science, adjusted for smoking, waist circumference, and diet and exercise habits to assess the specific effects that the hours of sitting in a day impacts a person’s life span.  They found that sitting too long results in a decrease in muscle contraction of the big leg muscles and because these unused muscles need less fuel, more unused glucose (fuel) is stored in the muscle. High glucose levels result in high blood sugar, which leads to adult onset diabetes and other health issues.

How Sitting (TV Viewing) Impacts Life Span – as compared to non-viewers

One Hour Sitting (TV) after age 25 =   Decrease Life Span by 21.8 Minutes

One Cigarette Smoked after age 25 =   Decrease Life Span by 11 Minutes

Six Hours Sitting (TV) over lifetime = Decrease Life Span by 4.8 Years

It is very important to note that exercise alone was NOT the solution. Even people who exercise 30 minutes 3-4 days per week or more, but watch more than six hours of TV, have the same mortality as a non exerciser who does NOT watch TV.

But, if you watch TV AND sit in a chair all day at work in a sedentary occupation, YOUR LONGEVITY IS SHORTENED DRAMATICALLY!

The average adult spends 50 – 70% of their non-sleeping life time sitting. Those with greater sedentary behavior (TV + Sitting Time), have 112% increase risk for adult onset diabetes, 147% increase for cardiovascular disease, 49% increase risk for premature death…even with regular exercise.

Tips to Get Off Your Butt

Exercise

Exercise is still very important, but you still must sit less and be active in between exercise time.

Limit TV Time

Make a conscious effort to watch less than 2 hours of TV per day. Join the lower risk group.

Get Off Your Butt While Watching TV

When you watch TV, get up and move during every commercial…stand, walk, march in place.

Get Off Your Butt At Office

Every 30 minutes get up and stretch, march in place, or walk for 3-5 minutes. Take the stairs instead of the elevator. Stand up during coffee breaks or when you‘re on the phone. Consider having meetings in which you stand up, use a standing desk or a work station which allows you to walk slowly on a treadmill while you’re working such as a TrekDesk.R (www.trekdesk.com).  

In conclusion, don’t kid yourself. Exercise alone will not result in improved longevity if we eat poorly and sit around watching TV the rest of the time. It is about BALANCE…exercise, diet, stress management, and living an active lifestyle with more activity than inactivity. Shut off the TV and get off your butt!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

Paul J. Mackarey, PT, DHSc, OCS is doctor of health science specializing in orthopedic and sports physical therapy. He practices in downtown Scranton and is an associate professor of clinical medicine at GCSOM.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Apr
29

Avoid Spring Baseball Shoulder Pain

Dr. Mackarey's Health & Exercise Forum

It happens every spring. A young pitching ace that started strong is now beginning to lose some speed on his fast ball. A third baseman that had no problems last week can’t throw to first base without pain. Shoulder pain in young baseball players occurs every spring just as the first robin, warmer temperatures, and the emerging sprouts of the spring flowers. And, the well-intended father/coach develops severe shoulder pain from hours of throwing balls at batting practice. The cause of the condition was the usual: not properly preparing the arm for the season.
Spring shoulder pain may be prevented with the proper preparation for the season. Throwing a baseball requires the shoulder to be very strong. In the off season, a shoulder can lose much of its essential strength. This loss will result in a deconditioned shoulder at the start of the first spring practice. Practicing with a deconditioned shoulder commonly results in sprain, strain and pain.
To avoid spring shoulder pain it is necessary to maintain shoulder strength. Strengthening exercises need to concentrate on three groups of muscles: the large power muscles of the shoulder, the muscles which stabilize the shoulder and the all important rotator cuff muscles. Strengthening power muscles of the shoulder is fairly easy. Pushups, lat pulldowns, bench presses, and bicep curls will cover all bases. While these exercises are important in maintaining strength and power of the throwing shoulder, they are not as important as the exercises for shoulder stabilizers and rotator cuff muscles.

The shoulder stabilizer muscles connect the arm to the torso. They serve as the foundation of the arm helping to stabilize the arm to the torso. The many stabilizing muscles include the trapezius and the rhomboid muscles.

Exercise for theses muscles include: shrugs, T’s and Y’s. (See Photos A, B, C)


PHOTO A: SHRUGS: Stand with Dumbbell Weight in Hands, Raise Shoulders, Hold 3 Seconds and Repeat 10 times.
PHOTO B: “T’s”: Lying Face Down with Forehead on Towel Roll and With Light Dumbbell Weight in Hands, Raise Arms up in the shape of a “T.”
PHOTO C: “Y’s”: ”: Lying Face Down with Forehead on Towel Roll and With Light Dumbbell Weight in Hands, Raise Arms up in the shape of a “Y.”

The rotator cuff muscles have many functions. They are essential for the stability and proper function of the shoulder joint and in the throwing athlete they serve as brakes during the follow-through phase of a pitch. Exercises for the rotator cuff muscles include internal and external rotations. (See Photos D, E)

PHOTO D: Shoulder Internal Rotation: Stand with Exercise Band in the Throwing Hand and Elbow at the Side and Bent at 90 degrees, “Turn In – Against the Band.”

PHOTO E: Shoulder External Rotation: Stand with Exercise Band in the Throwing Hand and Elbow at the Side and Bent at 90 degrees, “Turn Out – Against the Band.”

While exercise is essential for conditioning the shoulder in the off-season, a graduated throwing program is also important. In the book The Athlete’s Shoulder, a throwing program is suggested. Training is every other day with a day’s rest in between. A ten minute warmup such as light jogging is suggested before throwing.
Day 1: 45ft – 25 throws – rest – repeat
Day 3: 45ft – 25 throws – rest – repeat – rest – repeat
Day 5: 65ft – 25 throws – rest – repeat
Day 7: 65ft – 25 throws – rest – repeat – rest – repeat
Day 9: 90ft – 25 throws – rest – repeat
Day 11: 90ft – 25 throws – rest – repeat – rest – repeat
Day 13: 120ft – 25 throws – rest – repeat
Day 15: 120ft – 25 throws – rest – repeat – rest – repeat
Day 17: 150ft – 25 throws – rest – repeat
Day 19: 150ft – 25 throws – rest – repeat – rest – repeat
Day 21: 65ft – 25 throws – rest – repeat
Day 23: 65ft – 25 throws – rest – repeat – rest – repeat

With the proper preparation, spring shoulder pain can be avoided in any baseball player.

Contributions: Gary E. Mattingly, PT, PhD is a retired professor at the University of Scranton, Dept of Physical Therapy
Models: Ron Chiavacci,, former professional baseball pitcher; Maggie Reilly, physical therapy student.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Apr
22

Vaccines and Children: What Every Parent Should Know, Part 3

Part 3 of 3

(Read Part 1 or Part 2)

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.

Dr. Timothy Welby
Dr. Timothy Welby

For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!

The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.

Vaccination Side Effects

Despite the overwhelming scientific evidence that childhood immunizations are safe and effective to protect children and adults from serious and potentially fatal diseases, many parents remain skeptical and reluctant to get their children immunized. As with any medication given to millions of patients annually, side effects do occur, however, most are mild and self limiting. Side effects include; redness, swelling or pain at the injection site (usually in the front of the thigh in children and the outer upper arm in adults and children over one). These symptoms are uncomfortable but not dangerous. Mild fever is also common after a vaccine or when multiple vaccines are given together and should be treated with ibuprofen (Motrin, Advil) for children over 6 months old or acetaminophen (Tylenol) for any age child. Fever, especially in a very young child, may not be a side effect to a vaccine but a sign of infection. High fever or lethargy in an infant or child should always prompt a call to the doctor.

Rarely a child can get an infection at the site of a vaccination. It can look similar to a mild reaction but tends to occur a few days after the injection, not immediately following. Also, some children can get a very high fever after vaccination, more likely after the Measles, Mumps, Rubella (MMR) or Measles, Mumps, Rubella, Varicella (MMRV) vaccines which can lead to fever seizures with illness unrelated to the immunization. Measles and chickenpox vaccine can also cause a rash 10 -14 days after immunization, which is harmless but alarming to parents if they are not expecting it.

Measles vaccine may also cause immune thrombocytopenic purpura, a frightening-sounding reaction that occurs when a child’s blood clotting system is affected by the immune system. The condition causes a rash and possible blood clotting problems which can be treated with medication but usually resolves on its own. Rotavirus vaccine, the only oral vaccine routinely given to children, may cause swelling of lymphoid tissue in the intestine called intussusception. It causes a bowel blockage and vomiting and requires urgent medical attention. Fortunately, this reaction is so rare that medical scientists are not sure if it is any more frequent in vaccinated babies as in those unvaccinated. However, what is clear is that prior to routine vaccination against rotavirus, about 60,000 children in the U.S. were hospitalized and 20-60 died each year due to the illness.  The most severe reaction to a vaccine is called anaphylaxis. It is a potentially deadly allergic reaction which occur less than one for every million doses administered. However, due to the life-threatening potential of this reaction, immunizations for children should only be administered in a setting fully equipped to handle this emergency.

Some patients with special needs, such as those with illnesses and immune problems, may not be able to receive certain vaccinations. This is not a complete list of reactions to vaccinations. Always ask your physician any questions you have before your child gets their immunizations.

MMR Vaccine and Autism Controversy

Some parents are hesitant to get their children immunized because they have unfounded fears about vaccine side effects. The biggest recent concerns surround the MMR vaccine and Autism, which arose after a small study linking MMR vaccine and Autism was published in England. The article was discredited and retracted by the journal that printed it. Unfortunately, fear remains despite the fact that there is overwhelming data proving that no connection exists.

Some parents also worry about the effect of multiple vaccines given together might “overwhelm” a young child’s immune system and lead to problems later in life. However, many studies have shown that children with a significant amount of exposures have better immune systems. For example, children who grow up on a farm with a vast number of exposures have better immune systems than their cousins growing up in a city. Ask your family physician or pediatrician … only a phone call away!

In conclusion, the research clearly supports the fact that your child and your community will be far healthier and safer from receiving their vaccinations and the low risk of side-effects and reactions far outweigh the risk of living without vaccination.

For More Information:  Center for Disease Control; The American Academy of Pediatrics; the American Academy of Family Physicians

Source: NEPA Vital Signs – The Journal of the Lackawanna County Medical Society

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Apr
15

Vaccines and Children: What Every Parent Should Know, Part 2

Part 2 of 3

(Read Part 1)

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Guest Author: Timothy D. Welby, MD – board certified pediatrician at Pediatrics of NEPA and associate professor of pediatrics at GCSOM.

Dr. Timothy Welby
Dr. Timothy Welby

For centuries, millions of adults and children died around the world of illnesses that are now preventable with vaccinations. In fact, just a generation ago, most Americans knew a family who lost a child to measles or pertussis (whooping cough). Those of that era also knew someone who had been paralyzed for life by childhood polio. But, thanks to modern medicine and science, this is no longer a common occurrence or fear. For example, in 2000, measles was eliminated in the United States, according to the Centers for Disease Control (CDC). However, since 2000, outbreaks of these preventable diseases have reoccurred. In 2015, almost 200 cases of measles were reported at an amusement park in California. Last year, 18 cases were reported in New York in the Orthodox Jewish Communities and this year the count rises again. What do all these outbreaks have in common? Unvaccinated children!

The purpose of this column over the next few weeks is to discuss the prevention of common childhood diseases using vaccinations and to review potential side effects, both real and imagined.

Preventable Childhood Diseases

While this column is not intended to present all of the diseases that childhood vaccines can prevent, it is imperative to discuss those which are most prevalent and important.

Measles

Measles virus infection causes high fever (as high as 105 degrees), cough, red eyes and a classic rash. It is highly contagious. One in every thousand people who contract measles will get encephalitis, a dangerous inflammation of the brain, which often causes lifelong damage. One or two in every thousand people with measles will die from respiratory or neurological complications. Prior to the measles vaccination in the United States in the early 1960’s, millions of children got measles annually and about 500 children died every year in this country alone. Even today, in countries too poor to afford vaccines, or with an underdeveloped medical care system, 115,000 children die each year of the measles. While measles has been eradicated in the United States due to vaccination, outbreaks still occur when measles is brought back to the states by travelers coming home or by people who caught measles in their home country and travel to the U.S. These outbreaks can spread quickly and become very deadly in areas where immunization rates are low.

Rubella Virus or German Measles

Rubella Virus, or German Measles, is also highly contagious but usually causes a milder illness with fever, sore throat and a rash. However, its true danger is to infants in the womb. If a pregnant woman gets Rubella, the infant can die in the womb or shortly after birth. The infant is also at risk for congenital rubella syndrome, which can cause deafness, heart and brain defects and glaucoma. There is no cure for congenital rubella syndrome and before routine vaccinations for it in 1969, outbreaks were common. In 1964-1965, for example, an estimated 12 million people got rubella. 11,000 women lost babies in utero, 2,100 died at birth, and 20,000 were born with congenital rubella syndrome. Currently, about 10 people get rubella yearly in the U.S. and all of these cases were contracted outside the country.   

Hepatitis B Virus and Human Papillomavirus (HPV)

Hepatitis B Virus and Human Papillomavirus (HPV) are unique among vaccine-preventable illnesses because they are a major cause of cancer in adults. Every year approximately 17,500 women and 9,300 men in the U.S. get diagnosed with cancers caused by HPV, and the most well known of these is cervical cancer in women and throat cancer in both men and women. It is well established that the current HPV vaccine used in adolescent girls and boys will prevent 90% of these cancers.

Hepatitis B virus causes infection of the liver. Symptoms of acute infection include vomiting, diarrhea and jaundice (yellow coloring of the skin). Some patients, children and adults, who get infected, progress to chronic hepatitis B infection which lasts for years and eventually can cause cirrhosis and liver cancer. 1800 deaths annually are directly related to this condition.

Influenza (Flu Virus)

Influenza or Flu Virus is an annually occurring illness that sweeps across the globe during the midwinter months in each hemisphere. Because the virus mutates (changes) every year and the vaccination only provides immunity for about 6 months, immunity against the flu must be repeated every year. Influenza virus causes fever, cough, headache, muscle aches and fatigue. It sometimes causes vomiting and diarrhea, more often in children than in adults. Unfortunately, antiviral medications used to combat the flu are not very effective, especially in young children, elderly and those at risk of getting seriously ill from the flu. Every year, about 100 children and thousands of adults die from the flu in the U.S.

Source: NEPA Vital Signs – The Journal of the Lackawanna County Medical Society

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Read Part 3 on “Vaccinations”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

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