Part 1 of 2

Recently, a very close friend confided in me that he was experiencing intermittent chest pain. Upon further discussion, he shared with me that has been under tremendous stress over the past few months. I urged him to see his family physician and after a series of examinations and tests it was concluded that his symptoms were stress related.  However, it reminded me of another friend who was not so lucky. He was experiencing similar symptoms, did not report them to his physician and suffered a heart attack. While he required coronary by-pass surgery, he is living a happy and healthy life today. For me, the disturbing part of these two stories is the fact that both middle-aged men live a very healthy lifestyle. They have healthy diets, get plenty of exercise, and maintain good weight control. Neither have any of the “risk factors” typically associated with heart disease: heredity, obesity, diabetes, high cholesterol, high blood pressure, and smoking. However, the one common factor that was evident for both men was “stress.” Stress is a significant risk factor. Unfortunately, some people, like my friends, do not handle stress very well, especially when coupled with the fact that they have classic “Type A” personalities. Medical researchers are not sure how stress increases the risk of heart disease but more and more evidence suggests a relationship between the two.

There are different types of stress. For example, physical stress such as exercise and other forms of physical exertion can place good demands on heart. In fact, the lack of physical stress (e.g. a sedentary lifestyle) is a major risk factor for heart disease. However, emotional stress, if severe and chronic enough, can also cause heart disease. Stress is unavoidable in a contemporary society. However, while we cannot control or avoid it, we can control how we react to it!

Emotional stress can be caused by many factors including minor daily hassles to major lifestyle changes: illness, death, screaming children, nagging boss or spouse, new job, unemployment, traffic, pregnancy, crowds, legal problems, and financial concerns. Our emotional responses to these and many other situations determine if we are experiencing good stress or bad stress. If we feel that we are in control of our lives and our destinies, we are in a better position to manage stress when faced with a difficult choice or when placed in a challenging situation. However, if we feel that the circumstance or situation controls us, our responses, we will feel out of control and experience bad stress. Also, our personality can be a factor in our perception of stress. If we have a “Type A” personality (e.g. time-sensitive, inpatient, chronic sense of urgency, tendency toward hostility, perfectionist, and competitive), we may be creating our own emotional stress! For example, a simple trip to the grocery store will be filled with episodes of bad drivers, poorly-timed traffic lights, crowded aisles, ignorant check-out clerks, and thin plastic bags that rip too easily.

Researchers are not sure if emotional stress is a direct or indirect cause of heart disease. As a direct cause, emotional stress has been shown to constrict coronary arteries, cause blood to clot more readily, increase heart rate, and raise blood pressure. Also, emotional stress can trigger an increase in cholesterol levels by causing the body to produce more energy in an attempt to adequately respond to increased stress. Increasing the body’s cholesterol, raises HDLs (good cholesterol) as well as LDLs (bad cholesterol). Furthermore, emotional stress increases the production of cortisol. Cortisol stimulates fat and carbohydrate metabolism for fast energy in addition to insulin release for maintenance of blood sugar levels. The end result of these actions is an increase in appetite.  Emotional stress that stimulates your appetite may cause weight gain. Moreover, cortisol can affect where you put on the weight. Cortisol tends to cause fat to deposit in the abdominal area rather than at the hips. This type of fat deposition has been strongly correlated with the development of heart disease.

As an indirect cause, emotional stress can cause people to participate in bad habits that are associated with heart disease. Overeating may be an attempt to fulfill a psychological need. People that overeat because of stress often binge on “comfort” foods that are high in fat, cholesterol, and sugar. These foods are associated with significant weight gain. Also, emotional stress can trigger depression. Depression can not only cause indulgence in comfort foods but also reduce motivation for physical activity and exercise. Moreover, an individual experiencing emotional stress may attempt to reduce stress by participating in dangerous activities such as smoking and alcohol abuse.

No one can escape from emotional stress because it is a normal part of everyone’s life. We must learn to manage stress effectively so that stress can be used as a motivational tool rather than as an implement of self-destruction.

Contributor: Janet Caputo, DPT, PT, OCS, is a physical therapist specializing in the management of orthopedic and sports injuries with a special interest in vestibular rehab and falls prevention at Mackarey Physical Therapy in downtown Scranton.

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

 This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.comPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.

Health and Safety Tips for Gardeners: Gardening with Disabilities

Summer is finally here and gardeners in northeast PA are anxious work in their gardens and enjoy the fruits of their labor. Last week, Health & Exercise Forum presented tips for gardeners for preventing hand and arm injuries such as carpal tunnel syndrome. This week’s column is dedicated to prevention of lower back and lower body injuries when working in the yard and for gardeners with disabilities….

A relaxing and enjoyable activity for many, gardening can turn dangerous without proper precaution as repetitive stress injuries, back pain, muscle pulls, can stem from raking, weeding, digging and pruning, can turn into serious problems if not treated appropriately. Since prevention is the best approach, the US Dept of Agriculture promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

People with various disabilities enjoy gardening at different levels. For example, those suffering from neurological diseases with muscle weakness, paralysis and poor balance as well as those with musculoskeletal problems such as neck and LBP or hip and knee arthritis can safely enjoy gardening at some level. This outdoor labor of love is very therapeutic.

Warm up and stretching is important. Don’t garden first thing in the morning before you have a chance to warm up. Get up, go for a short walk, have breakfast and maybe warm up with a hot shower before working in the garden. Some stretches include:

1. Chin Tuck – bring chin over shoulders
2. Shoulder Blade Pinch – pinch shoulder blades together
3. Standing Extension – bend backwards at the waist

Note: These exercises should never be painful when completing them. You should only feel a gentle stretch. Hold the stretch10 seconds and repeat 5 times before you garden and every 20 -30 minutes while working. Should you experience pain, please consult your family physician or physical therapist.

The following guidelines to prevent injury and foster healthy gardening for those with and without disability:

• Listen To Your Body – Aches and pains are signals from your body that you may be doing something wrong or overdoing it. Just like a baseball player in spring training, you must ease into a new activity slowly and stop before you get pain. Do not try to do it all in one day.
• Take Frequent Breaks – Perform work in short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue and pain.
• Change Positions Often – Alternate positions from standing, sitting, bending, and kneeling every 15 to 20 minutes.
• Use Large Muscles- When possible use the large muscles of the body to do the work. For example, use your legs to push a shovel blade into the ground instead of your arms. Also, lift with your legs and not your back.
• Avoid Awkward Motions – Do not squat, twist and bend at the waist for prolonged periods or with repetition.
• Use Supportive Devices and Braces – Remember to wear wrist and knee supports if you have a problem. A lower back brace or corset is also advisable when working in the garden to protect the spine and add support.
• Use Well Designed Tools. Use the right tools for the job. Padded, ergonomic handles with extensions to add reach are helpful.
• Use Sun Block and Sun Glasses – to protect your skin and eyes from the sun.
• Plan ahead. Use a container with wheels to carry supplies to the garden. When necessary it should be carried/pulled with hands, distributing the workload equally and decreasing stress in the joints of your body.
• Eat Well and Stay Hydrated – When working outdoors eat and drink properly for the climate and temperature.
• Use Adaptive Devices - Special gardening carts, wheel barrels, motorized carts, and a garden tractor with a cart can make a job easier, especially for those with disabilities.
• “Easy-Grip” tools are available for those unable to grip strongly. For example, hand shovels and weed cultivators that attach to the wrist/forearm with Velcro straps and tools with telescoping extensions are available. (www.wrightstuff.biz)
• Mobile Adjustable Stools – with arm rests and 2-3 steps that allow you to go from sitting upright to a position closer to the ground.
• Elevated and Raised Beds – allows gardening from a standing, sitting or wheelchair height for improved safety and enjoyment.
• Pipe Planter or Seeder – a PVC pipe 5-6 feet long allows planting and seeding without bending or kneeling. For example, a 6 or 8 inch pipe allows plants to slide down and be tampered into a hole and a 1-2 inch pip allows seeds to slide down to the ground for cover or planting.
• Kneeling Pads, Mats, Carts – are healthier for your knees and back.

Source: Karen Funkenbusch, MA; Willard Downs, PhD.: U. S. Department of Agriculture - Agricultural Engineering Extension

Model: Sarah Singer, PTA

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.

Health and Safety Tips for Gardeners: Prevention of Hand Injuries Associated with Gardening

Today is Memorial Day and for many it is the official first day of planting a vegetable garden in NEPA without fear of frost. While gardeners are anxious to work in their gardens and enjoy the fruits of their labor, a relaxing and enjoyable activity can turn dangerous quickly. Precautions are necessary as repetitive stress injuries such as shoulder and elbow tendonitis and carpal tunnel syndrome can stem from raking, weeding, digging and pruning. Additionally, simple scrapes, blisters, and bites can turn into serious problems if not treated appropriately. Since prevention is the best approach, the American Society of Hand Therapists (ASHT) promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

ASHT recommends following these upper extremity warm-up exercises prior to gardening:

Note: These exercises should never be painful when completing them. You should only feel a gentle stretch. Hold 10 seconds and repeat 5 times. Should you experience pain, please consult a physician or hand therapist.

1. Forward Arm Stretch: Fold your hands together and turn your palms away from your body as you extend your arms forward. You should feel a stretch all the way from your shoulders to your fingers. (See Photo 1)
2. Overhead Arm Stretch: Fold your hands together and turn your palms away from your body, but this time extend your arms overhead. You should feel the stretch in your upper torso and shoulders to hand. (See Photo 2)
3. Crossover Arm Stretch: Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder. This stretch for the upper back and shoulder and should be performed on both sides.

ASHT recommends the following guidelines to prevent injury and foster healthy gardening practices:

• Wear gloves at all times.   Bacteria and fungus live in the soil and a small irritation or cut can develop into a major hand infection. Glove choice should be specific to the specific task. Thick, leather or suede gloves may protect your hands from thorns, cuts and scrapes while pruning roses. Rubber or latex coated gloves may be appropriate to aid in grip when working in the soil.
• Keep your hands and arms covered. Be especially careful if you live in an area where you may disturb a snake, spider or rodent living in your garden. You will be better protected from poison ivy, insect bites, ticks and other common skin irritants that may inhabit a garden.
• Take a break every hour or switch to another activity. Overuse of repetitive motions, such as digging, and sustained/constant gripping can cause tendonitis of the wrist, elbow or lead to carpal tunnel syndrome. Break up large tasks into short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue.
• Use a tool when digging into unfamiliar or new areas. Buried sharp objects can cause tendon lacerations or punctures. Use the correct tool for the task at hand in order to avoid accidental injury.
• Store your tools to prevent accidents. Learn how to use and store your tools correctly to prevent accidents, and keep sharp tools out of the reach of children at all times. Also make sure to put all tools away after use to prevent future injuries.
• Regular/periodic tool maintenance. Keep garden tools in top working order to reduce the physical effort required for yard and garden work.
• Use well designed tools. Use tools with non-slip rubber or padded hands to protect the smaller joints in your hands. Make a circle with your index finger and thumb—that is how the grip of the tools should be. The shape of the handle should provide equal pressure along the palm.
• Avoid awkward motions. Using better body positioning minimizes muscle pain. Work with the wrists in a neutral position by avoiding the extremes of motion (up, down and sideways). Hold objects with a light grasps or pinch. To avoid a tight sustained grip. Use both hands for heavy activities like lifting a bag of potting soil and alternate hands on more repetitive tasks like scooping dirt out of the bag into a pot.
• Plan ahead. Use a basket or large handled container to carry supplies to the garden. The basket should be carried with both hands, distributing the workload equally and decreasing stress in the joints of your upper body.

Professional Contributor: Nancy Naughton, OTD, CHT, is an occupational therapist and certified hand therapist practicing in NEPA at Professional Orthopedics.

Model: Vanessa Borgia

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

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

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

Guest Columnist: Kevin Perry, 3^rd Year Medical Student The Commonwealth Medical College

“Should I use heat or ice?” While working as a third year medical student at TCMC, I was surprised to find that this is one of the most common questions asked by patients with musculoskeletal complaints. Trying to decide whether to use ice or heat to make an injury feel better and heal faster may not be so easy. Unfortunately, there is confusion, even among medical professionals, about the appropriate times to use of heat or cold. However, if we review the basic science on this subject, there are some valuable guidelines to consider.

The Science

When an injury is sustained, such as a sprained ankle, chemical signals are released in the area of the injury, which increases blood supply to the damaged tissues to allow appropriate cells to repair the damage. This response is evident by the principle signs and symptoms of inflammation including warm, redness, swelling, pain, and loss of function. This reaction makes sense because anytime tissues are injured; the body is responsible to protect the site until repair can occur. To protect the injured site, the body causes swelling and pain to prevent excessive movement or overuse which will lead to further injury. With the site of injury protected, the appropriate cells are able to lay down new tissue to repair the damage. As tissues heal, a web of connective tissue pulls the damaged tissues back together and holds them in place while new tissue is formed. Once the tissue is completely repaired, the blood flow returns to normal and fluid drains from the site of injury allowing restoration of motion and function. However, the new tissue is fragile and unorganized and often sticks together leaving tightness and weakness. After repeated use, the new tissue adapts to the stress placed upon it and becomes functional.

The Application

When grounded in science, the use of heat or cold can be used to expedite the healing process. While inflammation is crucial to the repair of injured tissue, the response can be exaggerated and last longer than necessary. Therefore, ice and heat can be used to modify the bodies’ inflammatory response and help us return to activity sooner.

How Cold Works

Ice causes blood vessels to narrow and nerves to slow down. When ice is applied to tissue, the body responds by decreasing blood flow to the area to preserve the core body temperature. Also, as nerves cool down, the signals they send slow down and become less frequent, therefore the pain signals they send to your brain become less intense. Thus, we can use ice to decrease blood flow to inflamed tissue which will reduce swelling and decrease pain. Ice is ideally used immediately following most injuries to control pain and swelling.

How Heat Works

Heat causes your blood vessels to open and increase blood flow to tissues. When heat is applied, blood flow and tissue temperature are increased and tight tissues relax and are better able to glide across one another. However, when applied too early in the healing process, heat, by increasing blood flow, can increase swelling and pain. Heat is ideally used after an injury has healed and there is residual tightness or protective muscle spasms.

Intervention

Now that we know how ice and heat work in conjunction with the inflammatory process we can easily understand when to use each one. Ice is best used following an acute injury. Anytime the principle signs and symptoms of inflammation are present, ice is the appropriate treatment of choice. For example, immediately after spraining your ankle, if it is swollen and painful to walk, ice is the preferred treatment. Regardless of when the injury occurred, if there is swelling and pain, ice is the appropriate treatment.  Heat should be used when there is tightness and stiffness and no signs of acute inflammation. For example, week two or three following an ankle sprain, if stiffness persists and swelling is controlled then heat would be beneficial.

How To…

Apply ice using a bag of ice and water, ice pack, or bag of frozen vegetables wrapped in a wet towel. Cover the injured and swollen area and if possible elevate the iced area above the level of your heart. You should apply ice for a maximum of 20 minutes and rest at least one hour between icing sessions so as not to cause harm. Never apply ice directly to skin and never fall asleep while icing.

Apply heat with a heating pad covered in a few towels or a bag of rice heated in a microwave. Cover in a towel and place the heat on the affected area for a maximum of 20 minutes and rest at least one hour between heating sessions. Never apply heat over skin that you cannot feel (numbness or loss of sensation) or on open wounds in the skin. Also, do not lie directly on the heating source and don’t fall asleep while using heat to avoid burns.

Hopefully this information is helpful in dispelling some of the confusion regarding when to use ice or heat. As you can see there is no “golden rule” or “72-hour rule” for advising when to use ice or heat. But if you stick to the principles discussed in this article, you should be treating your aches and pains appropriately. This has been a simplified explanation of a complex topic and if you have any further questions, please ask a medical professional.

Top Reasons for use of Ice (Cryotherapy):

• Acute Injuries (Example: Sprained ankle)
• Tendonitis (Example: “Tennis Elbow”)
• Osteoarthritis with swelling (Example: Any swollen arthritic joint)
• Following exercise to prevent swelling (Example: Rehabilitation)
• Muscle Spasms (Example: Overuse)

Top Reasons for use of Heat (Thermotherapy):

• Chronic Stable Low Back Pain  (Example: Healed Lumbar Strain)
• Postural Neck Pain (Example: Trigger Points)
• Prior to exercise/activity (Example: Rehabilitation)
• Osteoarthritis with stiffness (Example: Morning stiffness)
• Muscle Spasms (Example: Overuse)

Guest Columnist: Kevin Perry is a third-year medical student at TCMC. Dr. Perry grew up in Wyckoff, New Jersey before attending Loyola University Maryland as a Biology major and Mathematics minor while competing as a soccer player. He continued his education at the University of Scranton where he earned a Doctorate in Physical Therapy, graduated with academic honors, and published research about the diagnosis of meniscal tears. After medical school, he aspires to complete an orthopedic surgery residency.

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 and is an associate professor of clinical medicine at The Commonwealth Medical College

Part 2 of 2

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

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

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

Read “Health & Exercise Forum” – Every Monday 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.

Part 1 of 2

Despite the lingering winter temps, spring and summer will return to NEPA. So, get ready to enjoy the great outdoors because research shows that it is good for your health!

Daphne Miller, MD, is a physician, author, hiker and associate clinical professor at The University of California, San Francisco. She is an advocate of the National Park Service’s “Healthy Parks, Healthy People” program. She was featured in the 2014 Spring Edition of NationalParks Magazine for prescribing outdoor activities for the health and well-being her patients.

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

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

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

Drug: Exercise in Glen Canyon Park

Dose: 45 Minutes of Hiking, Walking, or Running

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

Refill: Unlimited

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

Favorite National Park?

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

Plenty of Green Space in NEPA!

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

Read “Health & Exercise Forum” – Every Monday 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.

With the increased popularity of local races such as the Steamtown Marathon and Scranton 1/2 Marathon, local interest in running is exploding. On many levels, including the improvement of the health and wellness of the residents of NEPA, this is a tremendous trend. However, as a health care provider, I am seeing a significant number of first time runners visit my office with a wide variety of injuries that are very preventable with a modicum of good judgment.

Runners are addicted to running for good reason. There is nothing like it! No exercise offers so much in such little time. Caloric expenditure is higher than in most other exercises, including biking. Running also allows for fresh air, beautiful scenery, minimal investment in clothing or equipment, little skill and time to learn. Moreover, the benefits are many; runners suffer from less depression, colds and flu symptoms, and experience less pain due to an endorphin release (a natural chemical in the brain associated with euphoria and pain control.)

This column will be dedicated to those who are interested in beginning a running program for all the reasons mentioned above and more. The program is designed to promote a safe and gradual introduction or return to running as form of exercise. The initial goal is to help you attain 30 minutes (approximately 2 miles) of running at a slow, relaxed and safe pace. This 30 minute goal is the standard used in most research that shows improvement in weight control, cholesterol, heart disease, blood pressure and adult onset diabetes. The 8 week program is a simple and safe program that begins with more walking than running and gradually reverses the proportion. The first two miles are the hardest and once mastered; one can begin to build on mileage and intensity if desired. For those interested in advancing to a half or full marathon, I recommend the book “The Marathon” by Jeff Galloway who advocates a run/walk program as you increase distances. Visit his website at: www.jeffgalloway.com.

Before You Begin Running:

•  Consult your physician: This is important if you have health issues, have not engaged in exercise for some time or you are 15-20 pounds overweight and over 40 years of age.

• Plan a schedule: Get committed. Use a computer, calendar, or fitness Apps such as Endomondo Sports Tracker or Argus.

• Get mentally prepared: You will have good and bad days. You have to do it, even on the bad days. Once you get to a certain level of fitness, it gets easier and more fun.

• Buy the proper shoes for you: Just because the sneaker fits does not mean you have to wear it! Manufacturers entice prospective buyers with a multitude of colors, fabrics, styles and designs. Instead of focusing on aesthetics, focus on function!
  • Note: New Balance, Brooks, Asics, Mizuno & Saucony all make quality running shoes to accommodate a supinated, pronated or normal foot.
  • The appearance of an arch in a weight bearing position does not automatically exclude the individual from excessive supination or pronation. Consult a podiatrist or an orthopedic physical therapist to determine the propensity toward supination, pronation or neutrality of the foot and ankle.
  • Other equipment: DryTech is great fabric for running which wicks the sweat away from the skin and prevents chaffing. It can be found in shorts, pants, shirts and socks Also, weather and temperature options are important, such as compression shorts in cooler temperatures to prevent muscle pulls.

Beginning to Run

• Week 1:
  • Monday, Wednesday, Friday, Saturday: Run 1 minute, walk 2 minutes. Repeat 10 times.
  • Tuesday, Thursday: Walk 30 minutes.
  • Sunday: Rest
• Week 2:
  • Monday, Wednesday: Run 2 minutes, walk 1 minute. Repeat 10 times.
  • Friday, Saturday: Run 3-4 minutes, walk 1 minute. Repeat 6-7 times.
  • Tuesday, Thursday: Walk 30 minutes.
  • Sunday: Rest
• Week 3:
  • Monday, Wednesday: Run 5 minutes, walk 1 minute. Repeat 5 times.
  • Friday, Saturday: Run 6 minutes, walk 1 minute. Repeat 4 times.
  • Tuesday, Thursday: Walk 30 minutes.
  • Sunday: Rest.
• Week 4:
  • Monday, Wednesday: Run 8 minutes, walk 1 minute. Repeat 3 times, then run 3 minutes.
  • Friday, Saturday: Run 10 minutes, walk 1 minute. Repeat twice, then run 8 minutes.
  • Tuesday, Thursday: Walk 30 minutes.
  • Sunday: Rest.
• Week 5:
  •  Monday, Wednesday: Run 12-13 minutes, walk 1 minute. Repeat twice, then run 2-4 minutes.
  • Friday, Saturday: Run 14-15 minutes, walk 1 minute, repeat twice, then run 2 minutes.
  • Tuesday, Thursday: Walk 30 minutes.
  • Sunday: Rest.
• Week 6:
  • Monday, Wednesday: Run 16-17 minutes, walk 1 minute, then run 12-13 minutes.
  • Friday, Saturday: Run 18-19 minutes, walk 1 minute, then run 10-11 minutes.
  • Tuesday, Thursday: Walk 30 minutes.
  • Sunday: Rest
• Week 7:
  • Monday, Tuesday, Wednesday: Run 20-22 minutes, walk 1 minute, then run 7-9 minutes.
  • Friday, Saturday: Run 24-26 minutes, walk 1 minute, then run 3-5 minutes.
  • Thursday: Walk 30 minutes.
  • Sunday: Rest.
• Week 8:
  • Monday, Tuesday, Wednesday: Run 27-28 minutes, walk 1 minute, then 1-2 minutes.
  • Friday, Saturday: Run 29-30 minutes, walk 1 minute, then run 0-1 minute.
  • Thursday: Walk 30 minutes.
  • Sunday: Rest.

Training Tips

• Fuel Up: drink water, eat a piece of fruit or a granola bar 45-60 minutes before

• Warm-up/Cool-down: 3-5 minutes before and after

• Stretch: after the exercise

• Use good form: elbows bent at 90 degrees, swing with momentum forwards, not sideways, limit trunk rotation

• Dress properly: layer to adjust to the temperature, wear a hat and use sunscreen

• Cross-Train: low impact exercise on walking days or one running day to protect your joints and prevent injury and burn-out (elliptical)

• Change shoes: every 250 to 300 miles

• Heat/Cold: use heat before and ice after exercise if you have sore muscles or joints when you first begin.

• Build on foundation: once you have a 30 minute base you can increase the duration and intensity on occasion.

SOURCE:  Runner's World

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.comPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.

Anjani Amladi

“Shatter the Silence. Stop the Violence.”

Guest Columnist: Anjani Amladi

3^rd Year Medical Student The Commonwealth Medical College

 Last Spring, while walking down Monroe Avenue in Scranton surrounded by women, men, and children in a sea of royal purple, I had an experience I never had before. I was invited to an event called “Take Back the Night,” hosted by the Take Back the Night Foundation, and at the time had no real grasp on what the night had in store for me. Based on my friend’s description of the event, I anticipated a small get together promoting sexual assault and domestic violence awareness. But I was surprised to be involved in an amped up rally, an inspirational program, and a new outlook on life. As a result, I plan to be an active participant for the “Take Back the Night 2014” on April 24.

At the beginning of the march, I trailed at the tail end of the line observing what was happening around me. With our sheer numbers we managed to stop traffic, draw incredible amounts of attention to ourselves, and dared to hold up signs that brought awareness to a topic that most people try to forget exists. As we walked, I noticed children halting their games and staring, parents coming out of their homes to figure out what the fuss was about, and a group of college guys ceasing their drinking activities to watch the participants. At that moment in time, a number of thoughts were percolating in my mind. I was proud to be a part of this group who so ardently advocates for all people, not just women… but I’m ashamed to say that along with pride I was also a little embarrassed. What are people thinking about us? What will they say? How are we being viewed? Are they upset at the disturbance? When I walked past a house with six men sitting on the porch drinking beers, I immediately looked at my shoes hoping they wouldn’t notice me. After addressing the discomfort I was experiencing, I pondered the possibilities as to why I was so uneasy, and after conducting research for this article I began to understand why others might be too.

The Numbers are Staggering

According to the Rape Abuse Incest National Network (RAINN), one of the largest anti-sexual violence organizations in the nation, one in six women in the United States has been a victim of an attempted or completed rape. This translates into 17.7 million American women who are survivors of such a tragedy. While women make up a disproportionate number of survivors, approximately one in thirty-three men have experienced an attempted or completed rape in their lifetime which translates into approximately 2.78 million men in the United States. 15% of sexual assault and rape survivors are children under twelve years of age and 90% of them know their attacker. Even more staggering are the small number of rapes that are actually reported, and the proportion of perpetrators that serve time in jail for their crimes. According to the National Crime Victimization Survey conducted by the United States Justice Department from 2006 to 2010, approximately 46 out of 100 sexual assaults were reported to the authorities (this means that the perpetrators who committed the other 54 acts will not spend a single day in jail.) Furthermore of the 46 that are reported, 12 arrests are made, 9 will subsequently be prosecuted, and only 5 will receive a felony conviction. To be put candidly, if 100 rapes took place only 3 of those perpetrators would spend time behind bars.

Why do the Statistics Matter?

The World Health Organization states that there are significant adverse health effects, both short and long term in survivors of intimate partner and sexual violence. These include back pain, abdominal pain, fibromyalgia, gynecological problems, sexually transmitted infections, depression, post-traumatic stress disorder, eating disorders, drug and alcohol misuse, and suicide attempts. By raising awareness, and creating an environment where the reporting of crimes, and prosecution offenders becomes the social norm, we can play an important role in decreasing the number of these life altering crimes.

What is the “Take Back the Night Foundation?”

An organization that “seeks to end sexual assault, domestic violence, dating violence, sexual abuse and all other forms of sexual violence,” with an emphasis on creating “safe communities and respectful relationships through awareness events and initiatives.” The first documented “Take Back the Night” event in the United States took place in Philadelphia, Pennsylvania in 1975 after the brutal murder of Susan Alexander Speeth, a microbiologist who was stabbed to death by a stranger near her home while walking the streets alone. The first “International Take Back the Night” event took place at The International Tribunal on Crimes against Women in Brussels, Belgium in 1976. The turnout was incredible and more than 2,000 women, representing 40 countries, were in attendance.

The inspirational program of “Take Back the Night” gave me hope despite the sharing of numerous tragic and painful stories. The camaraderie, sensitivity and receptiveness of all the participants left me with overwhelming feelings of strength and perseverance. The women and men who shared their stories were the most courageous people I have ever met, and I can only imagine how much gumption and strength it took to tell their stories to complete strangers. As we lit candles in honor of all individuals who have experienced unspeakable tragedies, the people in the crowd who started off strangers to me, now felt like friends.

After writing this article I now understand why as a society, we don’t like to think about these events due to the heaviness of the subject matter. But the lesson to be learned is that by ignoring the existence of these issues, we become part of the problem, when we should be part of the solution. As much as we would like to deny that rape, assault, abuse and neglect happen in our own back yard, sticking our heads in the sand is not the answer. When someone works up the courage to share their story, and our response as an audience is discomfort, that feeling is something to acknowledge, not ignore. Discomfort means we are not indifferent and we recognize that a wrong was committed. And as such, we bring it into our conscious mind where we can enact change. It is time to bring awareness to a topic that lives in the shadows, shine a light on it, and shatter the silence once and for all!

IF YOU WOULD LIKE TO PARTICIPATE OR WANT MORE INFORMATON REGARDING NEPA “TAKE BACK THE NIGHT” ON THURSDAY APRIL 24^th VISIT:

http:/www.scranton.edu/studentlife/studentaffairs/center/TBTN.shtml

Resources

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

National Domestic Violence Hotline http://www.thehotline.org/ 1-800-799-SAFE

National Sexual Assault Hotline http://www.rainn.org/get-help/national-sexual-assault-hotline/ 1-800-656-HOPE National Sexual Violence Resource Center http://www.nsvrc.org/ 1-877-739-3895

See Sally Kick Ass: A Woman’s Guide to Personal Safety Vogt, Fred Outskirts Press, 2006 ISBN-10: 159800820X ISBN-13: 978-1598008203

Guest Columnist: Anjani Amladi is a 3rd year medical student at The Commonwealth Medical College (TCMC). She was raised in San Ramon, CA and earned a B.S. in Biological Sciences at The University of California at Davis. She has a special interest in alternative medicine, wellness and preventive care. Her goal is to secure a Psychiatry residency with the hope of researching alternative therapies for psychiatric disorders. 

Anjani has a passion for people, and was so inspired by her experience with Take Back the Night that she decided to write this article in honor of all those who have been affected by violence and sexual assault. It is her hope to support those who have had the courage to share their stories and give a voice to those who have not.

Read “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 of 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.

Every day someone comes to our office with lower back pain (LBP). Often, the person’s primary complaint is that they cannot perform an important daily activity (work, clean, cook, run) because of back pain. However, no group of patients with lower back pain is more eager to recover and return to unrestricted activity than golfers.

LBP is the most common physical problem for golfers, especially males. The causes of LBP in golfers, especially in the amateur, are many: poor golf swing mechanics, excessive practice, inadequate warm-up and poor flexibility and conditioning. However, the very nature of the golf swing can create great stress on the structures of the lower back. Forward bending while twisting creates excessive torque on the discs, joints, muscles and ligaments of the lower back.

TIPS FOR GOLFING WITH LOWER BACK PAIN

Walk/Ride –

• Walking – walking an 18 hole golf course is the equivalent of a 5-7 mile walk. It keeps you fit, flexible and avoids the jarring of the bumpy cart. Taking a caddie is optimal. However, carrying your bag requires careful planning. Use a “Sunday bag: or ultra-light bag with a stand and double straps; remove extra balls, unused clubs and umbrellas to lighten the load. Arch your back and extend backwards with the club after every shot. If using a pull cart, push rather than pull, when not walking downhill.
• Ping Ultra-Light “Sunday” Bag (See Photo 1)
• Standard Light Bag with stand and double straps (See Photo 2)
• Cart Riding – sitting is the worst position for the discs in the lower back. Driving the cart and use the steering wheel to support your back can be helpful. Avoid big bumps. Sit with an arch in your lower back and stretch backwards when out of the cart.

Other Tips-

• Keep Fit and Trim - year round with light to moderate weight training, aerobic exercise, stabilization and flexibility exercises and good nutrition.
• Core Stabilization Exercises – Abdominal/Core Strengthening can be performed sitting on balance ball or standing on discs while doing biceps curls, shrugs, rows, lats, and leg extension. Contract abdominal muscles and keep balance with using arms and legs.
  • Core Exercises on Ball – Biceps Curls (See Photo 3)
  • Core Exercises on Discs – Biceps Curls (See Photo 4)
  • Core can also be incorporated by using a light resistance band while swing training on level or uneven surfaces.
  • Backswing. Tie a light resistance band (yellow) to a golf club at the top of the grip. slowly release to starting position. Repeat 5 to 10 times.
  • Golf Swing on Discs – Follow-Through same as above for backswing but perform in follow-through motion.
    • Core Exercises – Golf Swing on Discs – Backswing (See Photo 5)

Keep Good Posture – at home, work, and when playing golf keep your shoulders back, low back arched when sitting or standing. Use a towel roll in the small of your lower back when sitting. Extend your spine into throughout the day.

Bend Forward Carefully – bend at hips and knees with one leg ahead of the other when bending to get your ball out of the cup. Let the back leg lift up off the ground as you bend. Suction cups for the end of your putter are available to retrieve your ball from the cup.

Take a Lesson – learn the mechanics of a proper swing for less stress on your lower back from a PGA golf professional. It can make the difference!

Be Smart – Listen to Your Body- If the lower back pain is severe, long lasting or causes radiating pain, tingling or numbness into your legs, consult your family physician to determine the best course of action before you continue playing golf.

MODEL: John Mackarey, Temple University Doctor of Physical Therapy Student

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.

Every day someone comes to our office with lower back pain (LBP). Often, the person’s primary complaint is that they cannot perform an important daily activity (work, clean, cook, run) because of back pain. However, no group of patients with lower back pain is more eager to recover and return to unrestricted activity than golfers. Dr. Joe Cimochowski and Dr. Dan Sullivan are two good examples of successful return to the sport after spine surgery. I hope this column does not jinx them!

LBP is the most common physical problem for amateur golfers. However, professional golfers also are plagued with this problem. For example, recently, Phil Mickelson had to withdraw from Farmers Insurance Open Tournament and Tiger Woods backed out of the Arnold Palmer Invitational at Bay Hill due to lower back pain. Fortunately, PGA professionals benefit tremendously from sport science, physical therapy and fitness programs on tour.

The causes of LBP in golfers, especially in the amateur, are many: poor golf swing mechanics, excessive practice, inadequate warm-up and poor flexibility and conditioning. However, the very nature of the golf swing can create great stress on the structures of the lower back. Forward bending while twisting creates excessive torque on the discs, joints, muscles and ligaments of the lower back.

Tips For Golfing With Lower Back Pain

• Warm Up – Get to the course early enough to make time to stretch before you play and hit a few balls at the range. Always start with low irons and work up to driver. Take a hot shower before an early morning round and use compression shorts and shirts on cool days. Do Not Bounce or Overstretch! Stretch slowly, holding for 10-20 seconds:
  • Shoulder Overhead Stretch – slide hand up door jam while walking toward wall and raise arm until completely overhead. (See Photo 1)
  • Shoulder Chest Cross Stretch- bring one arm across chest using other arm to pull behind elbow. (See Photo 2)
  • Extend Middle and Lower Back Stretch – place club behind small of back and pinch shoulder blades together. Also, extend lower back against club. (See Photo 3)
  • Rotate Trunk Standing -while standing with an arched lower back and using club behind your back slowly rotate to right, then left. (See Photo 4)
  • Rotate Trunk Lying– lying on back and rotate upper trunk to right and then to left. Repeat rotating lower body right and left with knees bent. (See Photo 5)
  • Lower Back Flexion Stretch –lying on back and bring both knees toward chest. Hold with clasped hands and gently stretch. (See Photo 6)
• Set Up –    
  • Stance - Use stance for balance and power to protect your back. and allow your hips to rotate for less stress on the spine: stand with feet slightly wider than shoulder width, feet turned out 30 degrees, knees bent 10-15 degrees, lower back arched back with buttocks sticking out, head neutral. (See Photo 7)
  • Swing Change – Make swing more compact, flatten swing plane and minimize hip slide, lift left heel up on backswing and right heel on follow-through to protect lower back (for right handed golfer).
  • Stabilize Spine – Perform an isometric contraction of the abdominal and lower back muscles immediately before the backswing begins to protect you lower back. A lower back corset can be used in extreme cases or as a last resort.

MODELS: John Mackarey, Temple University Doctor of Physical Therapy Student; Frank Cestone, Scranton Prep Golf Team

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum" in the Scranton Times-Tribune. Next Week: Back Pain Prevention for Golfers - Part 2 of 3

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

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