Osteochondritis dissecans, also called OCD, is the most common cause of a loose body or fragment in the knee and is usually found in young males between the ages of ten and twenty. While this word sounds like a mouth full, breaking down its Latin derivation to its simplest terms makes it understandable: “osteo” means bone, “chondro” means cartilage, “itis” means inflammation, and “dissecans” means dissect or separate. In OCD, a flap of cartilage with a thin layer of bone separates from the end of the bone. As the flap floats loosely in the joint, it becomes inflamed, painful and disrupts the normal function of the joint.

Typically, OCD is found in the knee joint of active young men who participate in sports which involve jumping or full contact. Although less common, it is also found in other joints such as the elbow.

Often, the exact cause of OCD is unknown. For a variety of reasons, blood flow to the small segment at the end of the bone is compromised and the weak tissue breaks away and becomes a source of pain in the joint. Long term, OCD can increase the risk of osteoarthritis in the involved joint.

Common causes of OCD:

• Repetitive microtraumas to the end of the bone over time
• Age – Most often between the ages of 10 to 20
• Gender – More common in males
• Activity – Sports that involve jumping, running, sudden changes in direction for the knee or throwing or lifting excessively for the elbow
• Genetics – Some have a greater propensity than others

Some common signs and symptoms:

• Pain in the joint which is often brought on or increased with sports or activities such as: walking distances, climbing stairs or hills for the knee or throwing or lifting for the elbow.
• Weakness in the muscles around the joint which often leads to a “giving out” of the knee
• Locking, snapping or popping of the joint – the knee/elbow may get “stuck” in a specific position as the bone/cartilage fragment moves around
• Loss of Motion – the knee or elbow will not completely bend or straighten
• Swelling and tenderness in the joint – worsened with sport or activity

Diagnosing OCD:

To properly diagnose OCD a physician will consider onset, related activities, symptoms, medical history, and examine the joint involved for pain, tenderness, loss of strength and limited range of motion. Often, a referral to a specialist such as an orthopedic surgeon for further examination is necessary. Special tests may be employed to specifically detect a defect in the bone or cartilage of the joint such as:

Radiograph (X-ray) may be performed to assess the bones.

Magnetic Resonance Imaging (MRI) may be performed to assess bones and other soft tissues such as cartilage, ligaments, muscles and tendons.

Treating OCD: 

The primary goal of treatment for OCD is to relieve pain, control swelling, and restore the complete function (strength and range of motion) of the joint. Treatment is dictated by the age of the patient and severity of the injury. Medications for pain and inflammation may be prescribed.

Conservative Treatment:

Young patients who are still growing have a good chance of healing with conservative treatment. Rest and physical therapy are the conservative treatments of choice. Rest entails avoiding any activity that compresses the joint such as jumping, running, twisting, squatting, etc. In some cases, using a splint, brace and crutches to protect the joint and eliminate full weight bearing, may be necessary for a few weeks. Physical therapy, either as a conservative or post operative treatment, involves restoring the range of motion with stretching exercises and improving the strength and stability of the joint through strengthening exercises. Modalities for pain and swelling such as heat, cold, electrical stimulation, ultrasound, compression devices may be employed depending on the age of the patient and severity of the problem.

Surgical Treatment:

Conservative treatment can often require 3 to 6 months to be effective. However, if it fails, arthroscopic surgery may be required to stimulate healing or reattach the loose fragment of cartilage and bone. In some cases if the defect is small, surgery involves filling in the defect with small bundles of cartilage. In other cases, the fragment is reattached directly to the defect using a small screw or bioabsorbable device. More recently, surgeons are using the bone marrow of the patient to repair the deficit by stimulating the growth of new tissue (bone marrow stimulation). In other cases, a plug of healthy tissue from the non-weight bearing surface of a patients knee is transplanted to the defect to stimulate healing (osteochondral autograft transplantation OATS). While there are many surgical options for OCD, an orthopedic surgeon will help the patient decide the most appropriate procedure based on age, size of defect, and other factors.

Preventing OCD

While prevention is not always possible, some measures can be taken to limit risk. For example, if a child playing sports has a father and older brother who had OCD, then it would be wise to consider the following: Avoid or make modifications for sports requiring constant jumping. Cross-train for a sport to avoid daily trauma (run one day and bike the next). Also, do not play the sport all year round (basketball in the fall/winter and baseball in the spring/summer). Seek the advice from an orthopedic or sports physical therapist to learn proper strength and conditioning techniques. Learn proper biomechanics of lifting, throwing, squatting, running, jumping and landing.

Sources: Mayo Clinic

Read Dr. Mackarey’s "Health & Exercise Forum" – every Monday 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.

 

 

 

NEPA is fortunate to have many bright, altruistic and dedicated pediatricians. Over the past thirty years, I have had the pleasure and privilege to work with them and their patients. One of the most common problems referred to physical therapy by pediatricians is infant torticollis. Torticollis, also referred to as wryneck, means “twisted neck” in Latin. While adults often wake up in the morning with a stiff neck from sleeping in an awkward position, (acute or acquired torticollis), infants too, suffer from this condition when they are born with a stiff neck, locked in one position called infant or congenital torticollis. In one case, young “Packie” fought with his two brothers for space in his mother’s uterus. As a triplet, it is believed his head was tilted to one side for an extended period of time which caused him to be born with infant torticollis. In another case, little Britany, had a difficult birth and may have suffered some minor trauma to her neck muscles in the birthing process, resulting in infant torticollis. In the case of baby Mason, there was no history of trauma during or after birth and his stiff neck may have been due to uterine positioning.

WHAT IS INFANT OR CONGENITIAL TORTICOLLIS?

Infant or congenital torticollis occurs when an infant’s head is tilted to one side and rotated toward the other. For example, the infant's head is tilted with the right ear toward the right shoulder and the chin is rotated to the left due to the shortening of the muscle responsible for this position (See Photo 1 for example).

Infant torticollis is most often discovered at birth or shortly thereafter. Often, a parent will notice that the infant has a preference for looking in one direction and avoids the other. It is especially apparent when feeding, nursing, playing, resting, or sleeping.

Photo 1: Baby Mason Schneider (3 months) with “Infant Torticollis” demonstrates a shortening of the right sternocleidomastoid muscle of the neck which tilts his head to the right and rotates it to the left.

CAUSES

The medical literature cites several possible causes of infant torticollis. Most often it is due to poor positioning of the baby in the uterus especially when space is limited as in the case of twins or triplets. Infant torticollis can also occur when a fetus is in a breech position in the uterus. In breech, the baby’s buttocks face the birth canal and can also cause awkward positioning and difficult birthing. A difficult delivery using a forceps or vacuum device may contribute to the problem. In all of these cases, one of the neck muscles called the sternocleidomastoid, is traumatized which leads to shortening and tightening. Over time, the baby assumes the more comfortable shortened position which tilts the head toward the side of the tight muscle.  In rare cases, the condition is associated with damage to the nervous system, spine or blood supply.   

SIGNS AND SYMPTOMS

The classic sign of infant torticollis is limited range of motion of the neck as it tilts to one side more than the other. The classic head tilt may not be as noticeable immediately after birth and it is often detected by the parents while bathing, feeding, and playing with their infant. Once detected, it is important to bring it to the attention of your pediatrician because early intervention is very important. Remember, not all of the signs and symptoms need to be present to have infant torticollis, as there are various degrees of involvement.

• Limited Range of Motion of the Head – tilting to one side while rotating to the other
• One Shoulder Appears Higher Than the Other
• Stiffness in the Neck Muscles – on the side to which the head tilts
• Swelling or Thickness (feels like a cord) in the Neck Muscles – on the side to which the head tilts
• Strong Preference to Turn to One Side and Avoid the Other – especially while feeding and playing
• Painful and Stiff Movement – when moving the neck in the opposite direction of the tilt
• Skin Irritation – on the side of the neck to which the head tilts
• Flat Head Appearance – due to constant muscle tension on the bones of the skull and prolonged lying on one side more than the other for comfort

TREATMENT

Physical therapy is the treatment of choice for infant torticollis. However, it is important to note that the most important treatment given to an infant with torticollis is given, not by the pediatrician or physical therapist, but by the parents. The physical therapist will evaluate and treat the infant once or twice a week, but the parents will be instructed to continue the treatment several times a day for an optimal outcome.

Physical therapy involves stretching the tight and strengthening the weak muscles of the neck. The muscles can be prepared for stretch by employing a very light massage to the tight cord-like muscles. Care not to irritate the skin is important and skin care techniques may be required if the skin is open or irritated. Then, a mild to moderate passive stretch to the tight tissues is employed by the physical therapist. It should be slow, gradual and sustained for 30 to 60 seconds. It is expected that the infant will cry due to pain during the stretch but as the tissue elongates, the pain will dissipate. A pediatrician or physical therapist will teach the parents how to perform the stretch safely. Following the stretch, the infant will be placed in a position, often a car seat, with a towel roll to maintain a mid-line head position. This is also the position of choice throughout the day to maintain the head in mid-line. (See Photo 2 for example)

Additional instructions for the parents include: holding, feeding and playing with the child in positions that stretch the tight side and encourage movement in the opposite direction. Even when doing something as simple as holding the child face to face, the parents head can be used to maintain a mid-line position. (See Photo 3 for example).

 

PROGNOSIS – OUTCOMES

Not surprisingly, the earlier the detection and intervention, the better the outcome. I am pleased to report; in most cases, when treatment is employed within the first 3-4 months after birth, the outcomes are excellent in 3-6 months, depending on the severity of the problem. When parents are committed to participate and implement the program at home, progress is expedited. While rare, in more difficult cases, additional medical tests are often used to rule out other potential problems.

If you suspect that your infant may have torticollis, contact your pediatrician for a consultation.

MODEL: Mason Schneider– 3 months old

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.comPaul 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.

Prevent Overuse Injuries in Youth Sports. Part 2 of 2 on Health and Safety Tips for Youth Baseball Coaches.

Recently, much attention has been given to the drastic increase in the incidence of serious injuries in youth sports, like baseball, from overuse. In my practiced as an orthopedic and sports physical therapist, I have seen more overuse injuries in youth sports leading to surgery in the past 5 years than in previous 20 combined. Some examples are: little league elbow, ulna collateral ligament strain of the elbow (often requiring Tommy John surgery) and Dead Arm Syndrome at the shoulder. While these injuries can sometimes be related to poor mechanics, overuse is almost always the true culprit. Statistics clearly show that more children are participating in more competitive organized sports year round at an earlier age than in previous generations. Not coincidentally, a significant increase in the number of injuries has occurred and more than 50% of sports injuries in children and teens are due to overuse.

DEFINITION OF AN OVERUSE INJURY

When a bone, muscle, tendon or ligament is subjected to repetitive stress without adequate healing or recovery time, tissue damage occurs. Examples include:

Little league elbow: The muscles, tendons and immature elbow bone where the tendon attaches at the elbow become inflamed due to overuse.

Ulna collateral ligament strain: The ligament on the inside of the elbow becomes inflamed, partially or completely torn from excessive stress and overuse. It can often require surgery called Tommy John surgery, named after the all-star baseball pitcher who resurrected his career following the surgery to repair his ulna collateral ligament.

Dead Arm Syndrome at the shoulder: The posterior capsule of the shoulder (back of the shoulder where the rotator cuff attaches) is overused and stressed. Overtime, the tissues react, scar and tighten, creating an imbalance and abnormal forces on the shoulder joint and surrounding tissues. Eventually, an athlete cannot throw without pain, must compensate resulting in loss of velocity and effectiveness.

Overuse injuries are manifested in the form of pain, swelling, and inflammation, loss of range of motion, strength and function. Tennis elbow in tennis players, little league elbow in baseball players and shin splints in runners are a common example of an overuse injuries.

4 Stages of an Overuse Injury

1. Pain in the site of injury after the physical activity
2. Pain in the site of injury during the physical activity without restriction on performance
3. Pain in the site of the injury during the physical activity with restriction on performance
4. Constant pain in the site of the injury, even at rest

CHILDREN AND TEENS AT RISK

Children Are Not Small Adults! Therefore, they should not be treated the same way. Their bodies CANNOT take the same amount of stress as an adult because they are still growing and immature soft tissues and bones are less resilient to stress. Little league elbow and dead arm at the shoulder are two of the best examples.

PREVENT OVERUSE INJURIES

• Preseason Physical Evaluation: In addition to a physical examination from a family or sports medicine physician, a musculoskeletal screening by an orthopedic or sports physical therapist is valuable. Then, recommendations can be made to work on deficits, such as tight hamstrings and weak core muscles, during the offseason.
• Avoid Specializing in One Sport: Sometimes the best advice is to keep it simple…athletes should not specialize in one sport before puberty as most are too young to know your interests and strengths. Also, your body is too immature to handle the physical stress of using the same muscle, tendons and ligaments all year long. Moreover, not concentrating on one sport will help avoid “burn-out” before high school or college. This winter, play indoor soccer instead of baseball to develop lower body strength, endurance and agility. MIX IT UP AND HAVE FUN!
• Proper Preparation and Training: As discussed in last week’s column, warm up, stretching, protective gear and clothing will go a long way to prevent injury.
  • A warm-up routine is essential prior to stretching. As a total body   warm-up, take a short jog, two to three laps around the field. Then, move the muscles of the shoulder, elbow and wrist 20 – 25 times to warm up muscles and tendons prior to throwing. Lastly, throw in short to long toss, start at 10 feet and increase by 10 feet every 10 tosses.
  • Following a warm up, stretching is essential to protect against injury. Upper body: hands behind head, hands behind back, elbow across chest. Lower body: Indian sit, hurdle stretch, hamstring stretch lying on back, calf stretch.
• Watch for Signs of Injury - Pain/Swelling. Coaches and parents should not encourage youngsters to play through pain. Pain and swelling are usually warning signs of injury or a minor problem that can lead to a serious injury. Remember children have growth plates at the ends of their bones that are not fully fused.
• Treatment: The most important treatment for most sprains and strains in children and teens is rest. It is also the best way to prevent overuse injuries such as little league elbow and throwing shoulder tendonitis. Treatment includes
  • Rest- stop throwing
  • Ice – ice packs 15-20 minutes 3-5 times per day
  • Compression – compression bandage or sleeve
  • Minor Problem - if discovered early, the above treatment may be sufficient.
  • Physician Visit – if pain persists for more than a few days, a visit to your family physician is important to determine the extent of the injury.

 

REMEMBER: Kids are not small adults! Keep it light and have FUN!

SOURCE: The American Academy of Pediatrics

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.

Youth baseball can be a very rewarding experience for young participants, parents and coaches. Generally, well-intended people dedicate countless hours to develop and maintain baseball fields, organize schedules, and instruct basic baseball skills. However, most coaches, without a medical background or additional training, may not have the skill and knowledge to provide a healthy and safe environment.

Temple University Sports Medicine Center in Philadelphia offers several health tips for little league baseball. As a former little league coach and umpire and current health professional this information will hopefully assist youth baseball coaches in providing a healthier and safer season.

1. Children Are Not Adults: The number one rule to prevent serious injuries in youth baseball is to remember that children are NOT small adults. Therefore, they should not be treated the same way. Their bodies CANNOT take the same amount of stress as an adult because their bodies are still growing and are vulnerable to certain problems. Little league elbow and shoulder are two of the best examples.
2. Warm –Up: A warm-up routine is essential prior to stretching. A short jog, two to three laps around the field, will serve to warm up muscles and tendons prior to stretching.
3. Stretching: Following a warm up, stretching is essential. Upper body includes: hands behind head, hands behind back, elbow across chest. Lower body includes: Indian sit, hurdle stretch, hamstring stretch lying on back, calf stretch.
4. Protective Gear: Coaches should do their best to insure the use of mandatory protective gear (helmet, jockstrap/cup) and encourage the use of optional protective gear (face guard, batter chest protector, mouth guard) depending on age group.
5. Pain/Swelling: Coaches should not encourage youngsters to play through pain. Pain and swelling are usually warning signs of injury or a minor problem that can lead to a serious injury. Remember children have growth plates at the ends of their bones that are not fully fused.
6. Rest: The American Academy of Pediatrics recommends taking at least 3 months off from a youth sport each year. The most important treatment for most sprains and strains in children is rest. It is also the best way to prevent overuse injuries such as little league elbow and throwing shoulder tendonitis. This winter, play indoor soccer.
7. Pitch Count: College and professional pitchers DO NOT count innings, nor should little leaguers. Count Pitches  9-10 year olds: 50 per game 75 per week, 1000 per season, 11-12 year olds: 75 per game, 100 per week, 1000 per season, 13-14 year olds: 75 per game, 125 per week, 1000 per season as recommended by the American Journal of Sports Medicine.
8. Treatment of Most Minor Injuries in Little League:
   1. Rest- stop throwing
   2. Ice – ice packs 15-20 minutes 3-5 times per day
   3. Compression – compression bandage or sleeve
   4. Minor Problem - if discovered early, the above treatment may be sufficient.
      1. Physician Visit – if pain persists for more than a few days, a visit to your family physician is important to determine the extent of the injury.
   5. Change Position: in minor cases, or following 4-6 weeks of rest, the athlete may continue to play if the player is moved to a position in which very little throwing is required for a pitcher or squatting for a catcher, such as first base or second base.
   6. Once Healed – involves a slow and gradual return to throwing, at first from short distances, then advancing to 50 pitches from the mound. Focus on mechanics of throwing using the lower body to preserve the arm.
   7. First Aid Kit: gloves, gauze pads and roll, ace bandages, ice packs, antiseptic, band-aids, CPR mask, cellular phone for 911 call, health index cards for each player with special needs (asthma, diabetes, etc.)
9. Summer Safety:
   1. Hydrate: Make sure players drink plenty of fluids, (water, sports drinks) not soda before and during the game. Also, eat a small healthy meal or snack before a practice or game.
   2. Practice Cool: Plan early morning or evening practices to avoid the heat. Wear hats, rest often in shade for water breaks, and use sunscreen.

REMEMBER: Kids are not small adults! Keep it light and have FUN!

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey  “Health & Exercise Forum” in the Scranton Times-Tribune. Next week read: Little League Coaching Tips – Injury Prevention 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.

Part 2 of 2

After a long winter, spring is finally in the air as indicated by the number of golf enthusiasts as seen in the past few weeks at Pine Hill’s Golf Club in Taylor, PA. However, it is important to remember that without proper warmup and preparation, the risk of injury can increase substantially. PGA professionals benefit tremendously from sport science, physical therapy and fitness programs on tour year round. Amateurs in northern climates require diligence and planning to prepare for the game after 4-6 months off to avoid injury.

PRESEASON TIPS FOR GOLF – PART 2

• Keep Fit and Trim - year round with light to moderate weight training, aerobic exercise, stabilization and flexibility exercises and good nutrition.
• Walking – Begin a walking program as the first step to a comprehensive preseason conditioning program for golf. Start 1 mile for a week, then 2 miles for 2 weeks, then 3 miles.
  • Walking 18 holes on a golf course is the equivalent of a 5-7 mile walk. It keeps you fit, flexible and avoids the jarring of the bumpy cart. Taking a caddie is optimal. However, carrying your bag requires careful planning. Use a “Sunday bag: or ultra-light bag with a stand and double straps; remove extra balls, unused clubs and umbrellas to lighten the load. Arch your back and extend backwards with the club after every shot. If using a pull cart, push rather than pull, when not walking downhill.
• Core Tips- Maintaining a strong core is critical for a healthy golf swing
  • Core Stabilization Exercises – Abdominal/Core Strengthening can be performed sitting on balance ball or standing on discs while doing biceps curls, shrugs, rows, lats, and leg extension. Contract abdominal muscles and keep balance while using arms and legs.
  • Golf Swing on Discs – Backswing: Tie the other end to a door knob. Stand with feet shoulder width apart on discs or pillows. Slowly turn into backswing – hold 3-5 seconds- slowly release to starting position. Repeat 5 to 10 times.
    • Tie a light resistance band (red) to a golf club at the top of the grip.
  • Golf Swing on Discs – Follow-Through: Same as above for backswing but perform in follow-through motion.
• Take a Lesson – learn the mechanics of a proper swing for less stress on your body from a PGA golf professional. It can make the difference!
• BE SMART – LISTEN TO YOUR BODY - If the arm, leg, neck or back pain is severe, long lasting or causes radiating pain, tingling or numbness into your legs, consult your family physician to determine the best course of action before you continue playing golf.

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.

PRE-SEASON GOLF TIPS: Part 1 of 2

After a long winter, spring is finally in the air as indicated by the number of golf enthusiasts seen in the parking lot at Pine Hill’s Golf Club in Taylor, PA in the past few weeks. However, it is important to remember that without proper warmup and preparation, the risk of injury can increase substantially. PGA professionals benefit tremendously from sport science, physical therapy and fitness programs on tour year round. Amateurs in northern climates require diligence and planning to prepare for the game after 4-6 months off to avoid injury.

Muscle strains, ligament sprains, neck and LBP is prevalent in the early season for golfers, especially for the amateur. The reasons are many: general deconditioning after winter inactivity, poor golf swing mechanics, excessive practice, inadequate warm-up and poor flexibility and conditioning. The very nature of the golf swing can create great stress on the body, especially after time off.

PRESEASON TIPS – Best to begin 4 -6 weeks before the season

• Warm Up – Get to the course early enough to make time to stretch before you play and hit a few balls at the range. Always start with low irons and work up to driver. Take a hot shower before an early morning round and use compression shorts and shirts on cool days. Do Not Bounce or Overstretch! Stretch slowly, holding for 10-20 seconds:

• Shoulder Overhead Stretch – slide hand up door jam while walking toward wall and raise arm until completely overhead.
• Shoulder Chest Cross Stretch- bring one arm across chest using other arm to pull behind elbow.
• Extend Middle and Lower Back Stretch – place club behind small of back and pinch shoulder blades together. Also, extend lower back against club.
• Rotate Trunk Standing -while standing with an arched lower back and using club behind your back slowly rotate to right, then left.

• Rotate Trunk Lying– lying on back and rotate upper trunk to right and then to left. Repeat rotating lower body right and left with knees bent.
• Lower Back Flexion Stretch – lying on back and bring both knees toward chest. Hold with clasped hands and gently stretch.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune. Next Week: Part 2 - Pre-season Golf Tips.

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.

 

 

 

 

Spring has sprung and so too has Tour de Scranton, considered the “kick off” to biking season in NEPA as it springs into action in preparation for this Aprils big event. Dust off your bikes and warm up for the event by riding the many beautiful and well-maintained trails are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority.

Tour de Scranton is the official “kick off” to biking season in NEPA. This year, on Sunday, April 26^th, the 12^th annual Tour de Scranton will offer a selection of several routes and distances for the novice and experienced rider at its non-competitive bike ride for riders of every age and skill level. This event supports “The Erin Jessica Moreken Drug & Alcohol Treatment Fund” which provides charitable gifts to qualified local organizations or individuals struggling with the disease of addiction. For more information visit: www.tourdescranton.com.

WHY BIKE?

There are many obvious reasons to bike…cardiovascular fitness, burn calories, improve leg strength and others. But, the real question is, “what are the advantages of biking over other forms of exercise?” Glad you asked…

BENEFITS OF BIKING

1. INEXPENSIVE – while not as cheap as running, biking can be much cheaper than other sports. Starter bikes can be less expensive than high end running shoes.
2. EASY – most people can learn to ride a bike. Kids begin with training wheels and adult tricycles are available.
3. FAMILY FUN – something the whole family can enjoy in your neighborhood, at the beach or on one of the trails.
4. PRACTICAL EXERCISE – it is an opportunity to exercise while traveling to work, store, lunch etc…bike it!
5. CARDIOVASCULAR FITNESS – good for the heart and all that goes with it: burns calories, lowers blood pressure, lowers LDL, and elevates HDL and boosts the immune system.
6. LEG STRENGTH – pedaling a bike is a great way to improve leg strength.
7. CORE STRENGTH – core muscles of the neck, middle and lower back and the associated arm strength will improve while biking in order to maintain your torso on a bike on hills and turns.
8. IMPROVES BALANCE/COORDINATION/FALLS PREVENTION – riding a bike requires some balance and coordination and therefore will improve balance as a form of falls prevention.
9. GOOD FOR YOUR JOINTS – bike riding only requires partial weight bearing to the spine and lower body joints so it is more comfortable and gentle to your joints than walking or running. For this reason, it is often recommended to pregnant women suffering from leg or lower back pain as a safe alternative to running.
10. MENTAL WELLNESS – biking, like all aerobic exercise, is a great source of stress management as it releases endorphins and serotonin which improves mental health. With the added feature of being outdoors in the sunshine and fresh air, biking keeps you smiling!

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be in good working order such as tires, chain, brakes and pedals. Next, be sure to maintain a fairly good fitness level in order to bike safely. If you are a beginner, start slowly. Warm up and slowly bike for 10 to 15 minutes and build up over time. Practice the coordination of stopping, starting, shifting and braking. Work on good strength and flexibility of the hamstrings, quadriceps, calves and gluteal muscles. All of these muscles are necessary to generate pedal force. Balance is also important to safety and can be practiced on and off the bike. Be aware that adaptive equipment can modify your bike for added comfort and safety such as soft handlebar tape, seat post and front fork shock absorbers, padded biking shorts, c-out and gel pad saddle seats, and wider tires.

Be careful not to progress too quickly because inactivity to over activity in a short period of time can create problems. Overuse injuries such as tendonitis, can be avoided by cross training. Bike every other day and walk, run or swim on off days. Make sure to take time off to recover after a long ride. Use ice and massage to sore muscles and joints after riding.

Remember, cycling should be fun! Pain from improperly fitted and poorly maintained equipment is preventable. Excessive workouts and training rides should be kept to a minimum and consider cross-training in between.

CYCLING SAFETY

EQUIPMENT: Helmets are a must! Also, keep your bike in good condition. Road bikes should have mirrors and reflectors. Use hand signals and obey traffic rules. Dress for weather and visibility. Have a first aid and tire patch kit, tire pump and tools. Seat comfort can be improved with gel cushion or split seat.

BE ALERT: for traffic, parked cars, pedestrians loose gravel and cracks in the road.

SOURCES: American Physical Therapy Association

Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, and exercise regularly

EVERY 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 in downtown Scranton and is an associate professor of clinical medicine at The Commonwealth Medical College.

The Commonwealth Medical College will present: The 3^rd Annual Keystone Program “Child Abuse Symposium 2015”

In an effort to address the horrific problem of child abuse, TCMC, along with The Children’s Advocacy Center/NEPA, Lackawanna County Medical Society, and Luzerne County Medical Society, with host the 3^rd Annual Keystone SymposiumSpring 2015 – “Child Abuse – Recognizing & Reporting”on Saturday April 11, 2015 at the Radisson Lackawanna Station Hotel from 8 AM until 12:30 PM.

The purpose of the symposium is to provide strategies for health professionals and students to recognize and report child abuse. As of 2015, it is mandatory for licensed health professionals to receive continuing education credits for license renewal. For more information about the symposium contact: Gloria Colosimo at TCMC 570-504-9074 or email CME@tcmc.edu.

“Health & Exercise Forum” will dedicate the next two weeks presenting columns on topics related to this unconscionable problem on the local, state and national level.  

CHILD ABUSE

Part 2 of 2

Guest Author: AnjaniAmladi, MD4

AnjaniAmladi is a 4th year medical student at The Commonwealth Medical College (TCMC). She was raised in San Ramon, CA and earned a B.S. in Biological Sciences at the University of California at Davis. She plans to become a Psychiatry resident and specialize in child/adolescent psychiatry. 

Anjani is the recipient of the 2014/15 TCMC Healthcare Journalism Award by Dr. Paul Mackarey.

This is the second in a series of two columns dedicated to the topic of child abuse. Last week we discussed the definition and laws related mandatory reporting. This week will present prevention, identification and reporting of child abuse.

The unfortunate truth is that child abuse is much more pervasive in our society than can be imagined. Although the natural reaction is to avoid an issue that makes us so uncomfortable, by treating child abuse in this manner we do ourselves and our children a great disservice. The most important lesson my Internal Medicine preceptor taught me during my third year medical school clerkship was, “the eyes do not see what the mind does not know.” The goal of this article is to help readers “see”…what child abuse looks like in order to prevent, recognize, and report this unconscionable act.

While knowing what to do after a child has been harmed is vital to the interventional and healing process, knowing how to prevent a possible event from occurring is even more important.

Preventing Child Abuse/Exploitation

Top 10 “Safety Rules” for parents and children:

1. Talk to children about sexual abuse early, keeping their age and level of understanding in mind
2. Teach children that they have “private areas” nobody is allowed to touch
3. Explain to children that they can say “No” to an adult, and do not have to do anything that makes them uncomfortable
4. Teach children not to accept gifts, give personal information, or get in a car with a stranger; And to tell someone immediately if they are approached by someone they do not know
5. Be sure that a child knows how to call “911” if there is an emergency
6. Teach children to never meet anyone in person who they met online
7. Encourage open communication with children, and teach them to come to you if they have problems
8. Teach your children that you will always believe them if they tell you they are being hurt or touched by someone – no matter who that someone may be.
9. Be careful when selecting child care givers. Always check references of potential care givers.
10. Teach children that it is never ok to answer the door when they are home alone, or to admit to anyone over the phone that they are home alone

Signs of Physical Abuse

• bruises, welts, lacerations, or abrasions
• sprains or broken bones
• burns or bite marks
• injury in the shape of an object ie. belt, handprint, iron
• explanations for the injury is not consistent with physical findings, or explanation of the injury that keeps changing
• medical attention for the injury was not obtained soon after injury
• a child who attempts to hide injuries
• a child who is reluctant to go home or has fear of caregivers

Signs of Sexual Abuse

• genital pain, itching, or sexually transmitted disease
• ripped, stained, or bloody clothing
• difficulty sitting or walking
• advanced sexual knowledge or sexual behavior inappropriate for age level
• sudden personality or behavioral changes like hurting oneself ie. cutting, burning, drinking excessively or doing drugs

Signs of  Neglect

• poor hygiene
• clothing that does not fit or is inappropriate for the weather
• lack of medical or dental care needs
• a child who is constantly hungry and may beg or steal food
• a child who avoids going home, may show up at school early and stay late, try to stay at other people’s homes

What do I do if my child tells me they have been abused?

While difficult, the most important  step is to remain calm. Children rarely lie about being abused – so believe what your child is telling you. Avoid interrogating the child, let them explain to you what happened in their own words. Immediately let the child know they did the right thing by telling you, and be sure to emphasize that the abuse was not their fault. After a child has disclosed the abuse, make a report to the police, local child protective services agency, or a child abuse hotline. It is imperative that this be done after the child is able to tell their story. Assure the child that they will be protected, and that no harm will come to them because they told the truth. Obtain counseling services for the child and for the family. It is important that the child have an advocate, but it is also important for a counselor to help families to process the trauma as well.

How to report abuse

ChildLine: http://www.compass.state.pa.us/cwis 1-800-932-0313

Children’s Advocacy Center: 1710 Mulberry Street Scranton, PA 18510 570-969-7313 www.cacnepa.org

National Child Abuse Hotline: http://www.childhelp.org/ 1-800-4-A-CHILD

Other Resources: https://www.childwelfare.gov/ http://keepkidssafe.pa.gov/

MEDICAL REVIEWER: Karen Arscott, DO, Associate Professor in Clinical Sciences, The Commonwealth Medical College.

Read Dr. Mackarey’s Health & Exercise Forum in the Scranton Times-Tribune 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 The Commonwealth Medical College.

 

The Commonwealth Medical College will present: The 3^rd Annual Keystone Program “Child Abuse Symposium 2015”

In an effort to address the horrific problem of child abuse, TCMC, along with The Children’s Advocacy Center/NEPA, Lackawanna County Medical Society, and Luzerne County Medical Society, with host the 3^rd Annual Keystone SymposiumSpring 2015 – “Child Abuse – Recognizing & Reporting”on Saturday April 11, 2015 at the Radisson Lackawanna Station Hotel from 8 AM until 12:30 PM.

The purpose of the symposium is to provide strategies for health professionals and students to recognize and report child abuse. As of 2015, it is mandatory for licensed health professionals to receive continuing education credits for license renewal. For more information about the symposium contact: Gloria Colosimo at TCMC 570-504-9074 or email CME@tcmc.edu.

“Health & Exercise Forum” will dedicate the next two weeks presenting columns on topics related to this unconscionable problem on the local, state and national level.  

CHILD ABUSE: Part 1 of 2

Guest Author: Anjani Amladi, MD4

AnjaniAmladi is a 4th year medical student at The Commonwealth Medical College (TCMC). She was raised in San Ramon, CA and earned a B.S. in Biological Sciences at The University of California at Davis. She plans to become a Psychiatry Resident and specialize in child/adolescent psychiatry. 

Anjani is the recipient of the 2014/15 TCMC Healthcare Journalism Award by Dr. Paul Mackarey.

 

Child Abuse - The Problem

Every ten seconds a report of child abuse is made in the United States.This adds up to more than 3 million reports involving greater than 6 million children per year. More than five children die every day as a result of child abuse and most are under the age of four. About half of the cases of child fatalities due to abuse/mistreatment are not reported on death certificates. Though it may be easy to convince ourselves that child abuse or mistreatment does not happen in our own back yards, the sad part is that it happens everywhere. Child abuse occurs at every socioeconomic level, educational level, across ethnic and cultural lines, and yes in small, quite cities and towns in NEPA. In fact, the Children’s Advocacy Center, Lackawanna County’s designated child abuse center, provided services to 1,448 children and adolescents in 2014. Of these, 80% experienced sexual abuse, 16% experienced physical abuse, and the remaining 4% experienced a combination of both physical/sexual abuse and/or severe neglect.

Title 23 Chapter 63 (Domestic Relations), also known as the Child Protective Services Law, has undergone many recent changes which went into effect as of January 1, 2015. Perhaps the most important changes are lowering the threshold of what constitutes child abuse, increasing the list of who is defined as a mandatory reporter, clarifying the mandatory child abuse reporting process, and providing increased education to people who are defined by law as mandatory reporters.

Definition of Child Abuse – Child Protective Services Law – Title 23 Chapter 63

Pennsylvania law defines child abuse as intentionally, knowingly or recklessly doing any of the following:

(1)  Causing bodily injury to a child through any recent act or failure to act.

(2)  Fabricating, feigning or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or treatment to the child through any recent act.

(3)  Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series of such acts or failures to act.

(4)  Causing sexual abuse or exploitation of a child through any act or failure to act.

(5)  Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act.

(6)  Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act.

(7)  Causing serious physical neglect of a child.

(8)  Engaging in any of the following recent acts:

(i)  Kicking, biting, throwing, burning, stabbing or cutting a child in a manner that endangers the child.

(ii)  Unreasonably restraining or confining a child, based on consideration of the method, location or the duration of the restraint or confinement.

(iii)  Forcefully shaking a child under one year of age.

(iv)  Forcefully slapping or otherwise striking a child under one year of age.

(v)  Interfering with the breathing of a child.

(vi)  Causing a child to be present at a location while a violation of 18 Pa.C.S. § 7508.2 (relating to operation of methamphetamine laboratory) is occurring, provided that the violation is being investigated by law enforcement.

(vii)  Leaving a child unsupervised with an individual, other than the child's parent, who the actor knows or reasonably should have known:

(A)  Is required to register as a Tier II or Tier III sexual offender under 42 Pa.C.S. Ch. 97 Subch. H (relating to registration of sexual offenders), where the victim of the sexual offense was under 18 years of age when the crime was committed.

(B)  Has been determined to be a sexually violent predator under 42 Pa.C.S. § 9799.24 (relating to assessments) or any of its predecessors.

(C)  Has been determined to be a sexually violent delinquent child as defined in 42 Pa.C.S. § 9799.12 (relating to definitions).

(9)  Causing the death of the child through any act or failure to act.

Mandatory Reporting

For years, the designation of a mandatory reporter and the process in which to make a report has been cloudy to say the least. The new law defines a mandatory reporter as anyone who meets the following criteria: a person who is certified or licensed to practice in any health-related field, a medical examiner, coroner, or funeral director, an employee of a health care facility or medical provider that is responsible for the care or treatment of individuals, school employees, an employee of a child care service who has direct contact with children, a clergyman, priest, rabbi, minister, Christian science practitioner, religious healer or spiritual leader of any established church or religious organization, any individual paid or unpaid who accepts responsibility for a child (youth coaches, troop leaders, etc.), employees of a social services agency who have direct contact with children, a peace officer or law enforcement officer, emergency medical services providers, an employee of the public library that has regular contact with children, and independent contractors.

A mandated reporter is required to make a report of suspected child abuse if there is reasonable cause to suspect that a child may be being abused. An oral or written report must be completed and submitted within 48 hours to the state.

Increased Education Among Medical Practitioners

Act 31, an amendment to the Child Protective Services Law, requires that further training be provided for mandatory reporters. The law requires that anyone with direct contact with children or an executive/facility director who provides services for care of children that are applying for a license or certification must complete at least three hours of approved child abuse training; including foster parents. Additionally, anyone who is renewing a license or certification must complete at least two hours of continuing education per licensure cycle. At a minimum, the training must cover recognition or signs of child abuse, as well as reporting requirements for suspected or witnessed child abuse.

Where and How to Report Child Abuse

ChildLine: http://www.compass.state.pa.us/cwis 1-800-932-0313

Children’s Advocacy Center: 1710 Mulberry Street Scranton, PA 18510 570-969-7313 www.cacnepa.org

National Child Abuse Hotline: http://www.childhelp.org/ 1-800-4-A-CHILD

Other Resources: https://www.childwelfare.gov/ http://keepkidssafe.pa.gov/

MEDICAL REVIEWER: Karen Arscott, DO, Associate Clinical Professor in Clinical Sciences; The Commonwealth Medical College.

Read Dr. Mackarey’s Health & Exercise Forum in the Scranton Times-Tribune. Next Monday: Child Abuse - Part 2 of 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.

 

Spring is almost here! After a long and cold winter, many people in NEPA will start planning summer vacations. As you may have gathered from my previous columns, travel is one of my passions. For the past 15 years, my family and I have been fortunate to have visited many spiritual places of natural wonder and beauty that we call our National Parks. Many of the parks are on the west coast and require some preparation to endure the many hours of travel by airplane through different time zones. More recently, my wife and I traveled to Africa for our 30^th wedding anniversary. It was the trip of a lifetime as we experienced daily safaris like a real life version of Disney’s “Lion King!” However, the more than 16 non-stop hours on a plane took a toll on us and gave new meaning to the term “jet lag.”

WHAT IS JET LAG?

According to the Mayo Clinic, jet lag, also known as jet lag disorder, is a sleep disorder that can occur in people who travel through different time zones in a short period of time, such as a flight from New York City to Los Angeles. Obviously, the further the distance traveled and the more time zones entered, the more significant and drastic the symptoms, as found, for example, in those traveling from the United States to Asia.

Sunlight has a direct impact on our internal clock by regulating melatonin, a hormone that regulates sleep and wake cycles in the body. Travel through different time zones can affect the amount and duration of sunlight and therefore, impact the regulation of these cycles. The inability to regulate the cycles results in many symptoms.

SYMPTOMS OF JET LAG

• Sleep Disturbance – some experience insomnia, restlessness or waking up in the middle of the night, while others suffer from excessive tiredness or sleepiness
• Generalized Malaise – overall sense of not feeling well
• Muscle and Body Aches – generalized soreness
• Fatigue – general feeling of weakness, tiredness and fatigue
• Gastrointestinal Irritability – constipation or diarrhea
• Menstrual Cycle Changes – menstrual symptoms out of cycle
• Easily Distracted – difficulty concentrating or focusing

PREVENTION OF JET LAG

• Plan for a travel day or two – if time permits, it is wise to arrive a day or two early to acclimate to your new environment before you engage in demanding tours or physical activity. Olympic athletes keenly understand the importance of this strategy.
• Plan for the new zone – before you get on the plane, set your watch to the time zone of your destination. By doing this, you can begin to mentally and physically prepare by eating, drinking, and sleeping accordingly. For example, don’t ingest caffeine shortly before you need to sleep on the plane. Conversely, consider using a sleep aid at a time which allows you to get at least 8 hours of uninterrupted sleep and wake up to daytime in your new time zone.
• Plan for the trip – try to get on a healthy schedule, eat well and get plenty of rest before you travel
• Hydrate – the importance of hydration cannot be overstated. Air cabin climate and pressure promotes dehydration and dehydration will make jet lag symptoms worse. Keep in mind, alcohol and caffeine will increase dehydration, especially as you sleep
• Sleep – is an essential component to jet lag prevention. Use earplugs, eye masks, headphones and sleep aids if necessary. However, be sure to time your sleep according to the time zone you’re traveling to, not in presently. Therefore, it may be necessary to stay awake until the timing is right. Consult your physician about the best sleep aid for you and do not combine a sleep aid with alcohol.
• Avoid blood clots – keep moving! During the time that you are awake on the plane, set a timer to do exercises and intermittent walking on the plane. Every 15 -20 minutes perform a different exercise. Alternate between arms, legs and walking. Do 30 to 60 repetitions. Also, based on your medical history, ask your physician if taking an over-the –counter blood thinner, such as an 81mg of aspirin, or a natural product like vitamin E is appropriate.

EXERCISES FOR JET LAG

Posture Exercises

Posture exercises are designed to keep your body more upright and prevent rounded shoulders and forward head/neck.

• Row-The-Boat - Pinch shoulder blades together as if you are rowing a boat.
• I-Don’t-Know – Shrug shoulders up toward the ears as you do when you say “I don’t know.”
• Chin Tucks – Bring your head back over your shoulders and tuck your chin in\

Arm Exercises

 

• Bicep Curls – sit in chair and bend your elbows up and down
• Wrist Curls – as above but bend your wrists up and down
• Chair Push-ups – Push up with your arms as if getting out of a chair

Leg Exercises – 5- 10 times

 

• Hip Hikes – Sit in chair and march by hiking your hip and lifting up your heel 4-6 inches off the floor
• Leg Kicks – Sit in chair and kick your knee out straight – then bend it down to the floor
• Hips In and Out – Sit in chair and bring your knees/hips in and out
• Toe Raise/Heel Raise – Sit in a chair and raise your toes up/down – then raise your heels up/down

Breathing Exercises

 

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

Read Dr. Mackarey’s Health & Exercise Forum – every Monday 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.