Guest Columnist: Janet M. Caputo, PT, DPT, OCS
1st of 3 Columns on Balance Disorders and Falls Prevention
Northeastern Pennsylvania is home to a large elderly population and many of the medical problems we expect to see are age related. Dedicated medical practitioners are in constant search for new knowledge and information to prevent or delay many age related problems. One of the most devastating problems associated with aging is falling. My associate Janet Caputo and I have been involved in case presentations with Dr. Louis DeGennaro and Dr. Mark Frattali, two local ENT physicians and Dr. Seth Jones, a local neurologist, who treat patients with balance disorders on a regular basis. It will be the purpose of this series of three columns to educated local residents about the risks and causes of falling and the prevention and treatment of balance disorders.
Loss of balance causes falls. Falls are a leading cause of injury and death. Thirty percent of women and thirteen percent of men over the age of sixty-five will fall. Twenty to thirty percent of these individuals suffer moderate to severe injuries. Preventing falls is not an easy task. A good understanding of the causes of loss of balance and knowledge of a few fall prevention suggestions can enhance your balance and reduce your risk of a fall.
The causes of loss of balance which may lead to a fall are divided into three categories: age related changes, medical conditions and medications.
Age Related Changes affecting the sensory system, the musculoskeletal system as well as psychological behavior can negatively impact balance causing a fall:
Medical Conditions can also cause loss of balance increasing the risk of a fall:
Medications can also negatively effect balance and increase the risk of falls. Interactions between medications as well as the side effects of certain medications can cause dizziness or drowsiness resulting in loss of balance. Theses medications include: tranquilizers, sedatives, anti-depressants, alcohol, diuretics, blood pressure medications, cardiac medications, laxatives and pain killers.
In conclusion, determining who is at risk for a fall is a complex task since many factors including age, disease and medication can affect the outcome. Early intervention to prevent a fall can avoid many costly consequences.
Guest Columnist: Janet M. Caputo, PT, DPT, OCS is clinic director at Mackarey & Mackarey Physical Therapy in Scranton, PA and specializes in the treatment of balance and vestibular disorders.
Medical Reviewers: Dr. Louis DeGennaro, Dr. Mark Frattali & Dr. Seth Jones
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next Monday Part II on Balance Disorders and Falls 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 clinical professor of medicine at The Commonwealth Medical College.
Recently, a patient, Pat McKenna, editor of The Times-Tribune, came to my office with a partial tear and strain to one of his hamstring muscles. He stated that he has always had hamstring tightness and has walked backward as a warm-up exercise to prevent injury. I found the concept of backward walking, (also called retrowalking) interesting and decided to research the topic for more information and validation. As it turns out, not only does Pat know about editing a newspaper, he knows a thing or two about the body and exercise. Walking backward does have many therapeutic benefits, however, before you attempt this activity on a treadmill or elliptical, please consult your physician and physical therapist and have a spotter nearby.
At the 2011 annual meeting of The American College of Sports Medicine, several studies were presented on the topic of backward waking. Most of the research was conducted while moving backward on a treadmill and an elliptical machine. When comparing two groups recovering from knee injuries, the backward motion group showed significant improvement in strength in the quadriceps (front thigh) and hamstring (back thigh) muscles when compared to the traditional forward walking group. Furthermore, the muscles of the front (tibialis anterior) and back (gastro/achilles) of the shin/ankle also demonstrated an increase in strength and endurance with backward walking. One explanation is that forward motion is routine in daily living that it has become very efficient and does not tax or stress the muscles the body. While this efficiency prevents fatigue in daily activities, it may not stress the muscles enough to gain strength as quickly as an unfamiliar exercise.
Due in great part to the increased strain of performing an unfamiliar exercise, backward walking on a treadmill or backward pedaling on an elliptical, offered a greater cardiovascular benefit and caloric expenditure than forward motion at all levels. Specifically, walking backward on a treadmill at 2.5 mph at grades of 5% - 10% has been found to significantly increase cardiovascular endurance than walking forward under the same conditions. This knowledge is useful for healthy individuals in need of greater cardio exercise. However, it may also serve as a precaution for those with cardio problems and should consult their physician prior to engaging in this activity.
A recent study in the International Journal of Obesity, found that those who performed new activities or increased the intensity of an activity, even if for a short duration (interval training) expended more energy and burned more calories than those who worked out at the same pace consistently for a longer duration. Moreover, when engaging in a new activity such as backward walking, even more calories were burned. This phenomenon may be due to the fact that routine activities such as forward walking are performed more efficiently and easily. We challenge our body when we inefficiently perform a new motor skill such as backward walking and burn more calories. In other words, if you want to burn more calories without exercising for longer periods of time, than try a new activity and engage in higher intensity, intermittently, for part of the time. For example, walk backward on the treadmill for 30 minutes at 2.5 mph, but do so at a 5 – 10% incline for 1-2 minutes every 5 minutes.
Some studies show that using other muscle groups by performing different exercises not only prevents boredom, but also protects your muscles and tendons from overuse and joints from wear and tear. Specifically, the knee joint and the patella joint (the joint where the knee cap glides on the knee), benefits from backward walking due to less stress and compression forces on the joint. The thigh and ankle/foot muscles benefit from using a different form of contraction while lengthening the muscle. Some authors propose that this may also prevent strains and pulls and may be valuable to strengthen those with a history of shin splints and flat feet (pronation).
Mixing up your program prevents boredom. As a rule, those willing to change their exercise routine are more compliant and continue to exercise longer than those stuck in the same routine. A new challenge to improve distance, speed, and resistance while exercising in a different direction will be refreshing to your program.
Prevention of falls by improvement in balance and coordination has received a great deal of attention in the past few years. This is not only valuable to the athlete but may be even more important to those over 50. With age, balance centers are slow to react to changes in inclination, elevation, rotation and lateral movements. This slow reaction time leads to falls that may cause fractures, head injuries and more. Working on this problem by challenging the vestibular and balance centers before it is seriously compromised is important and backward walking is one way for this to be effectively accomplished.
NOTE: When walking backward, hold on to the grab bars on the treadmill and make sure to have a spotter to supervise the new activity until you become accomplished.
NOTE: Reduce the treadmill speed and elliptical resistance until you become more familiar with this new technique.
Visit your doctor regularly and listen to your body.
Photos: Jennifer Hnatko, Model: Amanda Brown, PTA, ATC
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.
Guest Columnist: Janet Caputo, PT, DPT, OCS
The sport of fast-pitch softball has become one of the most popular sports for female athletes in the United States. Female pitchers might not use a hard ball, but their injuries are just as significant as their male counterparts. Their shoulders endure the same torture and torment of training and performance, but research remains limited on prevention of shoulder injuries. Because the majority of pitching injuries occur at the shoulder, conditioning programs typically focus on the shoulder girdle muscles. However, current wisdom from the USA Softball National Team suggests shifting the training emphasis to the lower body. If the pitcher’s lower body cannot support the dynamic movements of her upper body, the weakest link, the shoulder, will be sacrificed.
At the collegiate level, fast pitch softball speeds can reach up to 72 mph. Where does all this power come from? The power behind the windmill softball pitch (WSP) is the lower body. Actually, the glutei muscles (i.e. the buttocks) have been found to have the highest level of activity during the entire sequence of the WSP.
According to Stacey Nelson, pitcher on the USA Softball National Team, the stride position is the power position. For right-handed pitchers, the stride position occurs when the pitcher steps out with her left foot. During the stride position, her right arm is in full elevation, which requires scapular (shoulder blade) stability. However, for a stable and efficient scapula, a pitcher requires proper trunk positioning (i.e. core stability), and trunk position depends on pelvic position. The pelvis forms the stable foundation that a pitcher requires to prevent rotator cuff injuries. So what stabilizes the pelvis...the glutei or butt muscles!
A pitcher’s glutei muscles stabilize her pelvis not only for scapular stability, but also to promote energy transfer from her lower body to her arm. The energy transfer chain requires proper muscular sequencing for a pitcher to deliver the ultimate WSP: hip → pelvis → trunk → scapula. Because a pitcher’s lower body supplies more than 50% of her upper extremity energy, improving gluteal muscle strength will also increase ball velocity by increasing stride length.
Even though the glutei produce the driving force for the hip, dynamic strengthening demands a stable core! Core stability exercises are initiated with isometric plank exercises:
Once isometric core stability exercises are mastered, you may begin gluteal strengthening
Sources: International Journal of Athletic Therapy and Training and Lower Extremity Review
Visit your doctor regularly and listen to your body.
CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.
Photos: Jennifer Hnatko
Photo Model: Stephanie Puckett, Keystone College Women’s Softball Team
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 in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.
Allergies affect 30 % of adults and 40% of children in the United States. Last week we discussed the definition, incidence, causes and treatment for allergy sufferers. However, many of those who suffer from allergies are those engaging in athletics. Avoiding the outdoors is often not an option. Not long ago, it was unthinkable that an athlete with serious allergies could compete at a high level, such as the Olympics. Now, in great part due to advanced research, medications and proper management, an Olympic gold medal for those suffering from allergies is a reality. Recently, the National Institute of Allergy and Infectious Disease at the National Institutes of Health have published research on this topic to provide a better understanding and make recommendations.
The most common allergic reactions which athletes suffer from are sneezing, itchy and watery eyes, runny nose and coughing. Moreover, 67% of those with these symptoms also suffer from asthma. The athlete in NEPA is particularly vulnerable when the pollen count is high during spring and fall for several reasons. One, after being indoors all winter, one might develop a heightened sensitivity to allergens. Also, increased rapid and deep breathing during exercise makes athletes more susceptible to significant symptoms when exposed to allergens such as tree, grass and weed pollens.
As mentioned last week, allergy skin testing can be performed to determine the allergens to which you are susceptible. Once determined, allergy shots are effective in building up tolerance to these allergens. If appropriate, you may be able to use allergy drops, administered under the tongue and conveniently used at home.
Asthma suffers should use their inhaler BEFORE symptoms occur. A recent study found that pretreatment using a short-acting bronchodilator inhaler within 15 minutes before exercise is very effective in preventing asthma symptoms for more than four hours. It is important to keep a bronchodilator available. If you fail to benefit from this, see your physician for other methods to control your exercise-induced symptoms.
Whether you have allergic respiratory problems from rhinitis or asthma, you many benefit from conditioning your airways with a 10 to 15 minute warm-up before and cool-down after the activity. This may serve to gradually prepare your lungs for an increased demand.
In addition to preventing dehydration on hot and humid days, constant hydration is very important for the athlete with allergies to prevent dry airways in athletes.
from the National Athletic Trainers Association:
Know the signs and symptoms of asthma (coughing, wheezing, tightness in chest, shortness of breath).
Some schools have a file on each student athlete with a allergic or asthmatic problem which requires medication. The file includes information such as medical doctor release and instruction, emergency contacts and medications. Students must have their medications on hand before they can enter the field. The National Athletic Trainers Association recommends using a peak flow meter to monitor at risk players and can determine when a player can return to the field.
If possible, find an alternate practice facility with climate control for athletes at risk. Plan practices for these athletes when the pollen count is low. Check the newspaper or internet for pollen counts in your area. Training by the water, (ocean) where there is a breeze and less pollen is helpful.
Shower and change clothing immediately after being outdoors
During a flare up, do less aerobic exercise to limit stress on respiratory system. Try strength training indoors instead.
When pollen count is high, keep windows shut at home and in your car….use air-conditioning.
Keep pets out of your bedroom…especially when sleeping
Dry clothing in dryer…do not hang on clothesline outdoors
Medical Contributor: Michael Freiman, MD, The Northeast Ear, Nose, and Throat Allergy Center located at 503 Sunset Drive in Dickson City, PA.
Sources: American College of Allergy, Asthma, and Immunology. National Athletic Trainers Association.
This spring and summer, make time to enjoy the beautiful outdoors in Northeast PA. But, for many, there is a price to pay for such pleasure…allergies! People often wonder whether or not the symptoms of sneezing, runny nose, and cough are due to illnesses such a cold, flu, sinus infection or allergies. The main distinguishing feature is that people feel very sick with illnesses, whereas often they do not feel ill with allergies despite the fact that they suffer from many of the same symptoms. In some patients, they may have both an illness and allergies, and sometimes their allergies predispose them to these illnesses.
An allergy is a response by the body, to a substance which is otherwise not necessarily harmful, but causes the body’s immune system to overreact and produce symptoms. These substances are known as “allergens” and trigger a wide variety of responses such as a runny nose, itchy eyes and palate and skin rash. Many senses can be affected by allergens such as smell, sight, taste, and touch and ranges from a mild irritation and inconvenience to extremely disabling and fatal.
Some sources estimate that 40 to 50 million people in the United States suffer from allergies. Moreover, experts feel that the incidence is rising rapidly. Some explanations are: air pollution, dietary changes, chemicals and preservatives, and genetic predisposition.
The main offending allergens during the winter are dust mites, cats, dogs, cockroaches, and molds. These are known as perennial allergies or all-year-round allergens. Many people tend to stay indoors during the cold winter month, which makes them more susceptible to these allergens. If you suffer from sneezing, itchy and watery eyes, runny nose, and cough when you start “spring cleaning” your home, then you may be experiencing mold and/or dust mite allergy.
Other common allergens are:
Air Fresheners and Scented Candles – If you notice that you sneeze, cough, or get watery eyes, every time you enter a room with these items, then you probably are having an allergic reaction to the many chemical substances in these products.
Alcohol – While not common, some drinks containing alcohol can be a source of allergens to those with sensitivity. For example, some wines and beer containing hops, barley, wheat and preservatives can create significant allergic reactions.
Animal Dander – This light weight allergen stays airborne for extended periods of time and is a common source of allergens for many
Allergy skin testing can be performed to determine whether or not you are susceptible to these allergens. However, a lot of allergy testing is done in the spring, summer, and fall when people with seasonal allergic rhinitis suffer most. Allergy testing, while valuable year round, is probably best done in the winter or early spring, when the offending pollens are not in the air, as it provides an extra layer of safety if you are not actively exposed to these highly potent allergens. In addition, if someone does have seasonal allergies, then the winter is a great time to start immunotherapy. The immunotherapy can be escalated during the winter months safely so that by the spring, summer, and fall, people do not react as briskly to the tree, grass, and weed pollens, respectively.
Allergy shots are effective in building up tolerance to these allergens, but also allergy drops administered under the tongue can be equally effective. In fact, allergy drops are safer than their shot counterparts and you don’t have to make repeated visits to the doctor’s office to get your allergy shot either. You can safely administer the drops under your tongue in the convenience of your home.
NEXT WEEK: TIPS FOR ATHLETES WITH ALLERGIES
Medical Contributor: Michael Freiman, MD, The Northeast Ear, Nose, and Throat Allergy Center located at 503 Sunset Drive in Dickson City, PA.
Sources: American College of Allergy, Asthma, and Immunology.
Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune. Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an associate clinical professor of medicine at The Commonwealth Medical College.
Part 2 of 2
Last week, Chris Cali, Scranton Prep graduate and junior biology major at Villanova University, shared his experiences living in a sustainable environment this summer while studying in Costa Rica at the Center for Sustainable Development Studies. In recognition of “Earth Day,” I have asked Chris to offer tips for sustainable living in order to promote health and wellness:
Solar Panels
Getting energy directly from the sun is the one of the cleanest and most efficient ways to make electricity. Solar panels on your roof can reduce your electricity bill to almost nothing, and the costly initial investment will pay off in time.
Drive a fuel efficient vehicle
Driving a car with good gas mileage is a no brainer with the current price of gas. While saving money, you will also be reducing your emission of carbon dioxide and therefore helping to fight climate change. Look into getting a hybrid electric vehicle, as there are tons of options now available, including SUVs and trucks. The extra cost of the vehicle will most likely be made up with the savings at the gas pump.
Rain Barrels
Reducing daily water use can save money and water for times of harsh weather. Collecting rainwater from the gutters and using it to water plants or the lawn is a good way to save water.
Composting
Composting fruit and vegetable remains is a good way, along with recycling, to reduce the amount of waste we send to the landfill. The composted soil can then be used to fertilize your own garden.
Eat Organic and local foods
Organic foods are grown without the use of any artificial pesticides or fertilizers and are not genetically modified. Studies have shown that organic fruits and vegetables actually contain more nutrients than conventionally grown food, and locally grown foods do not have the artificial preservatives that are used on commercial crops.
Eat less meat
The meat industry in the United States is unprecedented in its harm for the environment and our health. Animals are kept in disgusting conditions that are breeding grounds for E. coli and salmonella, animal wastes pollute the air and water, and tremendous amounts of water and food are used to raise the animals. If you love a good steak like I do, buy grass fed beef instead. Grass fed cows are treated better, and the meat contains more Omega 3 fatty acids necessary for a healthy diet.
Visit Nature: Be an Ecotourist
Ecotourism involves visiting a place to experience and learn about nature. It offers hope to preserve nature while at the same time, bringing economic development to local communities. Be wary however, because not all ecotourism is sustainable. Costa Rica has a government run program that certifies hotels and tour operators as sustainable. Travel websites such as Tripadvisor now display whether hotels have this certificate (CST, or Certificate for Sustainable Tourism) so that visitors can better chose sustainable options.
Write to Congress
The United States is one of the only developed nations that doesn’t have some restriction on carbon emissions known to cause global warming. A carbon tax on polluting companies would bring in much needed revenue for our government. Alternatively, a cap and trade system which allows companies to buy and sell carbon credits to each other would promote greener industry while fighting climate change.
Support Green Business
Consumers have the power when it comes to making our economy more sustainable. Read labels and choose products that do not contain substances that will harm the environment. Buy products made in sustainable factories or buy stock in companies that are environmentally friendly. Boycott companies that are known to pollute or treat their workers unjustly.
Plant Trees
Planting trees and preventing deforestation is the cheapest and most effective way to fight climate change. Tropical forests are especially important, as they take in huge amounts of carbon dioxide from the atmosphere. Every tree helps, so plant some in your own yard.
Be Less Consumptive
Walk more, use less gas. Eat less, use less food and energy. Both you and the planet will be healthier!
CONTRIBUTING AUTHOR: Chris Cali, is a graduate of Scranton Prep and is a junior at Villanova University where he studies biology and pre-medicine. He has a special interest in environmental sciences.
Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune. Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an Associate Professor of Clinical Medicine at The Commonwealth Medical College.
Part 1 of 2
Guest Columnist: Chris Cali
In 2006 my family and I traveled to Costa Rica with our travel mates, the Cali family, for what would become an unforgettable experience for all. In fact, last summer one member of the group, Chris Cali, a junior biology major at Villanova University, had the opportunity to study in Costa Rica at the Center for Sustainable Development Studies. In recognition of “Earth Day,” on April 22, I have asked Chris to share his experience living in a sustainable environment and how it relates to health and wellness:
I was among thirty students who spent the month learning about sustainability issues, ecotourism and the environmental problems our world faces. I knew this was not going to be the typical study abroad program when I saw a mosquito net, rubber boots, and biodegradable soap on the required packing list. However, I had one of the most memorable and unique experiences of my life. I hope to share some of my experience and discuss the topic of sustainability and how it relates to health and wellness.
The concept of sustainability addresses the issues of climate change and resource scarcity to ensure that everyone can lead healthy lives now and in the future. Sustainability is living in a way that meets the needs of the present without compromising the ability of future generations to meet their own needs. The goal of sustainability is to use resources that are renewable and to limit overall use so that natural processes are not interrupted. Sustainability focuses on using local resources and building community ties, as well as being self sufficient.
At the center where I lived, we tried to be as self sufficient as possible. We ate fruits and vegetables that were grown on our campus and raised chickens. We produced almost no trash as most table scraps were composted. The extra food was used again at the next meal, and anything that could not be used was fed to the dogs. Even the napkins were biodegradable. Instead of plastic wrap, we used banana leaves to cover our food. We washed dishes in a bucket of water rather than running them under the faucet. Our waste water was filtered naturally by aquatic plants. To save electricity, we had no hot water and hung our clothes outside to dry rather than using a machine. It was not the most convenient way of living, but it was more gratifying. It felt good to live more naturally and to do without the excesses of modern life. Costa Ricans call it “pura vida”, or pure life. It is a lifestyle that requires new types of thinking. It requires long term planning rather than short term benefits. It requires recognition of the interconnectedness of the world, and that we are all responsible for others and for our planet. Living in accord with nature and with neighbors is a fulfilling experience that strengthens the mind and body. Perhaps the best teachers of sustainability are the leaf cutter ants found crawling all over Costa Rica. These ants consume only a third of each leaf and a third of the plant’s total leaves so that the colony always has a renewable food source. Each ant carries out its own task for the betterment of the entire colony. In the same way, living sustainably requires us each to do our own part.
With climate change, scientists have observed an intensifying of natural weather patterns such as El Niño. This has both direct and indirect repercussions for our health. According to WHO, changing precipitation, humidity, and temperature patterns are causing more outbreaks of disease. Diseases and parasites once confined to the tropics are moving further north, putting more people at risk than ever before. The massive floods, droughts, forest fires, heat waves and hurricanes we are constantly hearing about in the news are not simply coincidence, as scientists are now seeing a direct link between climate change and natural disasters. The number of natural disasters has been steadily increasing, and there have been more since 2000 than in any other decade in history. Heat waves and droughts are becoming more frequent and costing more lives. These events have taken a toll on food production as well. Droughts and the price of oil have caused food prices for this year to be the highest they have ever been. This means the fruits and vegetables we need to stay healthy are getting more and more expensive. Many Americans are forced instead to buy cheaper processed food, contributing to our obesity problem. The world’s other main food source, the ocean, is being overfished and destroyed by rising temperatures. Moreover, tropical forests that provide food, medicines, building materials, and health and beauty products are at risk without a sustainability plan.
Next week, I will offer some tips on how we can all contribute to making our planet healthier.
CONTRIBUTING AUTHOR: Chris Cali, is a graduate of Scranton Prep and is a junior at Villanova University where he studies biology and pre-medicine. He has a special interest in environmental sciences.
Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune. Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an Associate Professor of Clinical Medicine at The Commonwealth Medical College.
Part 4 of 4
Guest columnist: Janet Caputo, PT, DPT, OCS
The past three columns have demonstrated the lengthy rehabilitation process following an ACL reconstruction. The first four weeks after surgery can be a little uncomfortable and repetitive. The program focuses on controlling pain and swelling, increasing tolerance for weight bearing, restoring knee motion, and developing muscular control. Then the FUN begins! After four weeks, your knee should have healed enough to allow your therapist, with your surgeon’s approval, to add more challenging exercises to enhance balance, coordination, and agility. These exercises will be added over the next 8 to 12 weeks in two phases, as described below.
During weeks 5 to 12, the exercises mentioned last week (i.e. Phase One and Phase Two) will be progressed by adding weights and increasing step height. Additional exercises may be added:
At 12 weeks post-op, sport specific activities are allowed as long as sufficient strength and balance have been achieved. Jogging, agility drills, and a functional running program will be initiated and progressed as tolerated.
You can expedite your recovery if you perform all exercises, in all phases, pain-free and as directed by your physical therapist. Even though progression through the rehabilitation phase is an individual process, expect to return to your sport no earlier than 6 months after your ACL reconstruction.
Visit your doctor regularly and listen to your body.
CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.
Photos: Jennifer Hnatko, Photo Model: Danielle Dalessandro
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 in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.
Part 3 of 4
Guest Columnist: Janet Caputo, PT, DPT, OCS
Even though your surgeon probably reconstructed your ACL in about 2 to 2 ½ hours, your rehabilitation phase will require a much longer period of time. Typically, regaining the motion, strength, and function of your knee following ACL reconstruction requires more than three months. And, while you may be allowed to run and jump, you may not be allowed to engage in competitive sports for 6 months.
Your post-operative ACL rehabilitation will be divided into stages. Achieving certain milestones at specified intervals will be important in gauging your progress. If certain goals (i.e. strength gains, increases in motion, and improved function) are not reached within a reasonable amount of time, your program must be re-assessed, or your performance of your program must be re-evaluated. This will be the coordinated effort between your surgeon and your physical therapist.
When your surgeon refers you to physical therapy, he/she may forward his ACL protocol to your therapist. A protocol is a tool used by your physical therapist to design an appropriate rehabilitation program and gauge your progress. Your surgeon’s protocol ensures not only that your physical therapist will not exceed any post-operative limitations or restrictions but also that you regain function to your knee as quickly as possible. Your post-operative rehabilitation protocol will differ slightly based on the type of ACL reconstruction you have received (refer to last week’s article) and upon your surgeon’s preference.
Post-operative rehabilitation following ACL reconstruction can be divided into 4 phases as follows:
Weeks one and two focus on decreasing post-op pain and swelling and gradually increasing your knee mobility. Immediately after surgery, you will be walking with crutches and a knee brace/immobilizer to protect your knee and limit weight bearing. After the first week, you will be encouraged to gradually wean from your crutches, as tolerated. By the second or third week, you may be allowed to walk with just your knee brace/immobilizer. The knee brace/immobilizer may be required for walking for up to 6 weeks after surgery. Some exercises that you will be required to perform include:
By 3 to 4 weeks, you should be walking without crutches. Weight bearing exercises will be added. Some examples are as follows:
Visit your doctor regularly and listen to your body.
CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.
Photos: Jennifer Hnatko, Photo Model: Matthew Knowles
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next week read: Part 4 of 4 on ACL injuries.
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 Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.
Guest Columnist: Janet Caputo, PT, DPT, OCS
Part 2 of 4
If your orthopaedic surgeon suspects an ACL tear, he/she will order an MRI (i.e. magnetic resonance imaging) to confirm his diagnosis. The MRI results may also reveal damage to other critical structures in your knee such as the medial or lateral collateral ligaments on the side of the knee or meniscus (cartilage) shock absorbers between the bones. Your surgeon will discuss your treatment options which typically depend on your age, activity level, degree of knee instability, and if other structures have been injured.
If you are young and athletic, or have a physically demanding profession, the knee instability from your torn ACL will interfere with the performance of your sport, recreational, or occupational activity, because your knee will constantly buckle. This degree of knee instability is not only a safety hazard, but may also cause further damage to your knee joint resulting in the development of premature arthritis. Consequently, your surgeon will recommend surgery. Current techniques for ACL reconstruction are very successful in restoring knee stability, but the rehabilitation following surgery requires many weeks to months of time, commitment, and hard work to achieve full, optimal function of your knee. If you are older and more sedentary, or willing to avoid activities that place a high demand on your knee (e.g. basketball, soccer, racquetball), your surgeon may recommend a more conservative route. Individuals who are not surgical candidates or who opt not to have surgery will be required to perform exercises that emphasize strengthening and joint control (i.e. proprioceptive exercises).
Your surgeon may also recommend a functional knee brace which provides artificial support to your ligament-deficient knee to prevent your knee from buckling and to afford you pain-free performance of your activity. This is often worn before surgery and sometimes 4-6 weeks after surgery for protection.
If your surgeon recommends reconstruction, he/she will most likely prescribe several weeks of pre-operative physical therapy to not only reduce the swelling in your knee, but also restore your knee joint motion and normal walking pattern. This pre-operative phase may require two weeks to two months, depending on how your knee responds to the initial injury.
Several ACL reconstructions are available and typically your surgeon will recommend the technique that is best for your individual needs. Currently, ACL reconstruction is performed arthroscopically (with a scope) and considered a minimally invasive procedure which usually does not require an overnight stay in the hospital. During arthroscopic ACL reconstruction, your surgeon makes two small incisions into your knee joint: (1) one to place his arthroscope, which is a small camera to view the inside of your knee, and (2) the other to insert the surgical instruments that he will use to reconstruct your ACL.
Several arthroscopic options are currently available to reconstruct your ACL. Each option uses a tissue “graft” to substitute for your torn ACL. Your surgeon may recommend using an autograft (your tissue) or an allograft (donor tissue). Each option has its own advantages and disadvantages, and you should discuss any questions or concerns with your surgeon. Below is a brief outline of the available operative procedures for arthroscopic ACL reconstruction:
Join us next week when we will discuss the rehabilitation process following ACL reconstruction.
Join us next week to discuss rehabilitation after ACL injury.
Visit your doctor regularly and listen to your body.
CONTRIBUTING AUTHOR: Janet Caputo, PT, DPT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and neurological physical therapy.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune. Next week read: Part III of IV on ACL injuries.
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 Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.
