According to the North American Menopause Society (NAMS), 1.5 million American women reach menopause each year. The median age is 52, but some women will reach menopause as early as 40 or as late as 58. Recent research revealed that menopausal women who engaged in three hours of exercise per week for one full year reported improved mental and physical health.
Menopause begins when women’s ovaries are depleted of healthy eggs. Typically, women are born with 1-3 million eggs which are lost over the course of a women’s life through ovulation and other natural means. Under normal conditions, a reproductive hormone called follicle-stimulating hormone, (FSH) stimulates the growth of the eggs during the first half of the menstrual cycle. As a woman approaches menopause, the eggs become more resistant to FSH. Additionally, the ovaries produce significantly less estrogen, a hormone that affects the blood vessels, heart, bone, breasts, uterus, skin and brain. Many of the symptoms associated with menopause are due to the loss of estrogen. These symptoms include: hot flashes, irregular or skipped periods, insomnia, mood swings, fatigue, depression, irritability, racing heart, headaches, joint and muscle pain, decrease sex drive, vaginal dryness, and loss of bladder control. While not all women get these symptoms. Most women experience various degrees of some of these symptoms.
Several studies support the fact that women who engage in regular exercise report less menopausal symptoms than those who are inactive. One particular study in the Journal of Advanced Nursing, found that women who engaged in 3 hours of exercise per week for one full year reported improvement in mental and physical health as compared to the control group. The program consisted of cardiovascular, stretching, strengthening, and relaxation exercises.
In another study published in the Annals of Behavioral Medicine, researchers found that women who walked or performed yoga reported improvements in quality of life with less anxiety and stress related to their menopause symptoms. It is believed that exercise stimulates a release of endorphins in the brain and this is the primary mechanism by which exercise relieves symptoms associated with menopause.
Consult with your family physician before you begin an exercise program, especially if you have health issues. Consider a consultation with aN orthopedic or sports physical therapist for professional advice to begin an exercise program best for you. Wear comfortable exercise clothing and sneakers. Exercise to control menopause symptoms does not have to be extreme. A simple increase in daily activity for 15 minutes 2 times per day or 30 minutes 1 time per day is adequate to control your symptoms. This can be simply accomplished by walking, swimming, biking, and playing golf or tennis. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes 4-5 days per week with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for 5-10 minutes, 2-3 times per day. Then, add 1-2 minutes each week until you attain a 30-45 minute goal. Keep in mind, weight bearing exercises such as: walking, hiking, and light weight training are important for improving the loss of bone density associated with menopause.
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.
MARCH IS COLON CANCER AWARENESS MONTH. PREVENT COLON CANCER THROUGH EXERCISE!
In 2000, President Bill Clinton dedicated March as National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness about the facts about colon cancer. It is preventable, treatable and has a high survival rate. Regular screening tests, expert medical care and a healthy lifestyle, which includes a proper diet and exercise, are essential for success. Several studies have demonstrated that exercise can help prevent colon cancer.
The American Cancer Society estimates that approximately 136,830 people were diagnosed with colorectal cancer in 2014. Of these, 50,310 men and women will succumb to the disease. It is the second leading cause of US cancer deaths for men and women combined. Northeastern PA has been fortunate to have an active colon cancer awareness program with the help of some very visible members of the community. On a personal level this disease has had a great impact on me because my father, Paul Mackarey, was diagnosed with colon cancer 25 years ago. Fortunately, with great medical care, numerous prayers and endless support from family and friends, he is a proud survivor as a healthy 90-year-old who winters in Florida with my mother. This experience has had a great influence on my lifestyle: daily exercise, low-fat vegetarian diet, nonsmoker, moderate drinker, and colonoscopy screening every 3 years since age 35.
Early detection is the key to survival. Colorectal cancer progresses very slowly, usually over years. It often begins as non-cancerous polyps in the lining of the colon. In some cases, these polyps can grow and become cancerous, often without any symptoms. Some symptoms that may develop are: blood in stool, changes in bowel movement, feeling bloated, unexplained weight loss, feeling tired easily, abdominal pain or cramps, and vomiting. Contact your physician if you have any of these symptoms.
The risk of colon cancer increases with age, as 90% of those diagnosed are over 50 years old. A family history of colon cancer increases risk. Also, those with benign polyps, inflammatory bowel disease, ulcerative colitis, or Crohn’s disease are at greater risk and should be screened more frequently.
Exercise and Colon Cancer:
While there have been many studies about the benefits of exercise for colon cancer, none have been more encouraging than a recent study from the Hutchinson Cancer Institute in Seattle. Patients with abnormal cells on the lining of their colons as found by colonoscopy, demonstrated positive changes and reversal of these cells after engaging in 4 hours of exercise per week for one year. Some studies have shown that exercise can reduce the risk of colon cancer by 50%.
How Exercise Prevents Colon Cancer:
The intestine works like a sewage plant recycling food and liquid needed by your body. However, it also stores waste prior to disposal. The longer the wastes remains idle in your colon or rectum, the more time toxins have to be absorbed from you waste into the surrounding tissues. One method in which exercise may help prevent colon cancer is to get your body moving, including your intestines. Exercise stimulates muscular contraction called peristalsis to promote movement of waste through your colon.
Exercise to prevent colon cancer does not have to be extreme. A simple increase in daily activity for 15 minutes 2 times per day or 30 minutes 1 time per day is adequate to improve the movement of waste through your colon. This can be simply accomplished by walking, swimming, biking, and playing golf, tennis, or basketball. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes 4-5 days per week with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for 5-10 minutes, 2-3 times per day. Then, add 1-2 minutes each week until you attain a 30-45 minute goal.
Prevention of Colon Cancer:
Source: American Cancer Society
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.
Last week Health & Exercise Forum presented Part 1 of PRP Updates: What is PRP? How is it Administered? How it Works? This week will present PRP effectiveness and appropriate foot and ankle conditions for PRP.
The body has an amazing capacity to heal itself. When the body becomes injured, a natural healing process occurs to repair the damaged tissue. The body signals platelets and other components in our blood to migrate to the site of injury. Platelets are the primary factor for stopping blood loss at the site of injury. They coalesce at the site of injury and form a clot to stop the bleeding. Under normal conditions, in addition to forming a clot, these platelets release a variety of growth factors that initiate and subsequently promote healing. New advances in medicine have been developed to harness and concentrate these platelets to be introduced to a precise injury site in an injectable form. The implantation of these platelets from a small amount of the patient's own blood has the potential to enhance the body's capacity for healing at the site.
During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries. This column has presented this topic in the past; however, due to the growing popularity of the treatment, it seems appropriate to offer a PRP update. Specifically, PRP has become more common to promote healing of the soft tissues of the foot and ankle.
Effectiveness of PRP for Ankle and Foot Injuries
Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:
Chronic Tendon Injuries
Published clinical trials report success in treating chronic Achilles tendon injuries and tendonosis of the tendon which has been diagnosed through MRI studies. The Achilles tendon is often injured in runners or in “weekend warriors”. Conservative treatment includes rest and physical therapy. Injections of cortisone into the tendon are generally not considered as it can weaken the tendon and make it more prone to rupture. The Tendon injury can produce pain and swelling of the back of the heel. There can be other causes for pain in the area including heel spurs and tendon rupture. If conservative treatment fails, surgical intervention can be an option. PRP is proving to be a viable alternative to surgery.
Plantar Fasciitis
This condition is seen in runners and walkers as well as those just starting out on a new or different exercise regimen. It can appear suddenly or over a period of time. The pain is generally worse in the morning and lets up somewhat during the first few hours of the day only to return later in the day after standing or walking during the day. Conservative treatment consists of aggressive physical therapy, stretching and either oral or injectable anti-inflammatory medication and orthotic therapy. Cases that don’t respond to this can go on to surgery. PRP is a good option to try prior to contemplating surgical intervention.
Chronic Non Healing Ulcerations.
If a wound is located on the bottom of the foot or in an area that is subject to increased edema or stress it should be evaluated by a wound care specialist. The doctor will determine the cause of the ulceration and the best course of action in order to heal the sore. Often times for longstanding ulcerations which have failed conservative methods of treatment, PRP can be used to try and give the wound a kick start and achieve healing. Sometimes, PRP can be used in conjunction with a skin graft or a biologic skin substitute to achieve healing.
In conclusion, platelet rich plasma presents a promising method of treating a variety of conditions from chronic tendon or ligament injuries to long standing non healing ulcerations. The use of PRP for ankle and foot injuries is gaining more widespread acceptance and new and interesting studies are being conducted to show the mechanism of action of the procedure. It is being used successfully to help patients heal by using their own natural injury healing cascade in a concentrated fashion.
Sources: American Academy of Orthopaedic Surgeons (AAOS); American Orthopaedic Foot & Ankle Society.
Medical Contributor: Bill Brown, DPM practice podiatric medicine, including PRP for Ankle and Foot injuries, in Scranton, PA
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.
The body has an amazing capacity to heal itself. When the body becomes injured, a natural healing process occurs to repair the damaged tissue. The body signals platelets and other components in our blood to migrate to the site of injury. Platelets are the primary factor for stopping blood loss at the site of injury. They coalesce at the site of injury and form a clot to stop the bleeding. Under normal conditions, in addition to forming a clot, these platelets release a variety of growth factors that initiate and subsequently promote healing. New advances in medicine have been developed to harness and concentrate these platelets to be introduced to a precise injury site in an injectable form. The implantation of these platelets from a small amount of the patient's own blood has the potential to enhance the body's capacity for healing at the site.
During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries. This column has presented this topic in the past; however, due to the growing popularity of the treatment, it seems appropriate to offer a PRP update. Specifically, PRP has become more common to promote healing of the soft tissues of the foot and ankle.
Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.
What Is Platelet-Rich Plasma (PRP)?
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very essential to heal injured tissues.
PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
How is PRP Administered?
The procedure can be administered in an outpatient clinic. To develop a PRP preparation, a small amount of blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. The red blood cells are separated from the plasma and the platelets. An injectable solution of highly concentrated platelets is injected into the injured tissue with a local anesthetic block.
How Does PRP Work?
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process. The injured area is flooded with a high concentration of platelets and growth factors which are released from the platelets. This in turn begins the process of healing to the injured tissue. The growth factors are chemical messengers which signal the body to begin the complex healing cascade. In the foot and ankle, PRP is most commonly used in the following manner:
Sources: American Academy of Orthopaedic Surgeons (AAOS); American Orthopaedic Foot & Ankle Society.
Medical Contributor: Bill Brown, DPM practice podiatric medicine, including PRP for Ankle and Foot injuries, in Scranton, PA
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune. Next Week Read Part 2 of 2 on PRP Updates. 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.
Today is the last day of Presidents’ Day Weekend and many of you have visited our ski resorts enjoying one of the most popular ski weekends of the year. Mother Nature has cooperated with Elk Mountain and Montage Mountain to provide great conditions. While this popular recreational winter sport is fun and a nice diversion from what can otherwise be a long cold season, it is not without its risk for injury. The most common injury of the upper extremity that skiers experience is known as ‘Skier’s Thumb’. This condition refers to an injury to a ligament (the Ulnar Collateral Ligament or UCL) that connects two bones of your thumb together. Typically, the injury occurs when the thumb is moved forcefully away from the palm, causing the ligament to tear. This occurs commonly when a skier falls while holding ski poles. This injury, while common in skiers, does occur in other sporting activities such as football, basketball, and soccer. Sports that require the use of sticks, such as hockey or lacrosse may also predispose athletes to a ligament injury with the forceful movement of the thumb in an outward direction. It can also be the result of a chronic injury from repetitive stress on the thumb.
The Ulnar Collateral Ligament (UCL) stabilizes the thumb joint where the thumb connects to the hand.
It is necessary for this ligament to be stable because it makes an important contribution to grasping movements of the thumb. If you have injured this ligament it may be managed conservatively with immobilization. In more severe cases if the ligament has been completely torn, surgery mat be required to repair the ligament.
Non-surgical (conservative): Conservative treatment involves immobilizing the thumb in a neutral position to allow the ligament to heal in either a cast or splint.
Surgical treatment: Surgery would be indicated for a complete tear and/or joint instability. This would consist of outpatient surgery, where you would go home the same day. The surgery can be done with either a general anesthetic (the patient sleeps throughout the procedure with breathing assistance) or a regional block (the patient could either be awake or asleep while breathing without assistance).Post-operative care would include a cast for two weeks, at which point the sutures would be removed and a removable splint applied. The ligament would take approximately six weeks to heal.
Rehabilitation: If you have a strained ligament and do not require surgery you may be referred to a hand therapist for the fabrication of an orthosis or splint which will be worn for 4-6 weeks. The purpose of the splint is for protection from further injury and to position the thumb appropriately to allow for optimal healing. If there is a complete tear and surgical intervention is necessary you may be placed in a cast for 2 weeks followed by a splint for an additional 4 weeks. You should avoid activities that may cause re-injury for another 4-6 weeks.
Following the removal of the cast the thumb will be stiff and weak. A supervised exercise program is important to regain thumb range-of-motion. Once sufficient range of motion is restored, strengthening exercise will be initiated to regain maximal thumb strength and function. When necessary, a smaller splint can be made to allow earlier return to activity.
It is comforting to know that there are options available if you experience an injury or have compromised thumb stability from a long standing problem. Our thumbs are an integral part of our hand function and a stable thumb is essential for allowing us to participate in all aspects of our daily lives.New improvements have been made in breakaway ski pole straps that help prevent this injury. These devices can be found at local ski shops located by Elk Mountain and Sno Mountain.
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.
CONTRIBUTING AUTHORS:
Casey Burke, DO, is an orthopedic surgeon specializing in hand surgery in the greater Scranton area.
Nancy Naughton, OTD, CHT is a doctor of occupational therapy specializing in hand therapy in Scranton, PA
Born on February 12, 1809, in the small town of Shrewsbury, England, Charles Darwin circumnavigated the globe on the HMS Beagle at the young age of 22 to make keen observations and document findings in unparalleled detail. He spent the next three decades analyzing his data to support a thesis and published his findings inarguably the most controversial book ever written, The Origin of Species.
Darwin’s impact on contemporary medicine is far reaching and is predicted to have an even more powerful impact in the future. The growing field of genetics supports this claim. According to geneticist Theodosius Dobzhansky, "Nothing in biology makes sense except in the light of evolution." He purports that if evolutionary biology is the foundation for biology and biology is the foundation of medicine, than the two must coexist if one is to discover the true cause of a disease. More recent studies suggest that, while one’s DNA is not alterable, the process by which genes operate may be influenced.
The New York Times recently published an article about the impact of DNA on our health and wellness. Specifically, the article discussed the results of a new study that discovered the positive effects of outside influences such as exercise, on the behavior of DNA. The study found that exercise can change the shape and function of genes in a healthy way.
The human genome is a complex and comprehensive set of genetic information shared by all members of the human race. DNA sequences are encoded in chromosomes in the cell nuclei, where two copies of each gene, one from each parent is stored.
When it all works well, genes create a normal, health well-balanced organism. However, it has long been know that many diseases are related to genes. In some cases, a gene is broken, missing, and in others an extra gene is present. Genetic mutations can create disease. For example, all humans possess a gene called CFTR. However, only those with a mutation of this gene develop the genetic disease, cystic fibrosis. Some mutations are in only one gene, while other mutations are more complex such as those associated with heart disease and diabetes, especially when combined with environmental and lifestyle factors. But, not all mutations are necessarily bad. For example, some genetic mutations create resistance to disease. For example, according to research published in Nature, one in ten people studied in Burkina Faso in West Africa have a genetic mutation that protects them from malaria.
The good news is that current research supports the idea that not all environmental factors have a negative effect on our genetic health and wellness. Scientists at the Karolinska Institute in Stockholm published their findings in “Epigenetics” which support the theory that positive external environmental factors such as exercise, can impact our DNA to make us healthier. In the study, subjects performed moderate endurance exercise on a bike for 45 minutes, 4 times a week, for 3 months using only one leg. Muscle biopsies and DNA testing were performed on both the control (non exercised leg) and the experimental (exercised leg) before and after the study began and assessed for DNA changes. Researchers were pleasantly surprised to find significant changes in methylation, a process in which the DNA receives and responds to biochemical signals. These changes were only found in the experimental leg, the leg that had undergone 4 months of endurance training. Moreover, the changes were most notable in the muscle-cell genes which were responsible for energy metabolism, response to insulin and inflammation in the muscles. In summary, while there were no actual changes in the DNA of the exercised leg, there were significant methylation changes, which are the enhancers which amplify the response of DNA to environmental changes.
William Meller, MD, author of Evolution Rx, reinforces the value of the Stockholm research. He states that in spite of our anxiety about chemicals in foods, toxins in the environment and prolific diseases such as cancer, human beings were designed to heal. He feels that this is supported by a million years of evolution and natural selection that has influenced us to be powerful, healthy and self-healing. In spite of germs, toxins, and pollution we continue to thrive. In 2000 there were 180,000 centenarians in the world and that number is expected to increase by eighteen times as 3.2 million people in the world may reach 100 years of age by 2050.
Therefore, if your gene pool is questionable like most of us, don’t use that as an excuse. There are things you can do to have a positive impact on your DNA to live longer and healthier…one of them is EXERCISE!
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” 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
I enjoy the privilege of working with people recovering from a wide variety of medical conditions. However, many of these directly affect activities of daily living, particularly, the ability to drive safely: orthopedic and sports injuries, fractures, sprains and strains, joint replacements, hip fractures, shoulder and elbow surgeries and spinal fusions. Despite the many different types of problems, there is one question that is invariably asked, “When can I return to driving?” Unfortunately, the answer is not as simple as the question because it depends on many factors. Furthermore, the implications, such as a serious accident causing further damage to the injury or surgical site or harm to someone else, are significant and possibly critical. So, the next time you ask your physician this question, please follow instructions and be patient…remember, it could be your child or grandchild running into traffic to chase a ball and you would want the driver to be at optimal function to apply the brakes!
In our culture, the inability to drive has a significant impact on lifestyle and livelihood. A study published in the Journal of Bone and Joint Surgery, found that 74% of those unable to drive due to injury or surgery are dependent on family and most of the remainder depend on friends. 4% of those unable to drive have no help at all and more than 25% suffer major financial hardship.
The report also found that family physicians, orthopedic surgeons and physical therapists are keenly aware of this dilemma but often fail to communicate effectively to patients about driving. Most medical professionals express serious concerns about liability regarding return to driving following an injury or surgery. They feel that there is a lack of data to support decisions and inadequate communication among each other. They agree that they must do a better job communicating with patients and their families so they can better prepare for a period of time during their recovery in which they cannot drive.
A recent study published in the November 2013 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), reviewed the research and presented guidelines on this subject. It was determined that there are two significant components in the decision of safely returning to driving after an injury or surgery; the time required for healing and the time required for a return of function.
During the time required for healing, in addition to the fear of an additional trauma from a motor vehicle accident to the healing body part, there is a general concern about the potential damage that may come from over using the body part to drive before it is adequately healed. For example, a healing fracture in the right lower leg might be compromised or delayed if one must suddenly and forcefully apply the brakes. Also, during this time, it is not unusual for post-injury or post-surgery patients to use pain medications, including narcotics. This will also compromise judgment and reaction time while driving.
Most orthopedic conditions heal in 6 to 8 weeks. However, as many of you may fully know, once a cast or splint is removed, you are not ready to run or jump. Depending on the severity of the injury, it may take many weeks of aggressive physical therapy to regain strength, range-of-motion, agility and dexterity to function at a safe level for a full return to daily activities, including driving.
The current research reinforces the fact that driving safely requires good function of the entire body. For example, just because you broke your shoulder bone but did not fracture your right leg does not mean that you are able to drive safely. Wearing a sling after arm surgery also compromises driving. First, the injury must be stabilized and healed before you can drive. Then, you must work in rehab to make modifications to return to safe driving. The same scenario is applied to injuries or surgery to the spine (neck and lower back).
RETURN TO NORMAL BRAKING REACTION TIME AFTER SURGERY
(JAAOS)
Type of Surgery: Time Until Normal Braking*
Knee Arthroscopy 4 Weeks
Right Total Hip Replacement 4-6 Weeks
Right Total Knee Replacement 4-6 Weeks
Lower Leg Fracture 6 Weeks after initial weight bearing
Ankle Fracture 9 Weeks
Right Lower Leg Cast/Brace Full weight bearing after removal of cast/brace
*Based on research using driving simulators
Keep moving, eat healthy foods, exercise regularly, and live long and well!
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.
Knee Replacement Updates - Part 3 of 3
Getting a new knee doesn’t quite mean what it used to.
In younger, active patients — from about age 50 to 65 — having knee problems often means only one of the knee’s three compartments is degenerated. In the past, these patients relied on multiple conservative measures — steroid injections, for example, or oral medication — to tide them over for a few years until the degenerative arthritis advanced to the other compartments of the knee. Then, a total joint replacement — all three compartments — was performed.
Thanks to advances in technology, implant materials and surgical technique, people of all ages with arthritis and degeneration in only one compartment are eligible for a partial knee replacement, also called a hemiarthroplasty or unicompartmental knee arthroplasty (UKA). The benefits are many: shorter hospital stays, less blood loss, more aggressive rehab. And because UKA surgery maintains the ligaments and has less bone loss in the knee than a total replacement, the new knee moves in a more natural manner, which allows quicker return to more aggressive activities.
There also are benefits for older, less medically stable or overweight patients: less pain, less time in the hospital, quicker rehab. That results in fewer infections, blood clots and other complications, even though these patients often start off with other medical conditions.
By surgically replacing the arthritic ends of bones with metal and plastic components, a knee replacement creates new surfaces to allow a joint to function like a natural knee without the pain and restriction of a damaged, degenerative, arthritic knee.
A total knee arthroplasty (TKA) resurfaces all three compartments of the knee joint while trying to preserve most of the surrounding, supporting soft tissues. A TKA is required if cartilage — the thick cushion covering the ends of bones — in all three compartments is damaged or worn away, resulting in arthritis.
For those with arthritis and degeneration in only one compartment — usually the medial or inside compartment — a partial knee replacement may be a better choice. It’s also a less invasive procedure with fewer medical complications.
UKA was first presented as a surgical option for the treatment of arthritis in the inner compartment of the knee in the 1950s. The idea is to replace as little of the joint as necessary, preserving much of the natural knee anatomy. It was thought that with less bone loss, when the unicompartmental implant wore down, it would be much easier to graduate to a total knee replacement years later. Even then, it was recognized that a total replacement would eventually deteriorate and require a revision — and the revision surgery would be complicated by the loss of bone and soft tissue, rendering the second replacement potentially less effective than the first.
The early UKAs had limited success, due in part to problems with implant and material design, patient selection, limited technology and surgical techniques. Fortunately, that has changed for the better.
According to the American Academy of Orthopaedic Surgeons, a UKA is an option for a select group of patients with osteoarthritis of the knee limited to one compartment. Only the damaged compartment is replaced, with a metal and plastic implant; the healthy, unaffected compartments remain untouched.
Most qualifications for a UKA are the same as for a total replacement — age, weight and medical health are not necessary criteria. But there are some unique criteria to determine if you qualify:
When appropriate patients are selected and proper surgical technique performed, several studies have determined that the UKA is a viable and successful option. One study found that as many as 92 percent of UKA patients had excellent or good outcomes, with patients generally reporting a more natural and quieter knee.
Advantages identified in other studies include:
While less frequent, UKA complications are similar to those found with total replacement. They include blood clots, infection, implant wear or loosening, and degeneration of other knee compartments. But there is one risk specifically associated with a UKA: The effect of pain relievers is slightly less predictable.
While the idea of getting a knee replacement — partial or total — is intimidating, it actually is one of the safest and most effective medical procedures. Discuss which option is best for you with an orthopedic surgeon. Northeast Pennsylvania is fortunate to have many highly skilled and experienced board-certified orthopedic surgeons successfully performing knee replacements daily. For more information, and to find out who is performing UKAs in your area, visit the American Academy of Orthopaedic Surgeons website, www.aaos.org.
Medical Reviewer: HARRY SCHMALTZ, M.D., was medical reviewer for this column. He is an orthopedic surgeon and joint replacement specialist, certified Oxford Unicompartmental Knee replacement surgeon, Scranton Orthopaedic Specialists PC.
PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and an associate professor of clinical medicine at Commonwealth Medical College. His column appears every Monday in the Scranton Times-Tribune. Email: drpmackarey@msn.com.
Knee Replacement Updates - Part 2 of 3
There is good news for those in need of a knee replacement today! Recent advances have led to equally viable options for two very different patient populations; the younger active patient and the older and less medically stable patient.
Recent studies conclude that knee replacement has had a very positive impact on lifestyle and overall health benefits for more than 7 million people in the United States that have had a hip or knee joint replaced. In view of this, it is predicted that this number will increase substantially with the aging baby boomer population.
Last week, in Health & Exercise Forum, Part I discussed knee arthritis and treatment options, including knee replacement. This week, Part II will offer a self-assessment to determine if you are ready or eligible for a new knee. Next week, Part III will present the benefits and complications of a new knee and will specifically discuss a new option in knee replacement surgery – partial or unicompartment knee replacement.
Knee joint replacement is recommended for chronic, disabling arthritic knee pain not responding to conservative management such as: weight loss, activity modification, physical therapy, bracing, anti-inflammatory medication, pain killers, cortisone injections, viscosupplementation, arthroscopic debridement or osteotomy. Traditionally, a total knee replacement – TKR (also called a total knee arthroplasty - TKA) is recommended for 60+ year olds willing to eliminate high-impact activities (running, cutting, pivoting). Bicycling, swimming, golfing & walking are not usually restricted.
Today, however, there is good news for those in need of a knee replacement as recent advances have led to equally viable options two very different patient populations; the younger active patient and the older less medically stable patient. According to Harry Schmaltz, MD, a local orthopedic surgeon specializing in joint replacement, new advances, such as the unicompartment or partial knee replacement (UKA), offer significant benefits to both young and old alike…it is not age dependent. The UKA will be discussed in more detail next week in “Health & Exercise Forum.”
New research shows that those who suffer from knee pain due to arthritis for an extended period of time may be doing a great disservice to their overall health and well-being. The results showed that over time those suffering from advanced arthritis of the knee lose their ability to walk more than 1-2 blocks or climb stairs without severe pain. Also, they are unable to use a treadmill, bike, elliptical or stepper for aerobic exercise. As a result of this inactivity, they gain a significant amount of weight and are unable to enjoy traveling or doing things with their family due to the inability to walk. In addition to weight gain, a sedentary lifestyle leads to high blood pressure and sleep apnea. Over time, it is likely to lead to coronary artery disease and adult onset diabetes. Consequently, the arthritic pain in the knee can contribute to many health issues.
While surgery should never be taken lightly and is always the last option, sometimes it is the best choice.
Score each question below as follows:
Activities:
TOTAL SCORE _________/80
Scoring: The higher the score the more functional you are and less likely to need surgery for a new knee. For example, 80 out of 80 total points is normal. 60 and above is fairly functional. 40 to 50 points is a danger zone and below 40 you might start talking to your doctor about a surgery. Your orthopedic surgeon will help you decide if a total or partial knee replacement is best for you. Next week in “Health & Exercise Forum” in the Scranton Times-Tribune, read about the partial knee replacement.
SOURCES: Lower Extremity Functional Scale; American Physical Therapy Association; American Academy of Orthopaedic Surgeons; Biomet Inc.
Medical reviewer: Harry Schmaltz, M.D., orthopedic surgeon and joint replacement specialist, certified Oxford Unicompartmental Knee replacement surgeon, Scranton Orthopaedic Specialists, PC.
Knee Replacement Updates: Part 1 of 3
There’s good news for those in need of a knee replacement. New advances have led to equally viable options for two very different patient populations: the younger, active person and the older, less medically stable individual.
Knee or hip joint replacement has had a very positive impact on lifestyle and overall health for more than 7 million Americans -- a number expected to increase substantially with the aging baby boomer population.
We’ll look closely at this topic for the next three weeks, starting today with a discussion of knee arthritis and treatment options, including knee replacement. Part 2, on Jan. 19, will offer a self-assessment to determine if you are ready or eligible for a new knee. Part 3, on Jan. 26, will present the benefits and complications of a new knee and will specifically examine a new option in this field -- partial or unicompartment knee replacement.
I have been advising my patients to exercise, keep active and walk as long as they can to stay mobile and healthy. Still, seniors often tell me that activities that require prolonged walking are limited by knee pain from arthritis. But knee joint arthritis is not a death sentence to an active lifestyle.
The three most common forms of arthritis of the knee are:
Conservative Treatment:
In the early stages, your treatment will be a conservative, nonsurgical approach. You and your family physician, orthopedic surgeon or rheumatologist will decide which choices are best.
Conservative, But More Aggressive Treatment:
Surgical Treatment:
When conservative measures no longer succeed in controlling pain and deformity or improving strength and function, more aggressive treatment may be necessary.
SOURCES: Rothman Institute, Philadelphia; American Academy of Orthopaedic Surgeons; Biomet Inc.
Medical reviewer: Harry Schmaltz, M.D., orthopedic surgeon and joint replacement specialist, certified Oxford Unicompartmental Knee replacement surgeon, Scranton Orthopaedic Specialists, PC.
PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and an associate professor of clinical medicine at Commonwealth Medical College. His column appears every Monday in the Scranton Times-Tribune. Email: drpmackarey@msn.com.
