Congratulations to the close to 3,000 runners who finished the 20^th Annual Steamtown Marathon yesterday. Most, if not all of you are waking up this morning with a little less jump in your step than you had yesterday.

As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom, based on science, to encourage you to adequately rest and allow your body to recover.

 

GREAT EXAMPLE OF REST AND RECOVERY: 

With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks, while an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident…following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.

 

RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body:  (RunNow.com - Jim Peskett)

Muscle-Skeletal System:

 One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!

Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!

Cellular Damage:

 Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness.

Immune System:

 It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

• If I don’t have pain, then I did not damage my body and I can run again soon after the marathon.
  • FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
• Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
  • FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
• If I don’t run, I will lose all of my conditioning in one week.
  • FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi! Expedite Your Recovery:
    • Rest – Take it easy for a few days. Let you muscles/body heal. Take short walks.
    • Elevate – Elevating your legs to allow blood/fluid in you muscles to return to the heart without using gravity.
    • Massage – This can be an effective method of relaxing muscle spasms, cramps and mobilizing fluids from your muscles to your heart after the marathon. It should be very comfortable. You may find even more benefit from massage 24-48 hours after the race to assist in the recovery of delayed onset muscle soreness from lactic acid build-up in your muscles.
    • Slowly Reintroduce Exercise and Running – Gradually introduce longer walks and slow jogging after a few weeks. Cross-training is good for less joint compression and allows the use of other muscles. (Elliptical, bike, swim)
    • Listen to your body!

 

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 The Commonwealth Medical College.

Part 3 of 3: Health Tips for College Students

This is the third of three columns dedicated to healthcare for college students Please find the “10 Tips to Keep Yourself Healthy in College” helpful. However, no discussion regarding the health and wellness of college students would be complete and thorough without addressing what health care and university experts consider the two most dangerous behaviors on college campuses across the nation: binge drinking and unprotected sexual activity. While it is not my intent to offend the religious and moral values of any reader, it is my purpose to provoke direct and meaningful conversation between parents, religious leaders and students. To prevent serious health problems in college, parents must share their experience and discuss their values regarding sexual activity and alcohol consumption with children before they leave home to live independently in college. If you are unable to have a direct conversation about these issues, consider doing what several readers have done; mail a copy to your child!

10 Tips to Keep Yourself Healthy in College

(American Academy of Pediatrics)

1. Sleep – somehow, despite a busy academic and social schedule, you MUST get enough rest. Lack of sleep may be the single unhealthiest habit of a college student. It can lead to many negative consequences such as lack of concentration, poor emotional stability, and vulnerability to germs and disease. While one may get by on 3-4 hours sleep for short periods of time, eventually, your body will take control and shut down. Do your best to develop a regular sleep pattern and factor in short naps to catch up on needed rest if necessary.
2. Diet – the “freshman fifteen” is no joke, it is the real thing. Skipping breakfast, “pigging out” on junk food, late night eating, and drinking high calorie soda and beer all factor into weight gain and poor dietary habits. Make time to eat breakfast, snack on yogurt, fruit and nuts. Fill up on a healthy salad. Avoid a constant diet of fried foods and sweets.
3. Water – even adults forget to drink plenty of water throughout the day. Carry a water bottle and skip the soda.
4. Get regular check-ups – see your doctor when home on semester break for an annual check-up or more often if needed. Many college health centers offer this service. Many serious problems can be avoided with early detection.
5. Get a flu shot – remember, college campuses breed germs and most schools offer inexpensive flu shots.
6. Exercise – make time to exercise regularly (30-45 minutes 3-5 days per week). Walk, run, bike, lift weights, play tennis, racquetball or swim. Colleges have the best facilities for sports and exercise. Just DO SOMETHING! It will help you sleep, relax and feel better.
7. Relax – make time to relax. Read a book, go for a run, meditate, do yoga, or walk, and have good conversation with a friend. Mental health is important on a stressful college campus.
8. Emotional Health – is a vital component of a healthy person. College life can be very stressful. Depression, anxiety, addiction, eating disorders, and homesickness are some examples of emotional problems common among college students. If you feel emotionally unhealthy, get professional help. All colleges have trained counselors equipped to assist you.
9. Drink Sensibly – binge drinking might be one of the most dangerous behaviors on a college campus. Studies show 44% of U.S. College students engage in binge drinking uniformly among freshman through seniors. Of these, 50% binged 3-4 times in a two week period. Binge drinking is defined as 5 drinks in a row for men and 4 for women. Binge drinkers are more likely to be victims of poor academic performance, addiction, trauma, auto accidents, assault, unprotected sex, sexual assault, and death. Some of the most common reasons reported for binging are: to get drunk, status, campus culture, peer pressure, academic stress. TALK TO YOUR CHILDREN!
10. Safe Sex – promiscuous sex is physically and emotionally unhealthy. Unprotected sex can be LIFE ALTERING! Studies by the Center for Disease Control found that almost 80% of college students 18 to 24 years old had sexual intercourse at least one time during college. 73% reported having unprotected sex and 68% of this group did not believe that they were at risk of contracting a sexually transmitted disease. TALK TO YOUR CHILDREN! GET THE HPV VACCINE!

SOURCES: American Academy of Pediatrics

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” in the Scranton Times-Tribune.

Find Part 1 of this series here.

Find Part 2 of this series here.  

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 The Commonwealth Medical College.

Part 2 of 3

This is the second of three columns dedicated to healthcare for college students. As part of the preparation, think about a first aid kit, health care history, and insurance file. Once you finish with these preparations, plan to take dance, art history and conversational Italian classes to occupy your time without children, especially for those who will be empty-nesters. Life goes on!

Remember, in living a large community and sharing close quarters makes the development and spread of disease a natural progression. College life can be very unhealthy for many reasons: lack of sleep, poor eating habits, poor hygiene and stress.

10 Symptoms College Students Should Not Ignore

(American Academy of Pediatrics)

Last week we discussed common illnesses among college students, how to manage and when to seek professional help. Below you will find a list of symptoms that should never be ignored. The college health services department should be contacted if you have any of the following symptoms:

• Fever – 102 degrees F or higher

• Headache – if accompanied by a stiff neck

• Pain with urination

• Unusual discharge from penis or vagina

• Change in menstrual cycle

• Abdominal pain – that will not go away

• Persistent cough

• Persistent chest pain

• Persistent difficulty breathing

• Persistent pain or any other symptoms that last longer than you think it should

 

 

 10 Must-Have Health Care Items For College

(American Academy of Pediatrics)

Get a small/medium plastic storage box and use it to keep all of the following health care items together in one place.

1. Health Care Record – keep a copy of the required health care record required by the school in your health box. You may need it for the health services department or for an unexpected visit to the hospital.
2. Medication List – with names and dosages
3. Allergy List – with medication used for each allergy. For example, bee sting kit.
4. Past Medical History List – write down previous surgeries (appendectomy), diseases (Mono) and dates
5. Special Needs List – for example breathing inhaler for sudden asthma
6. Mental Health Problem List – problem and dates
7. Immunization Record – list shots/vaccines you have had and dates. For example, meningococcal disease vaccine.
8. Health Insurance Card – keep a photo copy of your health insurance card in your wallet and another in this college health care box
9. Hand Sanitizer
10. First Aid Kit:
    1. Bandages to dress wounds
    2. Gauze and adhesive tape to dress wounds
    3. Elastic bandage to support and compress sprains
    4. Antibacterial towel packets
    5. Antibacterial/antibiotic ointment
    6. Digital thermometer
    7. Chemical ice pack/Microwave heating pack for sprains/strains
    8. Acetaminophen and ibuprofen for aches/pains/fever
    9. Other prescribed medications
    10. Vitamins

SOURCES: American Academy of Pediatrics

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!”   Next Week: “Health Tips for College Students – Part 3”

If you missed it, read last week's article, Part 1 in this series.

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 The Commonwealth Medical College.

Health Tips for College Students

PART 1 of 3

 

Labor Day has passed and suddenly it is the middle of September. Students have returned to school and many college freshmen are still adjusting to their new environment away from home. Over the past month I have received several requests for a copy of my three part series of columns on health tips for college students. In view of this, I thought other parents preparing to send a child off to college this fall might also find this information valuable.

To fully appreciate the importance of this topic, one must keep in mind that living in a large community and sharing close quarters is the first ingredient in the development and spread of disease. College life can be very unhealthy for many reasons. Lack of sleep, poor eating habits and stress add spice to the recipe for disease. Lastly, poor hygiene added to the equation, will really get the Petri dish cooking up some nasty germs.

Common Health Problems for College Students (American Academy of Pediatrics)

1. Colds and Flu These are caused by viruses. While both are similar, flu symptoms are typically more severe.
   1. Symptoms:
      1. Cold: coughing, sneezing, watery eyes, mild fevers
      2. Flu: high fever (above 102 degrees), body aches, dry cough, upset stomach or vomiting
   2. Treatment: rest, plenty of fluids, and treat symptoms. Consult your physician or college health services for the best medicines to control your symptoms. Caution should be used when taking excessive flu meds containing aspirin because an increase in complications (Reye Syndrome) are associated with the flu in college students.
   3. Prevention: While it is not possible to prevent getting a cold or flu, you can take precautions, such as washing your hands and getting a flu shot
2. Strep Throat, Sinus Infections, Ear Infections- caused by bacteria
   1. Symptoms: very sore throat, pain in the ears or sinuses, persistent fever
   2. Treatment: These symptoms require a visit to the college health services department. You may need to take antibiotics. If so, take as directed and take all of them or you may have a relapse.
   3. Prevention: Avoid close contact with infected people – no kissing, sharing drinks or eating utensils. Wash your hands, get plenty of rest
3. Meningococcal Disease- Meningitis is a common form of this disease that can infect the brain, spinal cord and/or blood
   1. Symptoms: high fever, stiff neck, severe headache, a flat, pink or purple rash, nausea and vomiting, as well as sensitivity to light
   2. Treatment: Immediate medical treatment is required. This disease is serious. It can be fatal or cause permanent brain damage.
   3. Prevention: It is strongly recommended that all teens, especially incoming freshman college students, receive a vaccine to prevent the infection of most, but not all, strains of bacteria that cause this disease
4. Mononucleosis (Mono): Mono is caused by a virus and is also known as the “kissing disease.” It is very common among college students.
   1. Symptoms: fever, sore throat, headache, swollen lymph nodes (glands) in the neck, extreme fatique.
   2. Treatment: If a sore throat or flu symptoms do not resolve in 7- 10 days, see your doctor for a blood test called the “monospot.” While there is no specific treatment, plenty of rest and a healthy diet are essential. Medication to control symptoms can also be used.
   3. Prevention: Plenty of rest, healthy diet, good hygien
5. Bruises, Sprains and Strains: These are very common in healthy, active college students and are rarely serious.
   1. Symptoms:
      1. Bruises: a bump or bruise can cause the skin to turn purple, brown or red in color.
      2. Strains: are injuries to muscles or tendons from overuse or sudden overstretching.
      3. Sprains: are injuries to the ligaments which connect the bones. It can be caused by a twist or fall or awkward sudden movement.
   2. Treatment: RICE: Rest, Ice, Compression, Elevation
      1. Rest – the first 24-48 hours
      2. Ice – use ice or cold gel packs on the injury for 20-30 minutes several times per day
      3. Compression – to the area with an elastic bandage
      4. Elevation – elevate the injury on pillows, etc to limit swelling.
      5. If the pain or swelling is not improved in 1-2 days, or if you cannot bear weight on the extremity, visit the college health services dept.
   3. Prevention: While it is important to be physically active, one must do so intelligently:
      1. Use Proper Equipment – eye protection, helmets, mouth guard, etc
      2. Warm up/Cool Down – take time to warm up, stretch and cool down
      3. Take Breaks – ease into activity and rest when necessary.

SOURCES: American Academy of Pediatrics.

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” in the Scranton Times-Tribune.   Next Week: “Health Tips for College Students – 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 The Commonwealth Medical College.

New Protective Equipment Available!

Fall is not only the time of year for football, but it is soccer season as well. Moreover, concussions are not only associated with football, but with soccer as well. However, new protective equipment may offer a solution.

 

 

What is a Concussion?

Concussions occur when a person’s brain is violently rocked back and forth inside of the skull because of a blow to the head or neck. Severe concussion, although rare, can lead to brain swelling, blood vessel damage, and even death. According to the University of Pittsburgh Medical Center, approximately ten percent of all athletes involved in contact sports, such as football, hockey, and soccer, suffer a concussion each year. In soccer, in a career of 300 games, a soccer player sustains an estimated 2000 blows. Even in contact sports, some concussions can be prevented by teaching proper playing and tackling techniques and by wearing proper headgear. Symptoms of concussion are not always definite and knowing when it is safe for an athlete to return to play is not always clear. Severe concussions display obvious symptoms and removal from participation is obvious. However, the athlete with a mild concussion can display symptoms that are less clear. There are serious repercussions of early return following even a mild concussion due to the long term effects of multiple mild concussions. Therefore, there is no substitute for prevention.

Hot Topic

As you may have read, the National Football League (NFL), the National Hockey League (NHL), and the National Collegiate Athletic Association (NCAA) are involved in litigation regarding concussions. Soccer has now joined the group.

In August 2014, a group of parents from California filed a class-action lawsuit against the Federation Internationale de Football Association (FIFA), soccer’s international governing body, for its improper management of concussions in the sport. The suit claims that the FIFA failed to properly prevent, monitor and treat head injuries in soccer. The plaintiffs do not seek financial reward, but rather request changes be implemented in the sport to protect players from head injuries beginning at a young age. Ultimately, the lawsuit seeks to limit the number times children under 17 years old would be allowed to “head” the ball, similar to enforcing a “pitch count” for baseball pitchers in little league baseball. “Heading” occurs when a soccer player uses their head to strike a soccer ball in the air and some healthcare professionals feel that accumulative “heading” in soccer is the equivalent to many years of “head blows” in boxing. Additionally, the mandatory use of protective equipment, similar to the required batting helmet in baseball, has been discussed. In fact, this fall, schools in Princeton, New Jersey required students playing soccer in grades 6 to 12, to wear protective headgear for both practice and competition.

New Protective Equipment for Soccer

As with all new equipment, protective headgear and headbands in soccer is not without its controversy. Some feel that protecting the head with equipment gives the player a feeling of invulnerability and promotes excessive use of the head in soccer. Others feel that protective gear leads to more aggressive play by participants. However, when skeptical healthcare professionals were asked about use of protective gear for their children, all stated that they would not opt out of a mandatory protective headgear program, similar to the one used in Princeton.

A recent study published in the Journal of Athletic Training, entitled, “The Efficacy of Soccer Headgear,” found that under all conditions tested in the study, protective headgear/ headbands successfully decreased the force of impact to the head from a soccer ball. However, it was also concluded that, while headgear may be of value, it should not be a substitute for proper technique or adequate strengthening.

The Products

There are two main types of protective headgear for soccer players. One is a “headband” type product which has an extra padding in the front of the forehead area. The other is more of a light and open “helmet” style with protection in the front and on top of the head.

• DonJoy Hat Trick (49.99 BetterBraces.com)
• Storelli ExoShield Head Guard (59.99 Dick’s Sporting Goods)
• Full90 Premier Protective Headgear (39.99 Soccer.com)

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey "Health & Exercise Forum" in the Scranton Times-Tribune.

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 The Commonwealth Medical College.

Happy Labor Day! Prevent Back Pain!

Lower back pain (LBP) is one of the most common problems people experience, not only in the workplace, but in daily life as well. LBP is not limited to the manual laborer but is also prevalent in those working in sedentary positions. It is estimated that 80-90% of adults in the USA will experience lower back pain at one or more times in their lives. 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.

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. The Occupational Safety and Health (OSHA) and the United States Department of Labor list the following risk factors for LBP:

• Poor Body Mechanics With Repetition:
  • Bending at the waist
  • Lifting from the floor
  • Lifting from overhead
  • Twisting at the waist
  • Twisting While Lifting
• Lifting or Moving Objects of:
  • Excessive Weight
  • Excessive Size
  • Asymmetrical Shape
  • Awkward Position or Locatio
• Poor Work Station Ergonomics Without Adjustable:
  • Desk Chairs
  • Foot Rests
  • Arm Rests
  • Body Supports
  • Table/Desk/ Height or Location
  • Phone Headset
• Poor Grips on Handles
  • Losing grip while lifting causing a jerk reaction to regri
• Slippery Footing
  • Slipping while lifting causing a quick jerk
• Prolonged Sitting (especially with poor posture):
  • Driving
  • Computer
  • Desk

Prevention of LBP with 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.

Those working at a desk or workstation spend much of the day with their spine bent or flexed forward for extended periods of time. Postural exercises are designed to stretch your back in the opposite direction of this forward flexed position. Examples include:

Posture Exercises:

• Chin Tucks – (Photo 1) 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.

Perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day

Ergonomics (Photo 4):

Sitting - When sitting, use an ergonomic work station and chair with a lumbar support and adjustable heights. Get close to your desk, keyboard and monitor.

Models:
Photos 1-3: Sarah Singer
Photo 4: Vanessa Serena

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune

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 The Commonwealth Medical College.

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

Guest Author: Soroosh T Hashemi

Soroosh T Hashemi is a 2015 graduate from The Commonwealth Medical College (TCMC).He was raised in Levittown,, PA and earned a B.S. in Biological from Penn State University. He matched in Internal Medicine at Penn State Hershey Medical Center.

This article appeared in “in-training,”a website for medical students, run by and written entirely by medical students. Proudly, this article, in which a medical student opens up his heart to divulge his innermost fears, was written by Soroosh T Hashemi, a recent graduate from TCMC, in an attempt to raise the level of consciousness for medical students and patients alike, that we are all vulnerable…”to err is human; to forgive, divine.”(Alexander Pope) I thought it might give patients insight and heighten sensitivity about medical students and young medical practicioners…they are bright, well –intended, and altruistic. But they are also inexperienced and vulunerable…just like their patients!

Kyle died early on a Sunday morning. His last meal was vanilla pudding, fed to him lovingly by his grandmother Shirley, while reruns of “Inspector Gadget” played in the background. When Kyle was born 25 years earlier, the family had been told he would not live more than a few weeks into infancy. But Kyle surprised everyone by surviving a quarter of a century with debilitating cerebral palsy. What surprised me most about Kyle was that he was always smiling, even though he was unable to communicate or control his body, and even though a majority of his life was spent on his grandparent’s living room floor.

I visited Kyle’s grandparents a month after the memorial service. Their living room, once a collage of toys and DVDs surrounding the living hearth that was Kyle, was now quiet and organized. I could hardly recognize the space without him. Kyle’s grandfather Bryce had recently been diagnosed with glioblastoma multiforme, but the family still smiled. Having just begun his course of gamma knife treatments and chemotherapy, Bryce had opted to keep the hairstyle his neurosurgeon had left him. Calling it his “Mohawk,” he grew a beard, began sporting punk rock tee-shirts and took to wearing thick black plastic framed glasses. Shirley and Bryce were adapting to yet another medical hardship with the style and grace they seemed to exude. They smiled together, not worried about tomorrow or depressed about today, but rejoicing in the love that made their family so indestructible.

Standing on the front porch during my last visit, I listened to Shirley as she talked about the recurrent pneumonias that finally took Kyle and the process of dealing with Bryce’s newly diagnosed brain cancer. I watched her as the sun set that afternoon, the light catching a newly visible grey streak she let grow in her hair to match Bryce’s punk rock style. It was obvious that she had become the keystone that held her family together; yet she seemed completely oblivious to the weight that she bore.

For the first time on that porch, I was able to sense her sadness as she spoke of the physicians who had cared for Kyle at the end of his life. She spoke of a surgery to repair Kyle’s hiatal hernia, she spoke of his inability to recover, and of the myriad of health care professionals who would visit periodically to suggest treatments before disappearing. Shirley recounted her feelings of helplessness as Kyle would cry, lapsing in and out of consciousness, and her frustration with the lack of face time doctors gave her. Grievous, she remembered feeling uninvolved and uninformed while decisions were made for Kyle during his final decline in health.

With the crisp smell of autumn in the air, and a languorous sunset catching the trees around us, Shirley asked, “Will you tell your classmates to remember to talk to their patients?”

“I will,” I responded.

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 The Commonwealth Medical College.

Read Dr. Mackarey’s Health & Exercise Forum – Every Monday in the Scranton Times-Tribune.

SIX PACK ABS – WITHOUT BACK PAIN! The Best Exercises to Strengthen the Abdominal Muscles Without Causing Back Pain

Part 2 of 2

It may not be possible to pick up a health and fitness magazine without a plethora of articles on how to gain “six-pack abs!” However, for most people, before you begin your quest to find the “abdominal holy grail,” you need to be aware of the many fallacies related to abdominal exercises and how to get a flat stomach.

First, you cannot reduce fat in a specific part of the body over another. If you have belly fat, you must lose overall body weight in order to allow the underlying muscles to become more visible. If you lose 10 to 15 pounds, it is lost in all parts of the body that have excessive fat, not one area more than another. Second, performing 100 sit up exercises will not guarantee washboard abs. More often than not, those able to perform 100 sit ups are already in excellent physical condition. Furthermore, people often use poor technique and substitute muscles other than the abdominals such as the hip flexors, when performing 100 sit-ups. Most importantly, performing too many traditional “sit-up” exercises may actually be lead to lower back pain.

Last week we discussed Level I Abdominal Exercises For Beginners and Level II Abdominal Exercises for the Moderately Fit. This week’s column provides abdominal exercises for Level III- Excellent Physical Condition (high fitness level).

LEVEL THREE – 6 Abd Exercises for a High Fitness Level 

• Abdominal Curl - Advanced (photo 1b): Position same as in basic abd curl. While holding the abs tight, slowly curl your upper body and lift shoulder blades up 4 inches and curl chest toward knees. Hold for 3-5 seconds and lower slowly. Repeat 5-10 times.
• Exercise Ball Hip Hikes (photo 1b): While sitting on an exercise ball, hike your hip and knee up to 90 degrees as if you are marching. Hold the position for 3-5 seconds on one leg and lower slowly. Repeat this on the other leg and alternate 10 times. Stabilize your core and do not let your trunk tilt
• Ball Planks (photo 3b):Using a Bosu Ball or Ther Ex Ball, prop up on forearms in a push-up position. Hold the position as a firm plank for 10-20-30 seconds. Advance to 60-90 seconds.
• Ball Plank – Ladder Climb or Scissor Kicks (photo 4b): Using a Bosu Ball or Ther Ex Ball assume same on forearms as above. Perform a ladder climb by hiking your hip slowly. Return to starting position and repeat on other leg. Once mastered, attempt a scissor kick motion by spreading your leg out 30 degrees to the side. Hold the position for 3-5 seconds on one leg and return slowly to cross over the middle. Repeat this on the other leg and alternate 10 times. Maintain a firm core without tilting the body during both of these exercises.
• Bicep Curls on Ball with Hip Hike (Photo 5b): Sit on exercise ball with ONE foot on the floor holding exercise band and the other foot 4-6 inches hiked up off floor. Hold band in both hands, tighten abd muscles and slowly bend elbows up toward shoulders. Lower slowly and switch foot to hold band on floor after 5 – 10 repetitions. Focus on trunk core stabilization while performing this exercise by keeping trunk stable. Eventually, this can be performed standing on a Bosu ball with two feet, then advance to one leg. If possible, perform in front of a mirror for feedback.
• Trunk Rows/Lats on Ball with Hip Hike (Photo 6b): Sit on exercise ball with ONE foot on the floor and the other foot 4-6 inches hiked up off floor. Attach exercise band to inside door knob and hold in both hands. Tighten abd muscles, pinch shoulder blades together and performing a “row the boat” movement. Return slowly and switch feet after 5-10 repetions. Focus on trunk core stabilization while performing this exercise by keeping trunk stable. Eventually, this can be performed standing on a Bosu ball with two feet, then advance to one leg. If possible, perform in front of a mirror for feedback.

Photos: Jen Hnatko Model: Samantha Snead

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.  

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 The Commonwealth Medial College.

The Best Exercises to Strengthen the Abdominal Muscles Without Causing Back Pain 

Part 1 of 2

It may not be possible to pick up a health and fitness magazine without a plethora of articles on how to gain “six-pack abs!” However, for most people, before you begin your quest to find the “abdominal holy grail,” you need to be aware of the many fallacies related to abdominal exercises and how to get a flat stomach.

First, you cannot reduce fat in a specific part of the body over another. If you have belly fat, you must lose overall body weight in order to allow the underlying muscles to become more visible. If you lose 10 to 15 pounds, it is lost in all parts of the body that have excessive fat, not one area more than another. Second, performing 100 sit up exercises will not guarantee washboard abs. More often than not, those able to perform 100 sit ups are already in excellent physical condition. Furthermore, people often use poor technique and substitute muscles other than the abdominals such as the hip flexors, when performing 100 sit-ups. Most importantly, performing too many traditional “sit-up” exercises may actually be lead to lower back pain.

The purpose of this column is to provide abdominal exercise for three levels of participants; Part 1: Level One- Poor Fitness Condition (non exerciser), Moderate Fitness Condition (exercises 1-2 days per week). Part 2 will be dedicated to abdominal exercises for those in excellent physical condition (high fitness level). These exercises are designed to strengthen the abdominal and trunk “core” to protect the lower back.

All of the following exercises can be performed at home without purchasing any equipment except exercise bands.

LEVEL ONE – 5 Abdominal Exercises for a Poor Fitness Level

• Isometric Belly Tuck (photo 1a) 
  • While lying on your back with your knees bent and feet on floor, tighten your belly muscles by tucking your belly and flattening your back into the floor. Hold this isometric contraction for 5 seconds, relax and repeat 10 times.
• Isometric Belly Tuck With Heel Slide (photo 2a) 
  • Position same as above. While holding the abs tight, slowly slide one heel up and down along the floor and then the other. Repeat 3-5 times with each leg. Rest for 3- 5 seconds and repeat this sequence 5-10 times.
• Isometric Belly Tuck With Hip Hike (photo 3a) 
  • Position same as above. While holding the abs tight, slowly lift one heel up (hike hip) and down to the floor and then the other. Repeat 3-5 times with each leg. Rest for 3- 5 seconds and repeat this sequence 5-10 times.
• Chair Push – Ups (photo 4a)
  • Sit in a chair with arm rests. While holding abs tight, get out of chair using arm rests as little as possible. Hold the position for 3 seconds and return to sitting slowly. Repeat this 10 times. Focus on trunk core stabilization while performing this exercise by keeping trunk stable. Once strong enough perform this exercise without using your arms.
• Trunk Rows/Lats in Chair (Photo 5 a)
  • Sit in chair and face door. Attach exercise band to inside door knob and hold in both hands. While holding abs tight, pinch shoulder blades together while performing a “row the boat” movement. Return slowly. Also, focus on trunk core stabilization while performing this exercise by keeping trunk stable.

 

LEVEL TWO – 5 Abd Exercises for a Moderate Fitness Level

•  Abdominal Curl (photo 6a)  
  • Position same as above. While holding the abs tight, slowly curl your upper body as if you were to lift shoulder blades up and curl chest toward knees. Hold for 3-5 seconds and lower slowly. Repeat 5-10 times.
• Isometric Belly Tuck With Bike Pedal (photo 7a) 
  • Position same as above. While holding the abs tight, slowly lift heel up like pedaling a bike while letting the heel tap the floor. Repeat 3-5 times with each leg. Rest for 3- 5 seconds and repeat this sequence 5-10 times.
• Bicep Curls on Ball (Photo 8a)
  • Sit on exercise ball with both feet on exercise band. Hold band in both hands, tighten abd muscles and slowly bend elbows up toward shoulders. Lower slowly. Focus on trunk core stabilization while performing this exercise by keeping trunk stable.
• Trunk Rows/Lats on Ball (Photo 9a)
  • Sit on exercise ball and face door. Attach exercise band to inside door knob and hold in both hands. Tighten abd muscles, pinch shoulder blades together and performing a “row the boat” movement. Return slowly. Focus on trunk core stabilization while performing this exercise by keeping trunk stable.
• Standing Wall/Countertop 45 degree Planks (photo 10a)
  • Face a countertop and hold on with both hands. Tighten you abds while lower your body like a plank to a 45 degree angle. Hold the position of 10-20 seconds. Repeat this 10 times. Once strong enough try on one arm at a time and alternate. Focus on trunk core stabilization while performing this exercise by keeping trunk stable.

Photos: Jen Hnatko. Model: Samantha Snead

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune. Next Week: Part 2 of 2– Abdominal Exercises.  

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 The Commonwealth Medical College.

Summer football training camps and practice sessions will soon be in full swing in Northeastern Pennsylvania. In 2013, the Pennsylvania Interscholastic Athletic Association (PIAA) implemented “Preseason Heat-Acclimatization Guidelines” This policy was recently updated for the 2015 season.

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, nause
  • 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 –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 drytec^R 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" in the Scranton Times-Tribune.

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 The Commonwealth Medical College.