2^nd of 2 Columns on Fall Prevention

Preventing a fall can not only save your independence but also your life! Last week, Health & Exercise Forum presented how to assess your risk of falling and exercises to limit your risk by maintaining a reasonable fitness level. This week will discuss the importance of fall prevention. Preventing injuries from falls reduces the need for nursing home placement. Injuries from falls are the seventh leading cause of death in people over the age of sixty-five.

The following suggestions will assist you in minimizing your risk of a fall:

• Exercise: Exercise and activity improves strength, flexibility and balance. There is no substitute for maintaining an active but safe lifestyle if possible. (refer to last Monday’s column for exercise tips)
• Diet & Hydration: Proper nutrition and hydration provides adequate amounts of vitamins and minerals to maintain energy levels and prevent drowsiness. Adequate hydration is also important. Treat dehydration from fever, diarrhea and vomiting by drinking plenty of fluids.
• Medication: Consult a pharmacist or physician regarding medications that can cause: drowsiness, dizziness, lightheadedness, faintness, fatigue, tiredness, unsteadiness, blurred vision, double vision, confusion, or otherwise affect alertness, balance or coordination.
• Positional Changes: Avoid sudden drops in blood pressure by avoid sudden changes in posture and position. Stand up slowly. Sit for a few minutes and tap your toes before getting out of bed. Consider raising the head of bed with a wedge pillow.
• Alcohol: Be cautious with alcohol since it interferes with alertness, balance, coordination and reflexes.
• Illness: Be sure to treat respiratory infections such as ear infections, colds, flu, sinus congestion to prevent labyrinthitis and Meniere’s disease (conditions which cause severe balance problems).
• Frequent Urination: Be cautious with urgency, especially at night. Consider bedside commode and a grab bar by the toilet. Turn lights on and put on eyeglasses to supplement vision. Night lights are recommended. A pendant alarm may be beneficial.
• Vision: Check your eyesight and hearing regularly. Poor eyesight makes it difficult to see potential hazards. Update old eyeglasses. Inner ear problems can affect balance. Adequate lighting is paramount. Light switches should be within reach without getting out of bed and on both ends of hallway. Nightlights in bedroom, bathroom and hallway are recommended. Keep a flashlight handy. Turn or leave lights on when entering house and at night. Use light paint and wallpaper to reflect more light. Use 100 watt bulbs for an adequate amount of light.
• Assistance Devices: Use assistive devices when negotiating uneven terrain or when you feel weak or tired. To avoid falls in the bathroom install grab bars in the shower, tub, and toilet areas. Use bathmats with suction cups or nonslip adhesive strips in tub/shower. Consider a shower stool and /or elevated toilet seat.
• Good Footing: Proper footwear with a flat sole, wide base and nonslip grips are important. Footwear should be tied securely and fit snugly. Do not walk in stocking feet as it can be very slippery.
• Remove Hazards: Inspect your floors for hazards! Remove rugs and runners that slip or attach nonslip backing. Tack loose rugs. Glue vinyl flooring. Keep pathways free of electrical/telephone cords. Remove wax from floors. Mops up spills promptly.
• Safety on Stairs: Install secure handrails on both sides. Improve lighting. Ensure carpeting on stairs is firmly attached. Highlight stairs with tape or paint edges of steps especially if narrow or higher/lower than the rest. Paint outdoor steps with a mixture of paint and sand for better traction. If carrying items up or down steps, use handrail.
• Walkways: Sidewalks and walkways should be clear, well lit and free of snow and ice. Salt or sand if slippery. Repair uneven paving.
• Eliminate clutter: Do not store items on steps. Rearrange furniture to move around easier. Watch out for pets. Avoid stepping over pets.
• Store Items Within Reach: Limit reaching by storing frequently used items where they can be reached easily. If reaching is required, use a stepstool with high, sturdy handrails. Repair or discard wobbly stools. Do not use a chair to reach for items.Following these helpful hints will keep you safe by preventing a loss of balance and a potential fall!

Guest Contributor: Janet M. Caputo, PT, DHSc, OCS is clinic director at Mackarey & Mackarey Physical Therapy Consultants, Scranton, PA where she specializes in the treatment of vestibular and balance disorders.

Medical Reviewers: Dr. Louis DeGennaro & Dr. Mark Frattali

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.

 

ARE YOU AT RISK OF FALLING?

1^st of 2 Columns on Fall Prevention

New research shows that falls are the number one cause of serious orthopedic injuries such as hip fractures in the elderly. As a result, falls prevention has become a health care priority. Studies also show that a comprehensive medical evaluation and a falls prevention rehabilitation program are very effective in lower the risk of falls

To determine your risk first it is necessary to define “a fall”.  A fall is an unplanned, unexpected contact with a supporting surface. A supporting surface is not only the floor or ground, but could be a chair (when rising and you fall backwards), a wall (when loss of balance causes you to bump into a wall) or a counter (when reaching overhead loss of balance causes you to bump into the countertop).

TEST YOUR FALL RISK

How likely are you to fall? Two quick tests that can determine your fall risk:

•  Timed Up and Go Test: This test :requires that you stand up from a chair, walk 3 meters (10 yards), turn around, walk back and return to the seated position. If completed in10 seconds, you are considered independent. However, if more than 14 seconds is required, you are at risk for a fall.

• Functional Reach Test (See Photo A): Tape a yardstick horizontally along the wall at shoulder height. Stand with feet shoulder width apart. Raise one arm so it is parallel to floor and in line with the yardstick. Without moving feet, reach forward without losing your balance. Measure the number of inches reached along the yardstick before you lost your balance. If your reach is 10 inches or more you are not likely to fall. However, if your reach was less than 10 inches, you are two times more likely to fall. If less than 6 inches, you are 4 times more likely to fall.

***BE SURE TO HAVE SOMEONE STANDING AT YOUR SIDE DURING THIS TEST TO MAKE SURE YOU DON’T FALL!  

What are the reasons why an older adult may be at risk for a fall?

Age related changes in strength, endurance, flexibility, reflexes, vision and posture creates a greater risk of falls in the elderly. The strength and endurance of your leg muscles decline with age. Strength can be reduced up to 40% by 80 years of age! The flexibility of your spine as well as ankle joints diminishes. Arthritis and pain can further limit motion in these joints. A stooped posture interferes with proper postural alignment and increases fall risk. Ankle flexibility is essential for effective balance responses and reflexes. Diminished sensation in the legs and feet (i.e. peripheral neuropathy) decreases responses to balance threats.  Cataracts, macular degeneration and retinal disease reduce your ability to use vision to maintain and/or regain balance and contribute to falls. Distractions can cause a fall since many older adults require more attention to complete a task safely. Anxiety and fear of falling can have a negative effect on balance performance.

Why is it important to address the issues that put you at risk for a fall?

Identifying and remedying all possible causes may prevent a fall. Preventing or reducing the likelihood of a fall may improve your quality of life. Elderly people who have fallen avoid performing basic physical and social activities (walking, shopping) because of fear of falling. If a fall causes a hip fracture, the resulting mobility deficits may prevent living independently and require nursing home placement. Fall prevention can lower health care costs. Health care costs of fall injuries for individuals 65 and older exceeded $19 billion in 2000.

Quick and Easy Fall Prevention Exercises:

Improve Flexibility:

• Calf Stretch (See Photo B):
  • Place hands on wall. Place leg to be stretched behind other leg. Keeping the knee straight, the heel down and the toes forward. Lean toward wall allowing the front knee to bend.
  • Hold: 30 seconds
  • Repeat: 3 times

Improve Leg strength:

• Standing Toe Raises(See Photo C):
  • Standing facing a countertop, simultaneously lift front of feet and toes upwards. Only use counter if necessary.
  • Repetitions: 10
  • Sets: 3
• Chair Squats (See Photo D):
  • Begin seated on edge of chair. Rise and return to sitting, without using arms, if possible. Elevate seat with pillow if too difficult from a standard height chair.
  • Repetitions: 10
  • Sets: 3

Improve Balance:

• Stand on One Leg (See Photo E):
  • Practice balancing on one leg facing a countertop. Only use counter if necessary.
  • Hold: 15 seconds
  • Repeat: 3 times with each leg

• Heel to Toe Walking (See Photo F):
  • In a narrow hallway, practice walking heel to toe. You can use a strip of tape to “walk the line.”
  • Duration: 2 to 5 minutes

 

 

Guest Contributor: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation as an associate at Mackarey & Mackarey Physical Therapy Consultants, LLC.

Read “Health & Exercise Forum” in the Scranton Times-Tribune every Monday…Next Week Read: Part 2 of 2 on Fall Prevention!  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.

If you are among the 2000 runners who finished The 19^th Annual Steamtown Marathon Sunday, then you are waking up this morning with a little less jump in your step than you had yesterday. Your should probably know that if you ran a marathon before the 1908 Olympics in London, then you would have run one mile less than you did yesterday. The Royal Family was picnicking at Windsor Castle one mile further than the original for starting place of the race. For fear of insulting Royalty, the starting point was moved to accommodate them. Ironically, several runners collapsed due to unusually hot and humid weather. But, one can’t help but to place partial blame on the Royal Family for lengthening the event. If you are sore today, blame the Royal Family.

I remember quite well the euphoric feeling of finishing my first marathon. That night, however, I was exhausted. So, I went to bed early and looked forward to a fun filled day on Monday, as I took the day off to relax and enjoy my family. To my surprise, I had great difficulty getting out of bed. My feet, knees, hips, and back were very sore and stiff. My toes nails were black and feet blistered. The “recovery – the day after the marathon” was something I was not prepared for. Today, I offer some helpful suggestions to expedite your recovery:

Recommendations:

PREVENTION BEFORE AND DURING THE RACE:

• Eat foods high in carbohydrates and low in fat.
• Drink 8-12 oz of water every few hours 1-2 days before the marathon
• Drink every 1-2 miles (at every water stop) during the marathon.
• Use a sports drink containing a carbohydrate and sodium.
• Take 30-60 grams of carbohydrate per hour to delay fatigue and fuel muscle contractions.

IMMEDIATE RECOVERY:

• Drink - 24 ounces of water for every 2 pounds you lose after your workout. This is based on pre and post exercise weight. You just burned 2,600 calories so don’t drink diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol. If you can’t adhere to this rule, wait several hours to have a beer. First drink plenty of water and Gatorade to prevent the diuretic from messing up your fluid balance.
• Keep moving – Walk, don’t run immediately after you cross the line. It is important that you continue to move. Coming to a complete stop or collapse does not allow the blood in your muscles to fully circulate back to your heart. Try to walk, stop, stand intermittently for 3-5 minutes.
• Rest – Take it easy for a few days. Let you muscles/body heal. Go home. Shower and rest in bed for 1-2 hours – even if you can’t sleep. Then, get up to eat and drink again.
• Elevate – By elevating you legs you allow blood/fluid in you muscles to return to the heart without effort using gravity.
• Refuel – Drink (water and sports drinks), eat carbs and snack, snack, snack. But, wait 3-4 hours for a full meal.
• Massage – This can be an effective method of relaxing muscle spasms, cramps and mobilizing fluids from you muscles to your heart after the long run. It should be very comfortable. Wait 45-60 minutes after the race so you have ample time to drink and eat and move around a little. You may find even more benefit from massage 24-48 hours after the race to assist in the recovery of delayed onset muscle soreness from lactic acid build-up in your muscles.

LONG TERM RECOVERY:

• DO NOTHING!– for 1 week after the marathon – NOTHING – no running, no long walking, no swimming, no weight training!
• 4-6 weeks for a complete recovery – even in elite athletes
• 6-8 weeks before beginning speed work training – even in elite athletes
• Ease back into running
• Studies show – even in elite athletes the damage to the body from running a marathon does not allow optimal performance for several weeks. This has been found even when the runner felt fully recovered.
• Temperature, Humidity, and Intensity of the race significantly effect recovery time.

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 19^th Annual Steamtown Marathon will be held on Sunday, October 12, 2014. The 26.2 mile event, beginning in Forest City and ending in downtown Scranton, is certified by USA Track and Field as a qualifier for the esteemed Boston Marathon and is highly regarded by running aficionados. By my view, the event represents everything that makes NEPA special: hardworking, unselfish organizers, appreciative and enthusiastic supporters, beautiful landscape and fall foliage. Many runners have local roots and return home to run with zealous love and support from family and friends along the trail.

This year at the race, whether running, working or cheering, take notice of the many runners sporting knee socks. You may wonder what this is all about…style, fad, or medical device.

Runners competing at this level constantly try to improve performance through training, diet, nutrition, mental focus and equipment. And, to advance to the next level, it is critical to limit exercise-induced muscle soreness from excessive training. One product purported to control post-exercise soreness has become popular over the past few years among members of this elite group: compression socks.

In 2009, compression socks burst onto the running scene when people witnessed Paula Radcliffe, one of the top female marathon runners, wearing what appeared to be knee-high socks as she ran the Boston Marathon and other major events. In fact, so many people took notice that the sock she wore, 2XU Compression Racing Socks, became the 2009 Product of the Year! Today, the company offers two socks: one worn while running to improve performance, and the other worn after prolonged activities to reduce exercise-induced muscle soreness.

How Do Compression Socks Work?

Most people recognize compression socks as the tight knee-high support stockings worn to prevent blood clots after a surgical procedure such as a knee or hip replacement. They are made with a special fabric and weave design that provide graduated compression (stronger compression at foot and ankle and less at the top of the sock) to promote better circulation and movement of fluids from the foot, ankle and calf back to the upper leg and, ultimately, to the heart. The theory that compression socks help runners relies on the idea that they facilitate the movement of stagnant fluid filled with lactic acid and other byproducts of exercise away from the legs and toward the heart, thereby rushing fresh blood, nutrients and oxygen to the legs. This exchange fosters the healing of micro-damage to tissue and promotes more efficient use of the muscles. If the product holds up to scientific scrutiny, compression socks could significantly benefit long distance runners, cyclists, triathletes, soccer players and others participating in endurance sports.

Will I Run Faster? Further?

In 2009, The Journal of Strength and Conditioning Research published a study suggesting that wearing compression socks significantly improved running performance, but similar studies have failed to support this claim. However, one finding that literature supports is that compression socks can improve the rate and magnitude of recovery when worn by soccer players and runners. A study in The British Journal of Sports Medicine confirmed this finding, and reported that the benefits of compression socks are more obvious for long-duration activities or when running 10km or more.

 

Conclusions on Compression Socks

Time will tell if the benefit of compression socks for runners is a fact supported by scientific research or a fad based on placebo effect. Current wisdom suggests that these socks may offer value and benefit for activities of long duration (more than 1 hour), long distance running (more than 10km), and when worn after prolonged activity to expedite recovery from exercise-induced muscle soreness. If you are an athlete who falls into one of these categories of activity, this product is worth a try. However, as with all new equipment, you should try the product during practice and only use it during competition if your training was successful. If you hesitate to use compression socks while running, consider wearing them after a prolonged training session or competition to reduce exercise-induced muscle soreness. If you are de-conditioned and attempting to begin a fitness program or if you are a novice weekend athlete, you may see the greatest benefit from compression socks, as the improvements recorded in well-trained athletes were minimal.

Where to find compression socks:

2XU Compression Racing Sock – www.2XU.com

Two socks are available – one for racing and one for recovery

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 affiliated faculty member at the University of Scranton, PT Dept.

Choosing a Cervical Pillow: 10 Tips to Choose the Best Cervical Pillow

Part 2 of 2

As discussed last week in Part 1 on Cervical Pillows, studies on cervical or neck pillows have shown that those using a cervical pillow demonstrated a significant reduction in chronic neck pain and headaches. However, researchers cautioned that there are many different types of pillows and that—depending on the individual—some may be more effective than others. This week, I offer tips on choosing the best pillow for you.

1. Get a Diagnosis – If possible, visit your physician to find out why you have neck pain and headaches. For example, those with arthritis, osteoporosis, degenerative disc disease or other bone and joint problems have great difficulty finding a comfortable position to sleep due to pain, stiffness and headaches upon waking up in the morning. These individuals may see great benefit from using the proper pillow.
2. Try it out in the Store – Cervical (or neck) pillows are designed to provide support to the cervical or neck area of the spine. In theory, the pillow attempts to align and support the natural shape of the neck while one is sleeping.
3. One Size Does Not Fit All - A traditional pillow is often designed as a one-size-fits-all rectangle that is more about form than function. Imagine that small-framed woman (5 feet tall, weighing 100 pounds) may use the same pillow as a large male football player (6 feet 5 inches, weighing 350 pounds). It is obvious that these two individuals have very different head, neck and shoulder sizes and therefore require two very different pillows.
4. Age Matters – People aged 16 to 40 have flexible and hydrated discs and benefit more from a contour pillow with a bump, core or butterfly shape. A thinner pillow that allows the neck to extend and distract while sleeping is helpful. People over age 65 often have arthritic and dehydrated discs with a more rigid spine, and they will benefit more from a thicker pillow with comfortable material such as synthetic down or memory foam which keeps the neck in a slightly elevated and flexed position to avoid hyperextension. People aged 40 to 65 are in between, and they may need to experiment with pillows that allow extension, flexion or neutral positions.
5. Special Circumstances – (See Photo of Filled Pillow on Wedge) There are exceptions to every rule. For example, those with allergies should always ask for hypoallergic materials. Those with respiratory conditions or hiatal hernias often require elevation for comfortable sleeping—they may benefit from using an 8-inch to 10-inch wedge and a full pillow, a combination that will elevate the head and chest.
6. Standard Filled Pillows – These pillows can be filled with hard or soft materials, such as synthetic or real down, and they resemble a more traditional pillow. They allow for a person to manipulate and shape the pillow according to his or her own liking.
7. Memory Foam Pillow - This unique material offers individualized support for almost every body type. However, it is often expensive (although there are now inexpensive versions from lesser-known brands), and it retains heat, which may make it too warm to use in the summer. This type may not be suitable for very small-framed people, as they may not be able to compress the material and will therefore not benefit from its contouring capabilities. (www.tempurpedic.com), (www.thergear.com).
8. Contour Pillow – (See photos of Contour Bump Pillow and Contour Core Pillow) These ergonomically designed pillows are contoured to support the “hollow” of the neck with a “bump” or “core.” Some offer a cut out for the side sleeper such as the “butterfly” pillow (See Cervical Pillows - Part I). They work best for younger, more flexible spines and small-framed people. Contour pillows can be found at (www.coreproducts.com), (www.painreliever.com), (www.bodyline.com).
9. Travel Pillow – (See photo of Travel Pillow) These pillows offer proper support to prevent your head from bobbing up and down while sleeping in a car or on a airplane. Most are horseshoe collar shaped, and I am partial to the inflatable version from Brookstone^R due to its portability (www.brookstone.com).
10. Keep Trying - It is important to remember that there is no one pillow fit for everyone—they are unique to each person. Pillow type should be based on body type, head size, shoulder width, favorite sleeping position, and medical conditions. Always try to sample a cheaper version of a product when possible.

If you missed Part 1 of this series, you can go back and read it here.

Read “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 in downtown Scranton, PA and is an associate professor of clinical medicine at The Commonwealth Medical College.

Choosing a Cervical Pillow: Part 1 of 2

Are you one of the millions of people who suffer from chronic neck (cervical) pain and headaches? Did you ever wonder if your pillow is right for you? Studies on cervical or neck pillows have shown that those with chronic neck pain showed a significant reduction in neck pain and headaches when using a cervical pillow for four weeks when compared to the control group. However, there are many types of cervical pillows, and there is no single best choice for everyone. This column will give you an overview on the different types of cervical pillows, and hopefully this information will help guide you to the right pillow for your individual size and shape.

Introduction

People who suffer from back and neck pain are always in search of something to lessen their pain and stiffness. Those with conditions such as arthritis, osteoporosis, or other bone and joint problems have great difficulty finding a comfortable position to sleep, and they often wake up with pain, stiffness and headaches in the morning. For these people, a cervical pillow may offer great comfort, because it is specifically designed to alleviate these symptoms.

Traditional pillows have drawbacks mainly because they are designed as a one-size-fits-all rectangle with greater emphasis placed on form than on function. Very often, a small-framed woman (5 feet tall, weighing 100 pounds) may find herself using the same style of pillow as a large male with the build of a football player (6 feet 5 inches weighing 350 pounds). It is obvious these two individuals have very different head, neck and shoulder sizes, and therefore they require two very different types of pillows.

Cervical or neck pillows come in a variety of shapes and sizes, and they are designed to provide support specifically to the cervical area of the spine. In theory, a cervical pillow attempts to align and support the natural shape of the neck while one is sleeping. Those suffering from neck or shoulder pain, degenerative cervical disc disease, or conditions such as arthritis or osteoporosis may find these pillows valuable.

Types of Pillows

Cervical pillows are made by many different manufactures and come in a variety of sizes, designs and shapes. Manufacturers claim that these pillows offer the benefits of increased circulation, improved breathing, reduced snoring and lessened neck and shoulder muscle pain and stiffness. One manufacturer, Tempur-Pedic^R (www.tempurpedic.com), boasts special memory foam technology that, they claim, offers unique and individualized support to accommodate the weight of every body type.

When selecting a cervical pillow, it is important to remember several things. First, know that most manufacturer claims are not subject to validation by independent research studies. Second, remember that, regardless of what a manufacturer states, no single pillow is right for every person. Third, realize that the most expensive option is not necessarily the best. Although many people consider Tempur-Pedic^R to be the leader in the field, they are costly, ranging from $89 to $349. If you shop around, you can find several companies that offer alternatives—both of similar and alternative designs—that may actually be a better fit for your neck and your budget. Other companies producing cervical pillows include Core^R, which offers support around the periphery with a special or dip (or “core”) in the middle in which your head rests (www.coreproducts.com), TheraGear^R, which offers a version of the orthopedic “bump” (www.painreliever.com), and BodyLine^R, which offers a model with both a large and a small orthopedic “bump” in one pillow (www.bodyline.com). These pillows are economical, ranging in price from $30 to $60.

Regardless of what brand of pillow you select, it is likely to fall into one of the following three categories:

1. Contour Pillows: (See photo below) Ergonomically contoured shapes support your head, neck and spine, and range from firm to medium-soft. These pillows are shaped with a hump or bump in the middle or on the edge, which is designed to fill in the gap between your neck and shoulder when lying on your back. Some offer a cut-out with a “butterfly” shape for the side-sleeper.
2. Filled Pillows: Softer, shapeable filled pillows in more standard shapes, with gentle head and neck support for a range of sleep styles. These pillows look like a more traditional pillow, but they are made with a variety of materials that allow you to manipulate and shape the pillow to your own liking.
3. Travel Pillows: (See photo below) Travel-size pillows deliver proper support and soothing comfort so you get more restful sleep while you’re traveling. These pillows vary in shape and size. For air travel, I am partial to the horseshoe collar style, which prevents your head from bobbing when reading and sleeping on long flights. The inflatable type is very convenient because it is portable, easy to pack, and it is available in airport stores or online at Brookstone^R at brookstone.com.

Conclusion

It is important to remember that there is no one pillow fit for everyone—each person’s needs are unique. You should select your pillow type based on your body type, head size, shoulder width, favorite sleeping position, and medical conditions, such as neck or lower back pain, osteoarthritis, headaches, etc. When choosing a pillow, try to sample a cheaper version of the product when possible. For example, if you think you might like the “orthopedic bump” style from Tempur-Pedic^R that costs $200, consider trying the $50-60 version from TherGear^R first. Better yet, if you have a friend or relative with a similar body type and problem who successfully uses a cervical pillow, try borrowing it! Finding the right pillow is a process of trial-and-error, so not get frustrated or give up. If you succeed in finding the right pillow for you, the result will be worth the search.

Read “Health & Exercise Forum” in the Scranton Times-Tribune every Monday. Next Week, Part II of II: Tips to Select a Good Cervical Pillow For You. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com.

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

Guest Columnist: Christopher Cali

Last week, in response to the popular “ALS Challenge,” “Health & Exercise Forum” featured the four most common neurodegenerative diseases; amyotrophic lateral sclerosis (ALS), Alzheimer’s,(the most common form of dementia), Parkinson's and Huntington’s in an effort to raise the level of awareness and educate the public. This week in Part II, I invited Christopher Cali, who is currently pursuing his PhD in Genetics at the University of Pennsylvania, to discuss updates on these diseases as it relates to his research.

 

ALS/DEMENTIA RESEARCH UPDATE

Neurodegenerative diseases, including; ALS, Alzheimer’s disease, (and various other forms of dementia), Parkinson’s and Huntington’s can take a devastating toll on patients and families. This broad category of diseases is characterized by the destruction of neurons that are important for memory and muscle function. It’s estimated that up to 50 million Americans currently suffer from a neurodegenerative disease, and this number is expected to grow as the Baby Boomer generation ages. The financial burden on society is huge as well.  Dementia care alone is estimated to cost $250 billion dollars each year in the US. With the enormous mental, physical and societal burden of these diseases, scientists have made understanding neurodegenerative diseases a major priority.

As a graduate student at the University of Pennsylvania, I am working to understand the genetic basis of neurodegenerative diseases. My current work focuses on ALS (Amyotrophic lateral sclerosis, also called Lou Gehrig's disease) and a type of dementia called Frontal Temporal Dementia (FTD). ALS is a truly devastating disease that affects at least 30,000 Americans. It normally strikes otherwise healthy individuals between the ages of 30-70. The first symptoms are usually mild and arise as muscle weakness and/or stiffness. Symptoms become noticeable after frequent stumbles and difficulty lifting normal household objects. Slurred speech is also a common early symptom. The pace of this disease is relentless. Neurons that control every muscle in the patient’s body deteriorate over a few years, leaving patients unable to move anything except their eyes. Most patients live only 3-5 years after diagnosis. However, some patients do live for decades after diagnosis.

There is currently no effective treatment for this terrible disease. The medication riluzole is the only approved ALS medication, and it only extends life by an average of 3 months. As for prevention, some studies have suggested that diet and exercise can delay the onset of ALS symptoms or lessen the severity of symptoms in ALS patients. For instance, one study from the Harvard School of Public Health found that people with increased dietary intake of carotenoids (found in tomatoes, carrots and squash) had a slightly lower risk of developing ALS. It’s still debated whether regular exercise can reduce the risk of developing ALS. Some studies show that exercise is not a risk factor for developing ALS. Interestingly, a few studies report that ALS is more common among athletes and those with physically demanding jobs. While the role of exercise in prevention of ALS is unclear, it is certain that regular exercise and physical therapy after diagnosis can delay the decline of ALS patients.

Frontal temporal dementia is the second most common form of dementia behind Alzheimer’s. Like ALS, it typically occurs in middle aged people. It is characterized by drastic changes in behavior, inability to recognize objects or people, loss of organizational and planning skills and various speech problems. There is also no cure for FTD. So how are FTD and ALS connected?

In 2011, two research groups published the finding that a mutation in a single gene was responsible for both ALS and FTD in a subset of patients. This finding led to a wave of new research on these two diseases. Interestingly, this same mutation was found in small numbers of people with other neurodegenerative diseases, including Alzheimer’s. Scientists are now realizing that these diseases often overlap with each other, and it’s possible for one patient to have symptoms from several different neurodegenerative diseases. The recently discovered mutation lies in a gene that hasn’t been well studied at all. In fact, this gene is so new that it does not even have a name (it’s referred to as C9orf72).

Scientists are now beginning to understand how this newly identified mutation causes the disease and have already designed drugs that turn off the mutant gene. These drugs, called Antisense Oligonucleotides, are made up of short pieces of DNA that are injected into the patient and block the mutated gene. Since most ALS patients with the C9orf72 mutation have one mutated gene and one normal gene, shutting off the mutated gene should be enough to halt the disease. These drugs are currently being tested in mice with promising results.

Another promising piece of new technology that has been used to study ALS and FTD are cells called Induced Pluripotent Stem cells. Induced pluripotent stem cells are derived from adult skin cells and can be changed into any cell type in the body. For instance, the skin cell can be changed to a stem cell, and then to a nerve cell. This technology was developed by Shinya Yamanaka, who was awarded the 2012 Nobel Prize. The new procedure side steps the ethical issue of destroying a human embryo to obtain stem cells. It also allows scientists to grow personalized cells from patients that they can study in a dish and test new medications on. One day, scientists hope to be able to correct any genetic mutations in a patient’s cells and then inject the stem cells back into the patient’s spinal cord. In the right environment, they will change back into neurons and replace the diseased neurons.

There is still much to be done to fully understand ALS and FTD. The mutation in C9orf72 accounts for only a small percentage of all ALS patients. This means that there are numerous other genes that contribute to ALS that have not yet been identified. With today’s technology, however, it’s possible to go from an unnamed gene to a viable treatment in only three years. This should give those currently affected by ALS, FTD or any other neurodegenerative disease immense hope, as a cure may just be right around the corner.

Visit your doctor regularly and listen to your body.

Christopher Cali, received his BS in biology from Villanova University and is currently pursuing a PhD in Genetics from the University of Pennsylvania. To find out more about his work or donate directly to ALS research in his lab, visit: www.med.upen.edu/tnr

Chris, has strong local roots as a 2009 graduate of Scranton Prep and is the son of Dr. Gregory and Celeste Cali of Dalton.

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.

 

 

ALS & DEMENTIA UPDATES: Part 1 of 2

By now, most of you are familiar with or have participated in the “ALS Ice Bucket Challenge.” If not, I encourage you to do so. I met my challenge a few weeks ago and dedicated it to my cousin, Joanne Mackarey Coyne. Joanne, with the tremendous love, care, and support of her dedicated family and friends, has not allowed ALS to daunt her strong spirit and beautiful smile. The ALS challenge has truly “gone viral” and has not only raised awareness about the disease, but as of August 27, 2014, the ALS Association has reported 94.3 million dollars (compared to 2.1 million last year) in contributions for research, support and education for this devastating neurodegenerative disease.

What is a neurodegenerative disease? Unfortunately, many of us have been affected by a friend or family member with a devastating disease that takes a tremendous physical, emotional and financial toll on everyone involved. Today Part I on ALS & Dementia in “Health & Exercise Forum” discusses the four most common neurodegenerative diseases, Alzheimer’s,(the most common form of dementia), Parkinson’s, Huntington’s, and amyotrophic lateral sclerosis (ALS) in an effort to raise the level of awareness and educate the public. Next week in Part II, Christopher Cali, a graduate student at the University of Pennsylvania, where he is pursuing a PhD in Genetics, will discuss updates on these diseases as it relates to his research.

 

What is a neurodegenerative disease?

Neurodegenerative diseases, including; ALS, Alzheimer’s disease, (the most common form of dementia), Parkinson’s and Huntington’s can take a devastating toll on patients and families. This broad category of diseases is characterized by the destruction of neurons that are important for memory and muscle function. It’s estimated that up to 50 million Americans currently suffer from a neurodegenerative disease, and this number is expected to grow as the Baby Boomer generation ages. The financial burden on society is huge as well.  Dementia care alone is estimated to cost $250 billion dollars each year in the US. With the enormous mental, physical and societal burden of these diseases, scientists have made understanding neurodegenerative diseases a major priority.

 

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis (ALS), also known as “Lou Gehrig’s Disease” is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, according to the ALS Association. As the disease progresses and the motor neurons are destroyed, the ability of the brain to initiate voluntary muscle movement is lost and paralysis remains. Early symptoms include muscle weakness in the arms and legs, difficulty swallowing and speaking. While there is not cure presently, riluzole, an FDA approved drug, has been modestly successful in slowing the progression of ALS. For more information visit: www.alsa.org

 

Alzheimer’s Disease

According to the Alzheimer’s Association, dementia is a general term used to describe a decline in mental function which presents significant difficulty in intellectual functions which affects everyday activities. Memory loss is the hallmark sign of this neurodegenerative disease. Alzheimer’s disease is one of the most common forms of dementia as it accounts for approximately 60-80 percent of all cases. Alzheimer’s is NOT a normal part of aging as approximately 5 percent of patients with the disease have early onset in their 40’s or 50’s. While dementia typically is a gradual process, Alzheimer’s is a progressive disease that often leads to the ability to carry on a conversation or provide self-care. While people with this disease can survive from four to twenty years, after the onset of noticeable symptoms, the average survival is eight years, depending on age and other health problems. For more information visit: www.alz.org

 

Parkinson’s Disease

Parkinson’s Disease is neurodegenerative brain disorder that occurs when neurons in the brain fail to produce enough dopamine, a chemical that relays messages from one part of the brain to another, to control movements of the body. A hallmark sign of this disease is the loss of smooth coordinated movement. The disease progresses slowly in most people as most live more than twenty years following diagnosis. While there is no actual cure for Parkinson’s, treatment is available to help control symptoms and improve the quality of life. For more information visit: www.parkinson.org

 

Huntington’s Disease

According to the Huntington’s Disease Society of America, Huntington’s disease is a neurodegenerative genetic disease the affects muscle coordination and leads to cognitive and behavioral symptoms. The hallmark sign of this disease is abnormal involuntary thrashing movements called chorea. It affects both men and women and symptoms using begin between 35 and 44 years of age. Early symptoms include mood and cognition changes that are followed by uncoordinated and unsteady walking. As the disease progresses slowly over twenty years full-time care is required in the later stages. While there is no cure available drugs are available to help control symptoms and improve the quality of life. For more information visit: www.hdsa.org

Visit your doctor regularly and listen to your body.

Contributor: Christopher Cali, received his BS in biology from Villanova University and is currently pursuing a PhD in Genetics from the University of Pennsylvania. To find out more about his work or donate directly to ALS research in his lab, visit: www.med.upen.edu/tnr

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune: Part 2 on “ALS UPDATE” by Christopher Cali.

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.

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

Lower back pain, one of the most costly illnesses to employers, is one example of a problem which can be prevented with a good health and safety program. It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics are essential in the prevention of LBP. At our clinic, significant time and effort is spent emphasizing the importance of these concepts to our patients and employees.

Kane Trucking is a perfect example of the merit and value of LBP safety and prevention. I have served as a rehab consultant for Kane Trucking for many years. During this time, Kane has noticed a significant reduction in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonomics.

Prevention of Lower Back Pain

• Maintain Fitness Level: As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.
• Practice Good Posture & Body Mechanics: Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
  • Chin Tuck (See Photo#1): Tuck your chin back to bring your head over shoulders.
  • Shoulder Blade Pinch (See Photo #2): Pinch your shoulder blades together.
  • Standing Extension (See Photo #3): While standing, put your hands behind back and  extend lower back 10-20 degrees. Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the surface resistance of the floor. Does it require two people to lift? Can I safely lift that high or bend that low? When bending to lift an object think about safety:
• Spread Legs Apart Shoulder Width
• Bend at the Knees and Limit Forward Bending the Spine
• Arch Lower Back Slightly
• Get and Maintain a Firm Grip
• Contract and Hold Abdominal (stomach) Muscles
• Lift With Legs (not back)
• Do Not Pivot or Rotate Spine With Load (use feet and step turn)
• Lift Slowly and Carefully (don’t hurry)
• Take Time to Perform Back Extension Stretches After the Lift
• Remember, Pushing is Better Than Pulling a Heavy Load (See Photo #4 for Proper Lifting Technique)

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.

MUSCLE CRAMPS!

PIAA fall sport teams began their first week of official practice a few weeks ago – including double sessions for high school football. While a warm August may be a wonderful time of year to swim and kayak, it may not offer the best temperature and humidity for athletes playing football or soccer. One common problem these athletes suffer from is severe muscle cramping. This year was not exception as many players limped off the practice field in pain and many concerned players, parents and grandparents repeatedly ask me about the problem. What exactly is a muscle cramp? Why does it happen? How can it be prevented?

 

What is a muscle cramp?

A muscle cramp is defined as an involuntary contraction or spasm of a muscle that will not relax. The tight muscle spasm is painful and debilitating. It can involve all or part of the muscle and groups of muscles. The most common muscles affected by muscle cramps are: gastrocnemius (back of lower leg/calf), hamstring (back of thigh), and quadriceps (front of thigh). Cramps can also occur in the abdomen, rib cage, feet, hands, and arms. They can last a few seconds or 15+ minutes. They can occur once or multiple times. It can cause a very tight spasm or small little twitches.

 

Theories behind muscle cramps?

Although the exact cause may be unknown at this time, there are several theories why muscle cramps occur. According to the American Academy of Orthopaedic Surgeons, when a muscle is flexible and conditioned, the muscle fibers are capable of changing length rapidly and repeatedly without stress on the tissue. Also, overall poor conditioning or overexertion of a specific muscle leads to poor oxygen/carbon dioxide exchange and build up of lactic acid and cause a muscle spasm. Also, this process can alter muscle spindle reflex activity and stimulate the spinal cord to send a message to the muscle to contract. If uncontrolled this leads to cramps and spasm.

Muscle cramps are more common in hot weather due to loss of body fluids, salts, minerals, potassium, magnesium and calcium. This leads to an electrolyte imbalance which can cause a muscle to spasm.

Common causes of muscle cramps

• Tight muscles
• Imbalance in strength/length between two cooperative muscles
• General Fatigue
• Overexertion in extreme heat
• Dehydration – electrolyte imbalance
• Medications/Supplements– some medications and supplements can increase risk of muscle cramps

High risk factors for muscle cramps

• Infants & young children
• 65+ years old
• Obesity
• Deconditioned Athletes in mid-40’s
• Smoking
• Medication/Supplements
• Endurance Athletes

Treat and prevent muscle cramps

First Aid

• Cramps usually do not require a physician visit
• Stop the activity
• Stretch or elongate the muscle
• Deeply massage the muscle while on stretch
• Heat the muscle if tightness continues
• Cold to muscle if sore later in day or next day

Prevention

• Exercise regularly and stay conditioned for your sport
• Reduce caffeine intake
• Hydrate regularly – especially in warm conditions .Use sports drinks, drink all day BEFORE the activity as well as during/after
• Stretch – AFTER you warm up – concentrate on the vulnerable muscles – stretch slowly, hold for 10 seconds, slowly release, and repeat
  • Hamstring – feel pull in back of thigh:
    • lying on floor in doorway, extend one knee and rest heel on wall
    • standing – lock knees and touch shins/toes
  • Calf – feel pull in back of knee and lower leg
    • stand and lean into wall with one leg back while keeping your heel down
  • Quad – feel pull in front of thigh
    • stand grab onto foot, bring heel to buttocks while extending hip
    • repeat while sitting on ground
• Consider:
  • Diet, vitamins, tonic water, sports drinks
  • Heel lifts for calf cramps when unable to adequately stretch calf
  • Compression shorts for hamstring or quad cramps
  • See you family physician if cramps persist or worsen. There are other medical reasons for persistent cramps and spasms.

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 TCMC.