Part 2 of 2 on prevention of football injuries.
“Prevention of football injuries” is the second of two columns intended raise the level of consciousness and to educate coaches, players and parents about the importance of injury prevention. While most high school programs have certified athletic trainers on staff, local pediatricians, Dr. Anders Nelson and Dr. Dennis Dawgert, are more concerned with the youth football programs. Often, these players are coached by a well-intended, but not well-informed parent without access to trainers or other medical personal at practices and games.
According to the Consumer Product Safety Commission, each year more than 3.5 million sports related injuries in youngster under 15 required medical treatment at a hospital or clinic. One million of those injuries are from football and basketball alone. The American Academy of Pediatrics and the American Academy of Orthopedic Surgeons offers medical information regarding the young athlete (15 and under) and recommendations for injury prevention. High school football is different. Coaches are subject to state regulation (PIAA) and medical personal and athletic trainers are present. However, youth football players may be more vulnerable.
“RICE” Rest, Ice, Compression, Elevation is the best treatment for most minor injuries to provide comfort and prevent further injury until a medical professional is seen.
If the following signs are present, timely medical attention is imperative:
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Part 1 of 2 on prevention of football injuries.
Soon summer football training camps and practice sessions will be in full swing in Northeastern Pennsylvania. At this time each year, I receive several emails from concerned parents regarding heatstroke in football players. For the next two weeks, this column will focus on “Prevention of Football Injuries” in an attempt to raise the level of consciousness and to educate coaches, players and parents about the importance of injury prevention. While most high school programs have certified athletic trainers on staff, I am more concerned with the lack of medical supervision in youth football programs. Often, these players are coached by a well-intended, but not well-informed parent without access to trainers or other medical personal at practices and games.
Anders Nelson, MD and Dennis Dawgert, MD, two local pediatricians who care for many young football players feel prevention is the best treatment for heat stroke. They feel that overweight and poorly conditioned players should be monitored closely by weighing in before and after practice. A player who loses more than 3% body weight is at risk for heat stroke. These players should be required to take more breaks, with more fluid intake before, during and after practice.
Heat stroke one of the most serious heat-related illnesses. It is the result of long term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible. It can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heatstroke is unclear. Prevention is the best treatment because it can strike suddenly and without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals, or back yard activities. The American Academy of Pediatrics and The American College of Sports Medicine has the following recommendations:
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: “Prevention of Football Injuries in Youth Football”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Guest Columnist: Dr. Gary Mattingly
2nd of 2 columns on Swimmer’s Shoulder
Last week, Dr. Gary Mattingly, local physical therapist and anatomy professor at the University of Scranton, Department of Physical Therapy introduced shoulder problems in swimmers. He defined “swimmer’s shoulder” as follows: “Part of the rotator cuff, a group of muscles that stabilize the shoulder passes between the arm bone (humerus) and a bone in the back (scapula). Due to a swimmer’s stroke or the overuse of the rotator cuff with constant lap swimming, the rotator cuff gets repetitively pinched between the two bones. This produces a painful inflammatory condition known as swimmer's shoulder.”
Impingement in the swimmer’s shoulder can occur during the pull-through phase of freestyle. The problem is more likely to occur in this phase if poor technique allows the hand to cross mid-line of the body. Impingement can also occur during the recovery phase of the freestyle and is more common when the rotator cuff muscles are fatigued and inefficient. Lastly, impingement can occur from overuse or overtraining. A competitive swimmer may perform 20,000 strokes per week which may result in inflammation and swelling. The increased swelling of the tendons make them more vulnerable to impingement in the small space between the shoulder bones.
These three types of impingement can be related. Overtraining can lead to shoulder pain if the swimmer continues to swim with fatigued muscles. As the muscles fatigue they will work less efficiently which has two poor consequences. First, the muscles will have to work harder in a weakened condition. Second, the swimmer will have to perform more strokes to cover the same distance, which is overusing already fatigued muscles. Together these factors can result in swimmer's shoulder.
Swimmer's shoulder can be prevented by using proper freestyle stroke. The hand should enter the water with the small finger first and the palm facing inward. When the hand enters the water it should not cross the middle of the body to avoid impingement. For further stroke instruction, seek the advice of a swimming coach.
Swimmers should avoid rapid increases in training distances or frequency of training as this is likely to wear out the shoulder muscles leaving them at risk for impingement and shoulder pain.
Swimmers have a tendency to develop “swimmer’s posture.” Swimmers have tight neck, chest and anterior shoulder muscles that cause them to assume a hunched over posture. This poor posture decreases the distance between the humerus and scapula making the shoulder more prone to impingement. Good posture with head and shoulders back increases the distance between the humerus and scapula. Therefore good posture is a good treatment for swimmer’s shoulder because it decreases the impingement. To address posture concerns, stretching shoulder, chest and neck muscles will help to prevent a swimming posture.
The Nicholas Institute of Sports Medicine and Athletic Trauma suggest the following stretches:
Keep in mind that avoiding bad posture in your day to day activities can help swimmer’s shoulder and remember “Sit up straight!”
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Guest Columnist: Dr. Gary Mattingly
1st of 2 Columns on Swimmer's Shoulder
Enjoy your pool during this heat wave, but don’t overdo it and get “swimmer’s shoulder. Gary Mattingly, PT, PhD. Dr. Mattingly is a professor of anatomy at the University of Scranton, Department of Physical Therapy. He has dedicated most of his professional life to the study, research, and treatment of shoulder problems. At our clinic, Dr. Mattingly works almost exclusively with shoulder patients and he will share his expertise to help you prevent shoulder problems from swimming.
The shoulder is the most complex joint in the body and one that is commonly injured. Shoulder injuries can span all ages and sports. A little league player can experience shoulder pain after a game while their grandmother can experience a similar shoulder pain after working in the garden. However, it is important to keep in mind that not all shoulder pain is the same. Since the shoulder is such a complex joint, many different things can go wrong resulting in pain. A partial list of some of the most common shoulder problems follows:
Arthritis – inflammation of the lining of the joint either caused by trauma such as falling of the shoulder or due to a disease such as osteoarthritis or rheumatoid arthritis.
Frozen Shoulder – when the connective tissue that holds the shoulder together becomes too tight. This limits the shoulder‘s freedom of movement. If you have shoulder pain from trauma, tendonitis, or bursitis and the arm is protected at your side for an extended period of time, you may lose the ability to raise your hand over your head. This is very common in middle-aged females, and diabetics.
Shoulder Dislocation – when the bones “pop out of joint” either caused by trauma or a genetic predisposition.
Torn Rotator Cuff – the rotator cuff is made up of muscles which hold the joint together. A rotator cuff can become torn due to trauma such as falling on the shoulder or following wear and tear from years of overhead activities. Rotator cuff tears are common both in athletes and in the older population.
Impingement – when one or more of the rotator cuff muscles gets pinched between two bones. This is very common and very painful especially when you attempt to raise your hand over your head.
Tendonitis – inflammation of the rotator cuff tendons of the shoulder from impingement and/or overuse.
Bursitis – inflammation of a fluid filled sack that tries to protect the shoulder from impingement.
It is well-known that swimmers are vulnerable to shoulder pain for many reasons. The last three shoulder problems from the above list, (impingement, tendonitis, bursitis) are the most common for a swimmer.
“Sit up straight!” While growing up we must have heard this statement thousands of times from parents and teachers and if you have kids, especially teenagers, you have probably said it a few times yourself. Interestingly, your parents may have been on to something very good if you became a competitive swimmer. New research is demonstrating that good posture may help or even prevent swimmers shoulder.
Part of the rotator cuff, a group of muscles that stabilize the shoulder, passes between the arm bone (humerus) and a bone in the back (scapula). Due to a swimmer’s stroke or the overuse of the rotator cuff with constant lap swimming, the rotator cuff gets repetitively pinched between the two bones. This produces a painful inflammatory condition known as swimmer's shoulder.
One type of pinching or impingement occurs during the pull-through phase of freestyle. The pull-through phase begins when the hand enters the water and terminates when the arm has completed pulling through the water and begins to exit the surface. At the beginning of pull-through, termed hand-entry, if a swimmer's hand enters the water across the mid-line of her body this will place the shoulder in a position which pinches part of the rotator cuff.
A second type of impingement may occur during the recovery phase of freestyle. The recovery phase is the time of the stroke cycle when the arm is exiting the water and lasts until that hand enters the water again. As a swimmer fatigues it will become more difficult for her to lift her arm out of the water, and the muscles of the rotator cuff become less efficient which can also result in impingement.
A third type of impingement may result from simple overuse or overtraining. A competitive swimmer may perform over 20,000 strokes per week. This overuse may cause the muscles and tendons of the rotator cuff to become inflamed and swell. The swelling of the muscles and tendons will make the shoulder more prone to impingement.
Read Dr. Mackarey’s Health & Exercise Forum – every Monday. Next week, read “Swimmer’s Shoulder- Part 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 affiliate faculty member at the University of Scranton, PT Dept.
Enjoy the recent heat wave by getting in the pool! Each summer in Northeastern Pennsylvania people open their pools for fun in the sun. However, this summer I urge you to look at your pleasure puddle in different light…a health spa! It may very well be the exercise of choice for many people. Many have discovered the benefits of moving their limbs in the warm water of a home pool following knee or shoulder surgery. Also, long distance runners who often look for cross training methods without joint compression and arthritis sufferers who are often limited in exercise choices by joint pain from compressive forces when bearing weight, can enjoy the buoyancy effects of water. These are good examples of the benefits or water exercise…aerobic and resistive exercise without joint compression.
Most doctors recommend some form of exercise with arthritis. Pain and fatigue are the most limiting factors for the person with arthritis. Pool exercise may be the answer. With proper technique, adequate rest periods, appropriate resistance and repetitions, water exercise can be very effective.
The following are some of the benefits of water exercise:
1. Start Slowly – Don’t Overdo it
2. Submerge The Body Part that you want to exercise into the water and move it slowly
3. Complete The Range of Motion: Initially 5 times, then 10-15-20-30 times
4. Assess: Determine if you have pain 3-4 hours after you exercise or into the next day. If so, you overdid it and should make adjustments next time by decreasing repetitions, speed, amount and intensity of exercise.
5. Warm-Up. Make sure you warm up slowly before the exercise with slow and easy movements.
6. Advance Slowly. By adding webbed gloves, weighted boots, and buoyant barbells to increase the resistance.
7. Exercises – standing in shallow end of pool
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
As we discussed in last week’s article, hypermobility (joints that are too mobile/flexible)—as demonstrated by the ability to perform tasks such as bending forward and placing your palms flat on the floor without bending your knees—can lead to joint injury, pain and possibly arthritis pain caused by excessive joint movement. This week’s article will discuss how you can improve your stability and strength to protect your shoulder joint, which is commonly injured by excessive motion. If you are not a hypermobile individual, this program can also help improve shoulder function and prevent injury.
The shoulder joint is designed to allow tremendous freedom of movement in order to allow the dexterous hand to reach as many objects as possible. In addition to being mobile, the shoulder must also provide strength and stability for the hand to perform intricate tasks, whether that is throwing a 90-mile-per-hour curve ball for the New York Yankees or playing Rimsky-Korsakov’s “Flight of the Bumblebee” on the violin. However, somtimes the shoulder is too flexible and unstable. This leads to pain, weakness and loss of function. There are several causes of hypermobility or instability in the shoulder.
In some people’s shoulders, the socket of the “ball and socket joint” is too shallow or is shaped in a direction that allows it to move excessively. For other people, the ligaments or the outer layer cartilage (labrum) of the joint are too loose or insufficient. And for some people, the rotator cuff muscles lack tone and strength. Those with shoulder instability often have one or more of these issues, and are vulnerable to problems from excessive motion.
The origin of these problems can be congential – hypermobile joints, like we discussed in the past two weeks, can be something we have since birth. Or, it may come when the joint forced out of place by traumatic event, such as bike, motor vehicle, or sports accident. Many people have shoulder instability from chronic microtraumas that occurred over years of wear and tear from overuse. Professional baseball pitcher Ron Chiavacci is such an example—he suffered a torn labrum and rotator cuff tear from excessive movement from multiple microtraumas that occurred over years of throwing high-velocity baseballs.
Sometimes an unstable shoulder feels like it is loose and wants “come out of joint.” This is called subluxation and is associated with a feeling of the shoulder dislocating. This often causes sudden onset of pain, muscle spasm, and weakness. However, the shoulder never actually comes out of the socket. A more serious and painful problem associated with shoulder instability is shoulder dislocation. This occurs when the head of the humerus in the shoulder comes out of joint from the socket. It is painful, often requires an emergency room visit to put the shoulder back into the joint, and reoccurrence is common. Muscles and ligaments are often stretched or torn during dislocation.
For those who have experienced a sensation of subluxation or instability or for those engaged in high-velocity throwing sports, improving shoulder stability is essential, and the following exercises can assist in this goal. For those with a recent history of dislocation, consult your physician or physical therapist before you attempt these exercises.
For each of these exercises, tie a Theraband® to a fixed surface, such as a door-handle. With your arm in the position described with each exercise, stand far enough from the door that the Theraband® has no slack but is not stretched tightly. Then, without moving your arm, take two steps away from the door, stretching the Theraband®. Hold for a count of 10. Keeping arm still, return to your starting position by taking two steps toward the door. This is one repetition. For each exercise, complete 1 set of 10-20 repetitions.
1. Hold your arm at your side with your elbow bent 90-degrees with the band pulling “in,” across your body. Take two steps away from the door, stretching the Theraband®. Hold for a count of 10. Keeping your arm still, take two steps toward the door. This is one repetition.
2. Hold your arm at your side with your elbow bent 90-degrees. This time, stand with the Theraband® pulling “out,” away from your body. Complete the exercise by taking two steps, as above.
3. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling back, behind you. Complete the exercise by taking two steps, as above.
4. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling forward, in front of you. Complete the exercise by taking two steps, as above.
5. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling “in”, across your body. Complete the exercise by taking two steps, as above.
6. Stand with your arm down by your side, elbow locked straight, and the Theraband® pulling “out”, away from your body. Complete the exercise by taking two steps, as above.
Photos: Gary Mattingly, PT, PhD; Model: Brian Connor
Read “Health & Exercise Forum” – 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 affiliate faculty member at the University of Scranton, PT Dept.
As we discussed in last week’s article, hypermobility (joints that are too mobile/flexible)—as demonstrated by the ability to perform tasks such as bending forward and placing your palms flat on the floor without bending your knees—causes excessive joint mobility that can lead to joint injury, low back pain, and possibly arthritis pain. This week’s article will discuss ways that you can protect your joints by improving your core strength. If you are not a hypermobile individual, this program can also help increase core stability and prevent low back pain.
The focus of core stabilization is the simultaneous activation of the back muscles and the abdominal muscles. Core stabilization exercises create a deep, internal, protective corset around the spine, which helps you maintain stability during all activities.
Improving your strength will help compensate for your joint instability. Your exercise program should challenge your muscles while minimizing impact on your joints.
Initially, you should focus on core stability, which will promote stability at your other joints. Pilates, Swiss ball ®, and Bosu ® exercises are activities that concentrate on your core muscles while simultaneously strengthening the muscles in your arms and legs.
Before you begin core stabilization exercises, it is important to identify the “neutral spine position” (NSP). This position is the most comfortable point between the extremes of an arched-back position and a flat-back position. Once you find your neutral spine position, maintain this during all core stabilization exercises and during your functional daily activities.
The exercises below will help you begin a core stabilization program. You should start with the beginner set and only advance after you can complete each activity while maintaining a neutral spine position: this is essential for those with hypermobility. For photos of all exercises, visit www.mackareyphysicaltherapy.com and search “hypermobility.”
Isometric Belly Tuck: While lying on your back with your knees bent and feet on floor, tighten your belly muscles by tucking your belly and flattening your back into the floor. Hold this isometric contraction for 5 seconds, relax and repeat 10 times.
Isometric Belly Tuck With Heel Slide: Position same as above. While holding the abs tight, slowly slide one heel up and down along the floor and then the other. Repeat 3-5 times with each leg. Rest for 3- 5 seconds and repeat this sequence 5-10 times.
Abdominal Curl: While lying on your back with your knees bent and feet on floor, hold the abs tight. Then, slowly curl your upper body as if you were to lift shoulder blades up and curl chest toward knees. Hold for 3-5 seconds and lower slowly. Repeat 5-10 times.
Isometric Belly Tuck With Bike Pedal: Position same as above. While holding the abs tight, slowly lift heel up like pedaling a bike while letting the heel tap the floor. Repeat 3-5 times with each leg. Rest for 3- 5 seconds and repeat this sequence 5-10 times.
Trunk Rows/Lats on Ball: Sit on exercise ball and face door. Attach exercise band to inside door knob and hold in both hands. Tighten abdominal muscles, pinch shoulder blades together and performing a “row the boat” movement. Return slowly. Focus on trunk core stabilization while performing this exercise by keeping trunk stable.
Muscle endurance is also important and should be addressed with low-impact activities such as cycling, low-impact aerobics, cross-country skiing, elliptical training, and deep-water running. Aquatic exercise reduces joint compression through buoyancy and is helpful when painful musculoskeletal injuries prevent participation in other forms of exercise. Remember, the contraction of the “abdominal core” should be maintained during all exercise and activities to protect those with hypermobile joints.
Proper posture, good body mechanics, and appropriate exercise protect and stabilize your joints. If you notice a progression of your hypermobility or pain despite these efforts, consult your physician who may recommend physical therapy for a more formal, structured program.
Photos: Jennifer Hnatko. Models: Samantha Snead.
Contributor: Janet Caputo, PT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC. She is presently pursuing a doctor of physical therapy degree at theUniversity ofScranton.
If you missed last week's article, go back and read Part 1 on the Hazards of Hypermobility. Next week, read part 3 of 3 on exercises for shoulder instability.
Read “Health & Exercise Forum” – 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 affiliate faculty member at theUniversity ofScranton, PT Dept.
Guest Columnist: Janet Caputo, PT, OCS
Are you hyperflexible? Do people call you a contortionist? Are you the main attraction at parties, like Dominique DelPrete and Amy Simrell Mifka, because you entertain your friends by twisting your arms and legs in gross directions? Do you excel in dance and gymnastics because of your exceptional joint mobility? If you answered “yes” to any of these questions, you may be a hypermobile individual.
Considerable joint laxity is typically more evident in females and younger individuals, but if you are curious about your level of flexibility, take this quick and easy test. If you score 4 or more, you are considered hypermobile (too much mobility/flexibility). The Beighton score1 is calculated as follows:
1. Score one point if you can bend forward and place your hands flat on the floor without bending your knees (see photo).
2. Score one point if your knees will bend backwards (see photo).
3. Score one point for each elbow that will bend backwards (see photo).
4. Score one point for each thumb that will bend backwards to touch the forearm (see photo).
5. Score one point for each hand when you can bend the little finger back beyond 90-degrees (see photo).
Hypermobility is more of a liability than an asset. First, your excessive flexibility can predispose you to musculoskeletal injuries. Second, repetitious and inappropriate use of hypermobile joints causes inflammatory conditions (e.g. tendonitis, bursitis, fasciitis). Third, recurrent sprains, strains, subluxations, and dislocations of the shoulders, knees, ankles, hips, and temporomandibular joints of the jaw (TMJ) lead to chronic, widespread pain. This pain usually develops early in life, progresses over time, and can be debilitating. Early onset of osteoarthritis, a consequence of excessive joint mobility, contributes to chronic pain. If persistent pain interferes with your ability to be physically active, your bone density may diminish.
Hypermobile individuals should be aware of certain activities and situations that make your joints vulnerable to injury and should therefore be avoided. First, since you are not in the circus, stop demonstrating your flexibility with all those funky, weird positions. Second, avoid high-impact, contact, or collision sports (e.g. football, soccer, rugby, and gymnastics), as they increase your risk of joint damage. Third, maintain a healthy weight, because obesity increases stress on your joints and makes your muscles work harder.
One of the best ways for hypermobile individuals to protect their joints is to practice proper posture. Sit and stand tall—do not slouch! Pretend you are a soldier standing at attention with your chin in, shoulders back, and chest out. A sway-back posture with your hips thrust forward and your knees locked backward strains your back and the joints in your legs. Sitting in the “W” position or “Indian style” stresses your knees and is not recommended. Kneeling with your buttocks on your heels while your ankles are pointed downward can injure your knees and ankles. Since most individuals with joint hypermobility have flat feet, throw out those flip-flops, and wear stable footwear with good motion control.
Performing activities with good posture and alignment is called “proper body mechanics,” and these techniques can minimize joint problems. Use a “weight-lifter’s squat” for lifting, which will help protect your spine. Carry objects with your elbows at the sides of your body, instead of reaching out, to reduce stress on your spine and shoulders. Adjust the height of your work surfaces during prolonged tasks (i.e. using computer) to lessen stress on your joints and strain to your muscles. Alternate tasks and schedule regular rest periods to reduce pain and muscle fatigue. Avoid sustained positions, and further minimize joint deterioration by lifting and carrying light loads, and using a hand truck or luggage cart to transport heavier objects.
Improving your strength will help compensate for your joint instability. Next week, read Part 2 of 3, which will provide exercises that improve core stability and help protect hypermobile joints.
Photos: Jennifer Hnatko.
Models: Dominiqe DelPrete, Amy Simrell Mifka, Alexa Merrill.
Guest Columnist: Janet Caputo, PT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC. She is presently pursuing a doctor of physical therapy degree at the University of Scranton.
Read “Health & Exercise Forum” – 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 affiliate faculty member at the University of Scranton, PT Dept.
Reference: Keer R, Grahame, R, eds. Hypermobility Syndrome. Recognition and Management for Physiotherapists. London: Butterworth Heinemann; 2003.
Guest Columnists: Nancy Naughton, OTD, CHT; Casey Burke, DO
Dirk Nowitski has had lots to add to his resume lately: NBA Championship, MVP of the playoffs, and—less glamorous, but still intriguing—a torn tendon in his middle finger. Since the first playoff game against the Miami Heat, there have been many questions and much speculation about the injury to Nowitski’s finger, which was made obvious by the tape on his finger.
The injury Nowitski sustained is referred to as a “mallet finger.” A mallet finger refers to a complete tear of the extensor tendon, which is the tendon that straightens the finger. This injury occurs when a ball or other object strikes the tip of the finger. Often, the tendon tears away from the point where it attaches to the bone. In children, mallet finger injuries may involve the cartilage that controls bone growth.
The finger is usually swollen, red, and painful. The fingertip may droop and will not be able to straighten it on its own.
Your physician may order x-rays to look for a fracture and may then refer you to an orthopedic/hand surgeon.
Some mallet fingers can be treated without surgery. Immediately following the injury, ice can be applied for swelling. Medical treatment should be obtained within one week. Treatment should be more immediate if the nail is detached or there is blood beneath the nail as these may be signs of a more serious injury, such as a nail bed injury or a serious fracture.
Your surgeon may refer you to a hand therapist. Initially, the therapist will make a splint that will fully straighten the fingertip. The splint must be kept in place for six weeks and not be removed. This will allow the injured tendon to heal appropriately. Night splinting may be continued for an additional 4-6 weeks. If the non-surgical treatment is not successful in regaining full extension or adequate finger function then you may be a candidate for surgery. A surgical repair may also be indicated if there are signs of bone fragments or a fracture.
Surgery is performed to reconnect the tendon to the bone. The surgeon may insert a metal pin in the finger to hold the joint straight. The pin would be removed approximately six weeks later.
Conservative and surgical treatments can both be successful, as long as the appropriate treatment is rendered. Although the appearance may not be perfect, the finger usually returns to a normal level of function.
If you do not seek medical attention, both the finger’s appearance and your ability to straighten the finger will not improve.
Other common sports-related hand injuries include “skier’s thumb” and “jersey finger.”
Skier’s thumb is an injury to a ligament at the base of the thumb. This injury occurs when the thumb is forcefully stressed in a direction away from the palm. If the ligament is partially intact, this injury may be treated non-surgically with splinting. A complete tear of the ligament may require surgery followed by immobilization.
Jersey finger is an injury to the flexor tendon on the palm side of the hand, which is responsible for bending your finger. It commonly occurs in football when grabbing the jersey of an opponent who is pulling away. With this injury, the finger would be unable to bend at the tip. Surgical repair is necessary for jersey finger.
As with all injuries, it is important to seek appropriate medical attention and follow the advised treatment recommendation. The injury may hold you back temporarily, but it doesn’t mean you have to be taken out of the game. Just ask Dirk Nowitski.
Sources: www.orthogate.org
Guest Columnists: Nancy Naughton, OTD, CHT is a certified hand therapist, Casey Burke, DO, is a specialist in orthopedic hand surgery; both are associated with Professional Orthopaedic Specialists, LTD, Scranton, PA.
Read “Health & Exercise Forum” – 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 affiliate faculty member at the University of Scranton, PT Dept.
Guest Columnist: Janet Caputo, PT, OCS
Just a few weeks ago, The Scranton Times-Tribune published a column on new research that shows an alarming increase in knee replacement surgery in the last decade. While the number of replacements have doubled for the general population, it reportedly tripled for those 45 to 64 years old: “boomers” who are attempting to stay active at all costs.
Many patients ask what they can do to prevent or limit the progression of knee arthritis. Genetics, age, obesity, knee injury, and knee surgery can lead to osteoarthritis of the knee. Many individuals with knee arthritis experience pain that limits their daily and recreational activities. When pain develops, the body attempts to protect the knee from further injury by inhibiting the knee muscles, which eventually leads to muscle weakness. The muscles supporting the knee also weaken because individuals with knee pain avoid many activities. This cycle of pain and disuse creates a situation that leaves some patients wondering if knee replacement is their only option.
Multiple studies have demonstrated that weakness of the thigh (quadriceps) muscle is associated with arthritic knee pain. But strengthening these muscles, especially the quadriceps, can help reduce the pain and disability associated with knee arthritis.
While studies show that higher quadriceps strength does not necessarily protect against the development of knee osteoarthritis, they have shown that higher quadriceps strength can protect against the progression of knee arthritis and prevent the development of knee pain from the osteoarthritis. Even though knee arthritis still developed, individuals with strong thigh muscles denied pain, aching, and stiffness in their knee joints. This is a significant finding, because it is pain from knee arthritis—not the osteoarthritis alone—that limits patients.
Interestingly, these findings apply to females more than males, and the researchers believed that several factors contributed to this difference. First, woman’s quadriceps strength is generally 60% less than that of a man’s. Therefore, a male’s higher quadriceps strength may already provide greater protection against knee pain associated with quadriceps weakness. Second, women generally have greater knee joint laxity and less joint stiffness than men. Because a woman’s knee joint is already more flexible and their quadriceps weaker than a male’s, women are predisposed to abnormal movement of the knee, which can increase pain with arthritis.
It is important to properly strengthen your quadriceps, because improper strengthening of arthritic knees can contribute to the progression of the disease, causing joint deformity (i.e. knocked knees or bowed legs) and joint laxity. The following are three exercises that you can do at home to properly strengthen your quadriceps muscles.
1. Quadriceps sets: Lying on back with both legs straight, tighten front of thigh to push the back of both knees toward the ground. Hold 5 seconds then relax. Perform 3 sets of 10 repetitions.
2. Straight Leg Raise: Lay on back with uninvolved knee bent and involved knee straight. Raise involved knee to level of bent knee. Hold 5 seconds. Slowly lower to start position. Perform 3 sets of 10 repetitions.
3. Knee Extensions: While seated in a chair, raise leg until knee is straight. Hold 5 seconds. Slowly lower your foot to the floor. Perform 3 sets of 10 repetitions.
Aim to perform these exercises daily. After two weeks, add a 5-pound ankle weight for exercises #2 and #3.
In one study, subjects who performed these exercises daily for 8 weeks experienced decreased knee pain, less knee stiffness, increased quadriceps strength, and improved knee function. Participants with mild arthritic symptoms showed greater improvement than those with advanced osteoarthritis.
Knee pain from osteoarthritis can interfere with your ability to enjoy life. However, appropriate exercise, sometimes combined with other treatments (i.e. injections, bracing), may alleviate the incapacitating symptoms and allow you to engage in the active lifestyle that you desire. Please consult with your physician before performing any exercise routine. Your condition may necessitate referral to a medical professional for appropriate treatment and supervision.
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Guest Columnist: Janet Caputo, PT, OCS specializes in orthopedic and neurological rehabilitation as clinic director at Mackarey & Mackarey Physical Therapy Consultants, LLC. She is presently pursuing a doctor of physical therapy degree at the University of Scranton.
Photos: Jen Hnatko. Model: Dominque DelPrete
Read “Health & Exercise Forum” – 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 affiliate faculty member at the University of Scranton, PT Dept.
