Part 1 of 4
What do Matthew Knowles, Danielle Dalessandro and Matthew Langan have in common? These local basketball stars had their season cut short due to devastating knee injuries: torn anterior cruciate ligaments (ACL). However, while they may have ended their seasons, they did NOT end their careers! Knowles and Langan tore their ACL’s when they aggressively pivoted on one leg while shifting their body weight in another direction, causing them to hyperextend and rotate the knee. Typical of ACL tears in women, Danielle’s mechanism of injury was much more benign. She simply landed on one foot and her knee bent backward resulting in an ACL tear.
The tragedy for these athletes is the fact that they have trained tirelessly to achieve a starting position on their high school basketball teams. For the past 8 or more years they have missed many family meals and weekend activities to train, practice and play on school and travel teams in order to develop their skills to the highest level. Now, they will work tirelessly for the next 6 months to gain full recovery. They will be back…better than ever!
The ACL (i.e anterior cruciate ligament), is the major ligament that stabilizes the knee by preventing the anterior or forward motion of one knee bone on the other. It can be injured during hyperextension of the knee which forces the lower leg on the upper leg (i.e. the knee is straightened more than 10° beyond its normal fully straightened position) and pivoting injuries of the knee involving excessive inward turning of the lower leg. Most ACL injuries occur during athletic activity and require either changing direction quickly (i.e. cutting around an obstacle or another player with one foot planted firmly on the ground) or landing after a jump with a sudden slowing down, especially if the leg is straight or slightly bent. A greater incidence of ACL injuries in women probably originates from several inter-related factors: hamstring-quadriceps muscle imbalance, joint laxity, and ankle braces.
Non-Contact Injuries:
Surprisingly, 80% of sports-related ACL injuries occur during non-contact activities involving:
Contact Injuries:
Sports-related, contact injuries to the ACL occur if the athlete gets hit very hard on the outside of the knee:
Non- athletic ACL injuries involving hyperextension and pivoting can occur with activities such as falling off a ladder, stepping off a curb, jumping from a moderate or extreme height, stepping into a hole, or missing a step when walking down a staircase. Motor vehicle accidents in which the knee is forced under the dashboard may also rupture the ACL. “Wear and tear” to the ACL from repeated trauma can result in small tears, which, over time, can cause complete rupture of the ACL.
The severity of the ACL injury will depend on not only the position of the knee at the time of the injury, but also the direction and magnitude of the force. Injury to the MCL (i.e. medial collateral ligament) as well as the lateral meniscus (i.e. shock-absorbing cartilage) may occur in more severe injuries.
These may include a popping sound at the time of injury, profuse knee swelling within 6 hours of injury, and pain, especially when putting weight on the injured leg. If you think you injured your ACL, go to the nearest emergency room to receive instructions on how to care for your injured leg, including contacting a doctor that specializes in orthopaedic injuries. Other helpful hints include:
Join us next week to discuss options 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 2 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.
Tennis elbow, also called lateral epicondylitis, is an inflammation of the lateral (outside) bony protuberance at the elbow. It is at this protuberance that the tendon of the long muscles of the hand, wrist and forearm attach to the bone. As the muscles repeatedly and forcefully contract, they pull on the bone, causing inflammation. The trauma is especially irritating when working the muscles in an awkward position with poor leverage such as hitting a backhand in tennis.
It is not unusual for a patient to come to my office with severe pain on the outside of his elbow after intensifying their tennis workouts or changing the racquet string tension. Others come to me with pain on the inside of the elbow (“golfer’s elbow”) from wrist action that advanced golfer’s use at impact. For that matter, laborers working with wrenches or screwdrivers with an awkward or extended arm can also develop tennis elbow.
In a more chronic problem, lateral elbow pain may be caused by a degenerative condition of the tendon fibers on the bony prominence at the lateral elbow. Sporadic scar tissue forms from a poor attempt by the body to overcompensate and heal without eliminating the cause.
Common characteristics of persons who develop tennis elbow:
While symptoms may vary, pain on the outside of the elbow is almost universal. Patients also report severe burning pain that begins slowly and worsens over time when lifting, gripping or using fingers repetitively. In more severe cases, pain can radiate down the forearm.
Conservative treatment is almost always the first option and is successful in 85-90 percent of patients with tennis elbow. Your physician may prescribe anti-inflammatory medication (over the counter or prescribed). Physical/Occupational therapy, rest, ice, and a tennis elbow brace to protect and rest the inflamed muscles and tendons may be advised. Ergonomic changes in equipment, tools, technique and work-station may be necessary. Improvement should be noticed in 4-6 weeks. If not, a corticosteroid injection may be needed to apply the medication directly to the inflamed area. Physical therapy range of motion and stretching exercises to the affected muscles and tendons may be necessary prior to a gradual return to activity. Deep friction massage can assist healing.
Exercises are performed in a particular manner to isometrically hold and eccentrically lengthen the muscle with contraction.
New Conservative Treatment: Platelet-Rich-Plasma (PRP) is a new treatment for the conservative management of degenerated soft tissues that has recently received great media attention, in great part, due to its success in several high profile athletes. According to the Journal of the American Academy of Orthopaedic Surgeons,(JAAOS) platelet-rich plasma (PRP) is autologous (self-donated) blood with an above normal concentration of platelets. Normal blood contains both red and white blood cells, platelets and plasma. Platelets promote the production and revitalization of connective tissue by way of various growth factors on both a chemical and cellular level.
The actual PRP injection requires the patient to donate a small amount of their own blood which is placed into a centrifuge (a machine that spins the blood at a high velocity to separate the different components of blood such as plasma, white and red blood cells), for approximately15 minutes. Once separated, the physician draws the platelet-rich plasma to be injected directly into the damaged tissue. In theory, the high concentration of platelets, with its inherent ability to stimulate growth and regeneration of connective tissue, will promote and expedite healing at the site of damage.
Surgery for tennis elbow is only considered in patients with severe pain for longer than 6 months without improvement from conservative treatment. One surgical technique involves removing the degenerated portion of the tendon and reattaching the healthy tendon to bone. Arthroscopic surgery has recently been developed to perform this technique; however, research does not support the value of one over the other at this point. Physical/occupational therapy is used after surgery. Return to work or athletics may require 4-6 months. More recently, a surgical technique using ultrasound to guide a needle to debride (clean) the area of scar tissue has been developed. If eligible for this procedure, the time required for healing, rehabilitation and return to activity is much shorter.
If you feel you suffer from tennis elbow, ask your family physician which of these treatment options are best for you.
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 in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.
Guest Columnist: Janet Caputo, PT, DPT, OCS
Hamstring injuries are common among athletes who participate in sports that require running, jumping, and kicking, especially when sudden changes in speed and direction are required. These injuries occur when the hamstring muscles are stretched too far or when caught off-guard during a sudden change in speed or direction. Sprinting and other fast or twisting motions with the legs are the major causes of hamstring injuries.
Following a hamstring injury, the incidence of re-injury is high. However, a rehabilitation program that focuses on stability (core and lower extremity), agility, and eccentric control is more effective in preventing hamstring re-injury than programs focusing on stretching and strengthening. Last week’s column illustrated some of the stability exercises that can be used during recovery from a hamstring injury.
The following exercises will target the essential agility and eccentric training requirements for recovery after hamstring injury.
Set up a series of markers similar to the diagram. Starting at the first marker, sprint backwards to the second marker and side-step to the third marker. Then, sprint backwards to the fourth marker. Rest and repeat in the opposite direction. Starting at #4, sprint forward to #3, side-step to #2, and sprint forward to #1.
Start with your feet hip width apart at the bottom of the ladder .Step your right foot out to the right of Square #1. Immediately, place your left foot into Square #1. Next, step your right foot into Square #1, next to your left foot.
To continue, step your left foot into Square #2, immediately followed by stepping your right foot into Square #2. You should count these first five steps in a 1-2-3-4-5 manor.
Continue by stepping your right foot forward into Square #3, followed by stepping your left foot forward into Square #3. Next, step your right foot to the right, into Square #4, immediately followed by stepping your left foot into Square #4.
Repeat this sequence for the full length of the ladder.
While kneeling, have a partner hold your ankles to stabilize you. Lean slowly forward, using your hamstrings to resist the fall. Keep your hips/trunk rigid and in line with your legs. This motion should look like a slow forward fall. Stop your motion when you reach the point where you can no longer hold yourself up with your hamstrings. Return to kneeling.
Guest Columnist: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.
Photos: Jennifer Hnatko.
Models: John T. Bedford, DPT, Amanda Brown, PTA, ATC.
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 clinical professor of medicine at The Commonwealth Medical College.
Guest Columnist: Janet Caputo, PT, DPT, OCS
Tim Lavelle practiced long and hard to attain a position on the University of Scranton men’s basketball team. Local long-distance runner Christopher Krall trained diligently for the Chevron Houston Marathon. But despite their careful and persistent training, both sustained hamstring injuries early in the preseason. How? Why?
Hamstring injuries occur when these muscles are stretched too far or when caught off-guard during a sudden change in speed or direction. Sprinting and other fast or twisting motions with the legs are the major causes of hamstring injuries. Hamstring injuries occur most often in sports that require running, jumping, and kicking, especially when sudden changes in speed and direction are required.
Research has identified several reasons that some athletes experience a re-injury to their hamstrings. First, a previous hamstring strain puts athletes at risk of re-injury. A strain can mean that either the muscle has been torn (i.e. moderate [grade II] hamstring strain) or that the muscle was overstretched and fibers were torn, which would have caused pain, swelling, and bruising (black and blue). Athletes are also at risk of re-injury if they have ever torn a large portion of the hamstring muscle or if they have had ACL (anterior cruciate ligament) reconstruction performed on the same side. Finally, athletes who have previously participated in a rehabilitation program that focused on stretching and strengthening of the injured hamstring without addressing neuromuscular training are also at risk of re-injury.
Although athletes cannot control the grade of a previous hamstring tear, the amount of muscle that their tear had involved, or whether they have had an ACL reconstruction, they can control the type of rehabilitation that they receive following a hamstring injury. It is important for athletes to realize that the right rehabilitation program may prevent their hamstring injury from becoming their Achilles’ heel (their great weakness)!
Scientific studies have discovered that rehabilitation programs focusing on stability (core and lower extremity), agility, and eccentric control are more effective in preventing hamstring re-injury than programs focusing on stretching and strengthening. This is because stability programs help develop the neuromuscular control that allows the body to respond to changes in surface or direction—these programs help the body “learn” how to monitor joint position, movement, direction, amplitude, and speed of movement. Agility programs develop coordination, power, balance, and speed.
Eccentric and neuromuscular training is critical because most hamstring injuries occur when the hamstring is contracting eccentrically (i.e. contracting and lengthening). A recent study revealed that eccentric training reduced hamstring injury by 60% and re-injury by 85%.
The following exercises will target the essential stability training requirements for recovery after hamstring injury.
Hamstring Curl
Lie on your back on the floor with your heels on a stability ball. Place arms over your chest and lift your hips so that you are straight from your heels to your shoulders. Tighten your tummy and slowly pull your heels towards your buttocks. Then, slowly return to the straight-legged position while you maintain a neutral low-back position. Repeat. (Beginner athletes should perform this exercise 10 times, intermediate 20 times, and advanced 30 times.)
Bent Leg Raise
Lie on your back on the floor with your feet flat on a stability ball. Place your arms on the floor, straight out from your sides, making a T-shape. Tighten your tummy. Push down with your feet while slowly lifting your hips toward the ceiling. Slowly lift your right leg up and then lower it back to the ball. Then, slowly lift your left leg up and then lower it back to the ball. Repeat this sequence. (Beginner athletes should perform this exercise 6 times, intermediate 10 times, and advanced 15 times.)
Lunge
With a stability ball behind you, place your uninvolved foot on ball (the one without a hamstring injury). Place your hands on your hips and tighten your tummy. Slowly, bend your standing-leg knee and lower yourself until your thigh is horizontal, parallel to the ground. Slowly raise yourself back up to the starting position. Repeat. (Beginner athletes should perform this exercise 10 times, intermediate 10 times, and advanced 15 times.)
Guest Columnist: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.
Photos: Jennifer Hnatko.
Model: John T. Bedford, DPT.
Read “Health & Exercise Forum” – Every Monday in the Scranton Times-Tribune. Next week, read Part 2 on exercises for hamstring injury rehab. 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.
Guest Columnist: Paul Mackarey, Jr. SPT
Contracting the cold or flu can make you feel run-down and under the weather for weeks. Unfortunately, your daily activities and responsibilities cannot take a sick day. Just because the temperature this winter has been unseasonably warm and we have had less than average snow, does not mean the flu bug is not active. The common cold and flu is most prevalent during late fall, winter and early spring. According to flufacts.com, “The influenza virus, more commonly known as the flu, is defined as a contagious respiratory infection that infects the nose, throat, and lungs. Each year approximately five to 20 percent of the population in America contracts the flu and related deaths caused by the flu virus average at 23,600.” Thankfully, there are several easy and effective preventive measures that can reduce the probability of contracting the cold and flu. These preventive measures are designed to help keep your immune system strong and healthy. A healthy immune system fights against pathogens, such as the cold and flu virus. This article will focus on the ten best ways to prevent the flu and cold this season.
The vaccine produces antibodies that protect against the cold and flu virus within two weeks after vaccination. There are currently two different types of vaccines; an “intramuscular shot,” meaning it is injected into the muscle and a nasal-spray vaccination is available for people two to 29 years of age. The traditional intramuscular vaccine has been used for decades and has been approved for use in people six months of age and older. Recently, two new intramuscular vaccines have been developed for use in 2011. A hi-dose vaccine was designed for people 65 years and older and a vaccine designed for people 18 to 64 years of age is also available.
The most common way to spread the cold and flu virus is by direct contact. The virus can live on surfaces for hours and even days eagerly waiting to get picked up by the next individual.
Germs attach onto your hands and can be passed onto other public surfaces. The most effective ways to cover a sneeze are to use a tissue or your sleeve.
Exercising regularly causes an increase in your heart rate. Therefore, the heart can pump more oxygen rich blood throughout the body. Increased blood flow to the body has been proven to increase the body’s immune system and help to prevent illness.
Eating nutrient rich foods is the best way to keep your immune system strong. Phytochemicals are natural immune boosting chemicals found in plants, fruits and vegetables, specifically, dark green, red, and yellow vegetables and fruits. Yogurt is also an effective way to prevent illness. Studies have shown that eating low fat yogurt regularly can
reduce susceptibility to colds by 25 percent. Research also suggests that the natural bacteria found in yogurt stimulates and strengthens the immune system.
Staying hydrated is important. Water flushes your system by filtering out poisons as it replenishes your body. Dehydrated individuals feel tired and unfocused. A healthy adult requires eight 8-ounce glasses of fluid a day. The easiest way to determine if you are dehydrated is by the color of your urine. If it is dark yellow your body may require fluids.
Doctors recommend a full eight hours of sleep a night. The demands of your busy life sometimes make that difficult. However, during the cold and flu season, it is particularly important. If you are not well rested, your body becomes tired and “run-down,” leading to a weakened immune system and leaves you more susceptible to illness.
Statistics show that smokers are at a higher risk of contracting more frequent and severe cold and flu symptoms. This is because the toxic chemicals in smoke are seen as pathogens or foreign contaminants in the body. As a result, your immune system is working overtime. Also, smoking is proven to paralyze cilia that line your nose and lungs. The cilia, or delicate hairs, are designed to remove cold and flu viruses out of your nasal passageway before they can infect the body. Smoking a single cigarette can paralyze the cilia for up to 40 minutes.
Heavy alcohol consumption negatively affects the body and its immune system in several ways. Heavy drinkers are more prone to cold and flu illnesses because alcohol suppresses the immune system and significantly dehydrates the body.
It is important to relax and “unwind” at the end of a busy day. Relaxing lowers cortizol levels in the blood. Cortizol is a hormone released into the body’s blood stream when a person is feeling stressed or pressured. Over time, this hormone weakens the immune system. Relaxing causes interleukins, the main components of your immune system that fights against the cold and flu virus, to increase in your bloodstream. It is recommended that one makes time for at least 30 minutes of relaxation each day.
Sources: www.flufacts.com; www.webmd.com; www.lifescript.com; www.cdc.gov
Guest Contributor: Paul Mackarey, Jr. SPT, is a graduate student in the Doctor of Physical Therapy Program at Temple University.
Read Dr. Paul J. Mackarey “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 in downtown Scranton, PA and is an associate clinical professor of medicine at The Commonwealth Medical College.
February is National Cancer Prevention Month. While there is no fool-proof method for cancer prevention, scientific research does support the fact that healthy lifestyle choices are essential. We are six weeks into the New Year and this is a good opportunity to assess our progress with our health related resolutions.
Important Tips to Reduce Your Risk of Cancer:
Perhaps the most important thing one can do to prevent cancer is to avoid smoking…first hand or second hand. It has been directly linked to cancer of the lung, head and neck, bladder and pancreas and others. Smoking increases the risk of lung cancer by 20 to 30 times.
30 -45 Minutes of moderate exercise or physical activity 4-5 days per week is recommended to reduce the risk of cancer. Walk, ride a bike, swim, or join a gym, just do something! Keep in mind, however, individuals that exercised for longer durations and at higher intensities were shown to experience the greatest reduction in their risk cancer.
Why Exercise Works
Various biological mechanisms including hormonal changes have been suggested as possible reasons for the reduction in cancer through exercise. However, current research has demonstrated a strong link between cancer and stress. Stress, which reduces our body’s natural defense mechanisms, such as adrenal cortical or stress hormones, increases our susceptibility to disease including cancer. Exercise and physical activity has been shown to not only reduce stress, anxiety, and depression but also to elevate mood. These psychological improvements may be the reason why exercise and physical activity are effective in preventing cancer.
Obesity as a risk factor for cancer has been demonstrated in the scientific literature for years. Individuals that are more physically active are usually not overweight. Exercise increases basal metabolic rate, expends calories, and burns fat to help control your weight and to help maintain a more normal lean body mass. Obesity can be prevented through physical activity and exercise.
Colorectal Cancer
Physical activity and exercise has been shown to have the greatest prevention against colorectal cancer. Colorectal cancer is the second leading cause of cancer death among American men and women combined. Physical activity reduced the risk of colorectal cancer up to 70% for both men and women.
Breast Cancer
Research has been able to establish a similar relationship between physical activity and breast cancer. Approximately one out of every eight women in the United States can develop breast cancer at some point in their lifetime. Exercise has been shown to reduce the risk of breast cancer up to 40%.
Prostate Cancer
Prostate cancer, the second most common cause of male death, will affect one in every five American males. However, the risk of prostate cancer can be reduced up to 30% through physical activity and exercise. Researchers hypothesize that exercise may have its greatest protective effect against prostate cancer when initiated early in a man’s life.
Cancer of the Lung/Uterus/Cervix
Lung cancer is the leading cause of cancer death in the United States. Cancers of the uterus and cervix will accounts for 7,400 deaths annually in the United States. Exercise and physical activity can reduce the risk of lung and uterine/cervical cancer up to 40% and 90%, respectively.
Both obesity and stress, as mentioned above, have been linked with cancer of various types. A healthy low-fat diet, limited in red meat, with moderate amounts of fish, rich in fruits, vegetables and nuts along with and regular exercise are essential components for prevention , especially for colorectal and prostate cancer.
The use of a good home water filter has many healthy benefits. It may reduce your exposure to carcinogens and other harmful chemicals. Also, using a steel or glass container to store drinking water is important to avoid chemicals such as BPA found in plastic bottles.
The American Cancer Society recommends drinking more than 8 cups of water per day to prevent bladder cancer by diluting the concentration of urine in the bladder.
Processed, charred, blackened, and well-done meats are associated with heterocyclic amines, which are cancer causing and formed when charcoal broiling meat. Marinating meat for an extended time prior to grilling has been recommended to improve safety according to some studies.
Some studies suggest that the really dark greens such as spinach, kale, collards and broccoli are valuable in cancer preventions. Endive, arugula, and romaine must be added to this list.
Some studies show that snacking on Brazil nuts and other nuts high in antioxidants, lowers the risk of some cancers such as bladder, lung and colorectal.
Take time to use adequate sun block and proper clothing to protect your skin from the sun to prevent skin cancer, especially if you are light skinned. At all costs, avoid sunburn!
When possible, buy fresh foods and meats free of antibiotic and hormones. Choose organic produce grown free of pesticides. Eat farm-raised fish and limit consumption of fish from waters high in mercury concentration
Regular check-ups by your physician is essential to stay healthy and have early detection of disease. Many tests and vaccinations offer life saving information such as: PAP tests, mammograms, colonoscopies, PSA blood tests and others. Ask your physician about new vaccinations such as HPV, Human Papillomavirus, are important for the prevention of cervical cancer in women and head and neck cancer in men.
In keeping with National Cancer Prevention Month, Delta Medix, Scranton, PA, announces the opening of “The Delta Medix Foundation for Cancer Care.” The foundation is a non-profit organization whose mission is to aid all local cancer patients and their families, from diagnosis through survivorship, to be a resource for all cancer patients through assistance with financial, physical, and psychological needs, specifically to enable cancer patients to receive complimentary services such as nutritional and psychological counseling, exercise and physical therapy to all cancer patients in NEPA.
CONTRIBUTING AUTHOR: Janet Caputo, PT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and sports physical therapy. She is currently a Doctor of Physical Therapy student at the University of Scranton.
MEDICAL EXPERT REVIEWER: Michael A. Burke MD, Radiation Oncologist, Center for Comprehensive Cancer Care, a division of Delta Medix, Scranton, PA.
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 TCMC.
February is National Cancer Prevention Month! In view of this, I thought it would be appropriate to raise the level of consciousness about nonsmokers and lung cancer. Nonsmoking women are at greater risk for lung cancer than nonsmoking men. This issue received great national attention several years ago when Dana Reeve, wife of former superman Christopher Reeve, died from lung cancer. Dana represents the 20% of women with lung cancer who have NEVER smoked while 8% of men with lung cancer are nonsmokers. However, make no mistake, smoking increases your risk of lung cancer roughly 20-30 times according to the current research.
There are many theories why nonsmokers develop lung cancer. Dr. Norman Edelman, from the American Lung Association, states that one reason nonsmoking women are more like to develop lung cancer is that more nonsmoking women in the United States live with men who smoke than the reverse. Therefore, if the man quits smoking, he is improving the health of two people, not one. Dr. Edelman believes that secondhand smoke is the number one reason nonsmokers develop lung cancer.
In addition to secondhand smoke, other potential causes of lung cancer in nonsmokers are: air pollution, radon exposure, and asbestos exposure. However, one theory that is recently receiving significant attention as a cause of lung cancer in nonsmokers is the “lung cancer gene” according to a Japanese study in the October 2006 journal of Chest. This study has several alarming findings: having a parent or sibling with lung cancer doubles a person’s risk, the risk of inherited lung cancer is significantly higher in women, and family history of lung cancer is related only to lung cancer, not other kinds of cancer.
While you can’t change your family history, you can take other proactive measures to prevent lung cancer. One, DO NOT SMOKE or QUIT SMOKING if you do! There are many good smoking cessation programs and medicines available. Two, AVOID SECONDHAND SMOKE! Be aware and avoid environmental hazards such as radon exposure. Get a radon test kit for your home or office. If you live or work in an older building, get it checked for asbestos. Have it secured or removed professionally. Live a healthy lifestyle. Eat well and exercise regularly.
Some simple suggestions for beginning an exercise program are:
** Contributions from: Dr. Gregory Cali, pulmonologist, Dunmore, PA
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly
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 clinical professor of medicine at The Commonwealth Medical College in Scranton, PA.
Does anyone in your immediate family resemble the the hunchback of Notre Dame? If so, you too, could be in jeopardy of developing osteoporosis when you get older!
While genetics can play an important role, recent studies strongly suggest that healthy habits as a young person are extremely important for the prevention of osteoporosis as an older adult.
So, girls, log off Facebook, put down the iPhone, and forget about your boyfriend! We have to discuss your bank account. I am not talking money, but I am talking bone! Most women consider osteoporosis as the bone destroying disease that plagued their grandmothers. Actually, researchers consider osteoporosis as a classic childhood disease that doesn’t show up until later in life.
Throughout life, your body constantly makes new bone and destroys old bone. Bone formation begins in childhood, peaks during adolescence (11-15 years old), and rapidly declines after 16 to 18 years of life. Since women accumulate almost half of their adult bone mass during adolescence, you must maximize deposits into your bone bank during this window of opportunity. The bigger your bone bank account, the longer it will last into your retirement years.
An INCREASE in WEIGHT during ADOLESCENCE is NORMAL and it occurs with the onset of your menstrual cycle. Increases in body weight and body fat in healthy, female adolescents allows their bodies to make hormones that are needed for bone health and development. Some girls feel embarrassed about these changes in their bodies that occur during puberty and may start a “diet” or “over-exercise” to prevent the weight gain. Some female athletes believe that staying lighter and leaner will improve their performance.
However, fooling with Mother Nature is not healthy and can have long term consequences. Current research on adolescent, female runners has shown that girls with low bone mass were shorter, lighter, leaner, and began menstruating at a later age. Researchers studied these same girls three years later and discovered that they had failed to increase their bone mass to normal levels for their age. Since these girls neglected to make enough deposits into their bone bank, they have increased their risk for developing osteoporosis later in life.
So girls, for strong, healthy bones, follow these ten simple rules:
A girl’s BODY WEIGHT is the LARGEST, SINGLE FACTOR influencing the health,
growth, and development of her bones. According to the Centers for Disease Control and Prevention (CDC), a 16 year old girl who is 5 feet, 5 inches tall and who weighs 125 pounds has a Body Mass Index (BMI) of 20.8 which puts her in the 54th percentile. For a healthy weight, the CDC recommends that girls should maintain their BMI between the 5th and 85th percentile. The CDC considers BMIs below the 5th percentile as underweight and BMIs above the 85th percentile as overweight/obese. If this sixteen year old girl weighed 100 pounds, the CDC would place her BMI in the 4th percentile and consider her underweight. If this sixteen year old girl weighed 150 pounds, the CDC would place her BMI in the 86th percentile and consider her as overweight. To calculate your BMI go to www.cdc.gov/healthyweight/
If you are a teenage girl with low body weight participating in an endurance sport and you noticed that your menstrual cycles have been irregular or absent, you may be robbing your bone bank. Use the link above to calculate your BMI. If your BMI is below the 5th percentile, tell your parents and consult with your pediatrician.
Sources: Medical Science of Sport and Exercise and The Journal of American Academy of Nurse Practitioners
Guest Columnist, Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC.
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 clinical professor of medicine at The Commonwealth Medical College.
Guest Columnist: Janet Caputo, PT, DPT, OCS
New research has found that exercise may help in the prevention of foot ulcers. Foot ulcers, while originally appearing as small and benign, often lead to one of the most serious problems in people with diabetes, amputation. Prevention is essential and understanding the risk factors and causes of foot ulcers is the first step. The most common risk factors for foot ulcers in diabetics are; foot deformities, loss of sensation, poor circulation, dry skin, and calluses. Once an ulcer forms, a diabetic’s weak immune system cannot fight the infection. Even worse, the antibiotics used to fight the infection cannot reach the infected area, because of poor circulation associated with diabetes. Over time, gangrene (death of tissue) may occur which may lead to amputation. Therefore, people with diabetes are encouraged to take care of their feet to prevent these ulcers. New research has found that weight bearing exercise, such as walking, can prevent foot ulcers. Also, regular visits to a podiatrist, proper shoe wear, controlling cholesterol and blood sugar and avoiding tobacco products help to prevent foot ulcers.
The tried and proven methods of preventing foot ulcers are; controlling blood sugar, lowering cholesterol and quitting smoking. While these options are difficult, the addition of weight bearing exercise, like walking, can control cholesterol and blood sugar AND PREVENT foot ulcers!
Dr. John O’Malley, Ph.D., professor at the University of Scranton, uses walking to control his diabetes. His biggest fear is not being able to walk, because he feels that WALKING is his LIFELINE! Dr. O’Malley has had diabetes for 14 years, but walks up to 8 miles every day. At one point, he did have a foot ulcer, but he said that he developed the ulcer during his “less active” years. Finally, current wisdom is catching up with what he knew all along…walking is the answer!
Some medical professionals caution people with diabetes about weight bearing exercise (i.e. walking, dancing, hiking, low impact aerobics, golfing, yoga, and Tai Chi) because of increased pressure on their feet, which was believed to lead to ulceration, especially in those with loss of sensation. Recent medical research, however, shows that weight bearing exercise does not increase the risk for foot ulcers, and that those people who were the most active actually reduced their risk for ulceration.
The American Diabetes Association promotes weight bearing exercise for people who do not currently have foot ulcers because people who performed weight bearing exercise developed less foot ulcers, and because this type of exercise could prevent, or at least delay, the development of diabetic neuropathy (i.e. loss of sensation).
How could an exercise that increases foot pressure prevent foot ulcers? “If you don’t use it, you lose it.” Our body’s tissues (i.e. skin, muscle, tendon, ligament, bone) respond to pressure, stress, force, load, or whatever you want to call it. A tissue that does not get used will get weak and shrink. A tissue that gets overused will get injured. But the tissue that gets a moderate to high level of stress becomes stronger.
It is foolish to rush out and walk ten miles after sitting in your rocking chair or on your couch for twelve hours a day for the past ten years. First, ask your foot doctor if you can begin a weight bearing exercise program. If you have a foot ulcer, they will not advise you to do so. Also, your doctor may suggest that you should be fitted for special shoes and inserts before you begin your program to properly support your delicate foot. Second, make sure your blood sugar is under control. High blood sugar reduces healing in your tissues. When you exercise, tissues are strained and need to recover. Third, start slow and increase your exercise gra-du-al-ly. If you are a couch potato, you may need to start by walking only a half a block and increase your distance by ¼ block intervals every couple of days. Your podiatrist might recommend a visit to a physical therapist to advise how to properly begin and advance your exercise routine. Your physical therapist can also help to identify certain problem areas that might make you more prone to foot ulcers (i.e. loss of joint flexibility, muscle weakness, improper walking style, balance problems) and make suggestions to remedy these potential problems. Fourth, monitor your feet! Use a mirror to look at the bottoms of your feet. Your feet need to be checked just like you need to check your blood sugar. Check your feet regularly and, at least, before and after your exercise routine. If you notice any change in either foot, stop your exercise and call your foot doctor. Following these four steps and engaging in regular exercise will not only help you prevent foot ulcers but also keep your heart and bones strong!
Source: Lower Extremity Review
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.
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.
A local high school teacher came to my office last year with weakness and numbness on one side of her face. This well-groomed attractive middle-aged woman was unable to smile, frown, pout, speak, or eat with facial symmetry. She suffered from a cold, on and off, for about two months. It was not a bad cold, but it would not go away. One day in early summer, while engaged in bird watching, one of her favorite pastimes, she noticed that she could not look through her binoculars. She noticed that her eye would not open and close at will. The next day she woke with ear pain, flaccid muscles on one side of her face, and an inability to close her eye. She had difficulty speaking with clarity due to weak mouth muscles and feared she had a stroke. She immediately saw her family physician who determined that she had shingles in her ear and developed Bell’s palsy. She was prescribed a steroid anti-inflammatory (Prednisone), antiviral medicine (Acyclovir), and a topical cream (Zovirax). Once she got over the initial fear and shock, she was grateful that her problem of facial weakness was not due to a more serious problem, such as a stroke or brain tumor. She began physical therapy and improved slowly. Her story reminded me of the need to educate my readers about cause, diagnosis, symptoms, complications and treatment of Bell’s palsy.
Bell’s palsy, a facial nerve paralysis, occurs when the nerve that is responsible for the movement and sensation of the muscle and skin of the face becomes damaged. The end result of this damage is paralysis of the muscles and numbness of the skin on one side of the face. Typically, the first sign of this disorder is the inability to close one eye or smile on one side of the face. While this problem can occur in any age group, it is rarely seen in people less than 15 or more than 60 years of age. The good news is that most people show signs of improvement within 3-4 weeks and have complete recovery in 4-6 months. The bad news is that reoccurrence can occur on the other side of the face in approximately 10 percent of those affected.
Bell’s palsy is caused by a viral infection. The most common virus is the herpes simplex virus, the same virus that causes cold sores and genital herpes. Other viruses that can cause Bell’s palsy are herpes zoster virus that causes chicken pox and shingles and Epstein-Barr virus, which causes mononucleosis, and cytomegalovirus. When one of these viruses causes inflammation to the facial nerve, it becomes swollen and irritated in the narrow tunnel of bone by the ear. As pressure on the facial nerve increases, damage progresses to the point that the muscles and skin of the face are unable to receive messages from the nerve, leading to paralysis, numbness and other symptoms.
The hallmark symptom of Bell’s palsy is sudden onset of facial muscle weakness and numbness on one side of the face. As a result, it is difficult to close the eye and smile on the weak side. Other symptoms on the affected side can include: the inability to make facial expressions, speak clearly (especially vowel sounds), diminished sense of taste, pain in the area of the jaw or ear, sensitivity of sound, headaches, and changes in production of tears and saliva.
While Bell’s palsy can occur in anyone, it is more common among those who are: pregnant, (especially during the third trimester or first week after birth), diabetic, or suffering from a cold or flu. Also, some research suggests that there may be a genetic predisposition to this problem.
In mild cases of Bell’s palsy, symptoms are completely resolved within 4-6 weeks. As mentioned before, most cases resolve in 4-6 months. However, recovery for those with complete paralysis may vary. For example, permanent facial weakness, facial muscle twitching, and visual problems due to the inability to close the eye, can occur.
Contact you primary care physician immediately, because these symptoms may be associated with a more serious medical condition such as a stroke. Remember, most people with Bell’s palsy make a complete recovery, but early intervention can expedite the process. In severe cases, a neurologist may be consulted. Two commonly used medications are corticosteroids and antiviral drugs. Corticosteroids such as prednisone are strong anti-inflammatory drugs used to reduce the swelling and inflammation on the facial nerve. Antiviral drugs such as acyclovir are used to stop the viral infection that may have caused the inflammation. Studies show that these drugs, when used in combination, are most effective when administered in the first 3 days of the appearance of symptoms.
Physical therapy can also assist in the restoration of facial muscle recovery. Ultrasound with anti-inflammatory drugs, electric stimulation, massage and exercise are commonly performed. While the use of electric stimulation has limited support in the literature, a home exercise program, performed throughout the day, is an essential part of the therapy program. Some simple exercises performed in front of a mirror are: raise eyebrows, bring eyebrows together, open/close eye, fill cheeks with air, suck in cheeks, smile, frown, whistle, say vowels.
Surgery, to relieve pressure on the nerve by removing bone, is rarely performed. Plastic surgery, to improve the appearance of the face, may be an option in cases with permanent paralysis.
Source: Mayo Clinic; WebMD
Contributions: Tina Evans, PTA is a physical therapist assistant at Mackarey & Mackarey Physical Therapy, Consultants, LLC in Scranton, PA.
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 an Associate Clinical Professor of Medicine at The Commonwealth Medical College.
