Whether you are a recreational bicyclist or competitive cyclist it is critical that you and your bike fit well together. A proper fit maximizes comfort and minimizes injury. Last week we discussed how to position handlebars, pedals, seat, at proper angles for the shoulders, trunk, hips and knees. This week, I would like to discuss the benefits of cardiovascular exercise and common problems that develop from biking on an improperly fitted bike.
Biking, like all aerobic exercise, provides all of the following benefits without the added stress of joint compression, and wear and tear associated with many other full weight bearing exercises such as running:
Prevention is the best management of musculoskeletal problems associated with biking. First, as previously discussed in Part I, prevent many of the above problems through proper fitting. Furthermore, it is important that your equipment is in good working order such as tires, chain, brakes and pedals. Next, be sure to maintain a fairly good fitness level in order to bike safely. If you are a beginner, start slowly. Warm up and slowly bike for 10 to 15 minutes and build up over time. Practice the coordination of stopping, starting, shifting and braking. Work on good strength and flexibility of the hamstrings, quadriceps, calfs and gluteal muscles. All of these muscles are necessary to generate pedal force. Balance is also important to safety and can be practiced on and off the bike. Be aware that adaptive equipment can modify your bike for added comfort and safety such as soft handlebar tape, seat post and front fork shock absorbers, cut-out and gel pad saddle seats, and wider tires. Remember, WEAR A HELMET!
Be careful not to progress too quickly because inactivity to over activity in a short period of time can create problems. Overuse injuries such as tendonitis, can be avoided by cross training. Bike every other day and walk, run or swim on off days. Consider sports such as tennis, golf, racquetball on off days. Make sure to take time off to recover after a long ride. Use ice and massage to sore muscles and joints after riding.
Remember, cycling should be fun! Pain from improper fitted and poorly maintained equipment is preventable. Excessive workouts and training rides should be kept to a minimum.
SOURCES: American Physical Therapy Association
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.
Spring has sprung! Dust off your bikes and discover the beauty and challenge of the new biking trails at Lackawanna State Park in Dalton constructed by the Countryside Conservancy, where you might just run into Cathy Guzzi, physical therapist and cycling enthusiast. I have been asked to run this column on cycling for those who may have missed it a few years ago. We are fortunate to have many places to ride for cyclists of all levels, so take advantage of these trails, not only for the exercise, but also for the beauty and tranquility of Penn’s Woods.
Bicycle riding is a great way to get cardiovascular exercise. It is easy, can be done indoors on a stationary bike or outdoors weather permitting. It is kind to your hip, knee and ankle joints. It can be inexpensive and enjoyed by the entire family. However, if not done properly, it can lead to problems. A poorly fitted bike can lead to hip, knee and ankle pain, tendonitis, or back and neck pain. Also, an improper fitting seat can lead to pain and numbness in the peritoneum or saddle and lead to prostrate inflammation and erectile dysfunction. The good news is that with a little effort a properly fitted bike can offer many safe miles of great exercise and health problems can be avoided. The Canadian Physiotherapy Association and Eugene Geeza, physical therapist and cyclist have assisted me in compiling the following recommendations:
Frame size is one of the most important steps to insure a good fit. To be sure that the frame of the bike is right for you, stand over the top cross-bar between the seat and the handlebars. Road bikes should allow 1 inch between the bar and your buttocks while a mountain bike requires 2 to 6 inches of space depending on the terrain and slope of the trail that may require you to get your feet to the ground quickly.
The saddle or seat should be as level as possible. If the seat tilts forward, then you will feel as if you are falling off the seat and your arms and back may take too much weight and stress. If your seat tilts backwards, then you will strain your lower back and too much stress will be placed on your buttocks and saddle area leading to discomfort. Proper saddle height should allow your leg to be just short of full extension, (a 10 to 20 degree angle) without locking the knee, at the bottom of the pedal stroke. If you are shifting your weight with each revolution, then your seat is too high.
Handlebar position has a direct effect on the comfort of your neck, middle and lower back while biking. If the bars are too low or too forward, it will force the rider to stretch and lean over and forward too far. This will stress the spine. If the bars are too high and back, it will force the rider to sit back too far and place more weight on the buttocks and saddle. As a rule, a taller rider is better with a bar that is lower than the saddle height and shorter riders are even or slightly above.
Misalignment of the feet while riding and pedaling repeatedly over many miles can create undue discomfort. In most cases, your feet should point straight ahead. However, due to unique differences in pelvis, hip, and lower leg alignment, a slightly toed out foot (10 to 20 degrees) may be necessary to prevent twisting stress in the legs as you pedal.
EQUIPMENT: Helmets are a must! Also, keep your bike in good condition. Road bikes should have mirrors, reflectors and obey traffic rules. Use hand signals. Dress for weather and visibility. Have a first aide and tire patch kit, pump and tools. Seat comfort can be improved with gel cushion or split seat.
BE ALERT: for traffic, parked cars, pedestrians loose gravel and cracks in the road.
Visit your doctor regularly and listen to your body.
Read Part 2, cycling tips.
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.
Osteoarthritis slowly develops in the weight-bearing joints, most commonly in the hip and knee, creating pain, stiffness, swelling and loss of function. There are many nonsurgical options such as: rest, weight loss, medication, physical therapy, steroid injections, and viscosupplementation injections. However, when conservative measures fail, surgical intervention, such as a joint replacement, becomes the next option. A total joint replacement uses a prosthesis to replace the end of the bone damaged from arthritis. These new metal and plastic surfaces in the joint allow pain free movement and function in the hip and knee. These procedures have been performed since the early 1970’s. The outcomes for active people continue to improve with advances in technology, prosthetic materials and new techniques. It will be the purpose of this column to present two new options in hip replacement surgery that may have promise for extending the life of the implant in younger, more active patients.
Surface replacement of the hip is an alternative to a traditional total hip replacement in which the thigh bone (femur) and the hip joint of the pelvis are preserved as much as possible while resurfacing only the ends of the bones. IT is best used in younger and more active patient. Just as in the traditional total hip replacement surgery, this alternative procedure is indicated for osteoarthirits, avascular necrosis and traumatic arthritis of the hip joint. While the traditional replacement is very successful and allows the patient to return to pain-free activity, the implant can wear out or loosen over time. When this occurs, pain and loss of function return. A traditional hip replacement removes the head and neck of the femur resulting in significant bone loss. This may complicate a revision when necessary. A surface replacement preserves the bone and sculpts a metal cap and short stem prosthesis over the end of the bone. A Two advantages of this technique are: the preservation of the bone allows the use of a much larger ball size. This permits greater stability of the hip joint leading to a a dislocation rate of 10 times less likely. Secondly, the resurfaced hip, with less bone loss has a greater success rate in the event of a revision. Therefore, younger, active patients, who may wear out a prosthesis sooner, will be less likely to dislocate and have a better outcome when they have a second hip implant. Previously, one would encourage patients to wait until they were older to have a replacement. They would be less active and less likely to live long enough to outlast their new hip. Resurfacing changes the outlook.
As with the traditional hip replacement, overall the risks are small. Some include loss of blood, blood clots, and infections. To a lesser degree than traditional hip replacement, there is a risk of dislocation and implant wear.or loosening. A risk unique to the surface replacement is due to the metal-on-metal bearings. While this may lessen wear and tear of the implant, it has been shown to cause metal ions to be dispersed through the body. It is measured in the bloodstream and has not been shown to cause cancer or other disease in humans. There is a 2% risk of fracture due to the the maintenance of more bone in the femur. However, if the patient maintains partial weight bearing status for 3-4 weeks for the bone to heal, this is rare. There is also a 1% chance of injury to the sciatic nerve due to increase work around the bone by the nerve. This may lead to transient weakness of the leg muscles. Stiffness may occur in some patients due to extra bone forming around the hip. Medications is used to limit this risk.
As with any new technology or procedure, it is unclear what the long term outcomes will be. The short term results at 4-6 years are very encouraging given the young age and increased activity level of the patient. However, it is too early to tell if this new technique is superiors to the traditional total hip replacement long term.
Improvements in hip implant design and materials continue to be introduced. Whether an implant is best for you is something to discuss with your orthopedic surgeon. It will be dependent on your goals, activity level, general health, and age.
Sources: Mayo Clinic, Minn; Hospital for Special Surgery, New York, NY
Read Part 1 on hip resurfacing.
Visit your doctor regularly and listen to your body.
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 Author: Janet Caputo, PT, OCS
Shin splints are to runners what tennis elbow is to tennis players. The repetitive microtrauma of the heel/foot strike on the ground often leads to pain in the shins of runners, hikers and laborers. When shin pain lasts more than a day or two following the activity, it is
often referred to as a shin splint. Foot/leg alignment, footwear, surface type, mileage, speed and sudden change in training can all contribute to this dreaded problem.
There are two types of shin splints: anterior or front of the shin and medial or inner border of the shin. The anterior shin splints may occur with a rigid (supinated, high arched) foot, but either may result from a floppy, flat foot (pronated). Therefore, the mechanism of injury and evaluation of intrinsic foot biomechanics are pertinent pieces of information in order to initiate appropriate treatment.
Anterior shin splints are caused by overuse of the muscles located in the front of the lower leg (Tibialis Anterior, Extensor Digitorum Longus and Brevis muscles). This can occur in a high arched foot if the athlete runs on hard surfaces or downhill, but may also develop in a flat foot since the Tibilias Anterior muscle assists in controlling the arch. This athlete will experience pain at the lower 1/3 of the outer border of the lower leg which will increase when the muscles contract or are stretched. Your podiatrist or family physician must rule out a stress fracture and a compartment syndrome, which would require medical intervention.
Medial shin splints result from overuse of the muscles on the inside of the shin (tibialis posterior) creating a tendonitis from excessive flattening of the arch due to a flat foot. This occurs because the tibilias posterior muscle has the most effective control over this abnormal, excessive flattening of the arch. This athlete may report either a rapid increase in mileage or running on crowned roads or up steep hills. Pain will usually be experienced 4-6” above the inside ankle bone and may also be elicited with resistance applied to the tibialis posterior muscle. Your podiatrist or family physician must rule out tarsal tunnel syndrome and stress fracture since they may present with similar symptoms.
Proper evaluation by a podiatrist and a physical therapist will determine if you are a rigid (supinated) or a flat (pronated) foot type. Once this determination is made appropriate treatment will begin.
If your foot is rigid and lacks shock absorption, you may benefit from:
If your foot is flat and/or floppy, you may benefit from:
In summary, to prevent the unwanted shin splints, be aware of foot type and shoewear as well as training regimen, surface, and intensity. If a foot abnormality is suspected, appropriate evaluation by your podiatrist or family physician with a referral to a orthopedic/sports physical therapist is needed to avoid future complications.
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
Janet M. Caputo, PT, OCS – guest columnist is an associate and clinic director at Mackarey Physical Therapy where she specializes in outpatient orthopedic and neurologic rehab. She is presently working on her doctorate in physical therapy from the University of Scranton.
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.
Osteoarthritis slowly develops in the weight-bearing joints, most commonly in the hip and knee, creating pain, stiffness, swelling and loss of function. There are many nonsurgical options such as: rest, weight loss, medication, physical therapy, steroid injections, and viscosupplementation injections. However, when conservative measures fail, surgical intervention, such as a joint replacement, becomes the next option. A total joint replacement uses a prosthesis to replace the end of the bone damaged from arthritis. These new metal and plastic surfaces in the joint allow pain free movement and function in the hip and knee. These procedures have been performed since the early 1970’s. The outcomes for active people continue to improve with advances in technology, prosthetic materials and new techniques. It will be the purpose of this column to present two new options in hip replacement surgery that may have promise for extending the life of the implant in younger, more active patients.
Surface replacement of the hip is an alternative to a traditional total hip replacement in which the thigh bone (femur) and the hip joint of the pelvis are preserved as much as possible while resurfacing only the ends of the bones. It is best used in younger and more active patients. Just as in the traditional total hip replacement surgery, this alternative procedure is indicated for osteoarthritis, avascular necrosis and traumatic arthritis of the hip joint. While the traditional replacement is very successful and allows the patient to return to pain-free activity, the implant can wear out or loosen over time. When this occurs, pain and loss of function return. In a traditional hip replacement the surgeon removes the head and neck of the femur resulting in significant bone loss. This may complicate a revision if necessary. The surface replacement preserves the bone by inserting a metal cap over the cup-shaped top of the hip joint. A short-stem prosthesis (as opposed to a long stem) is placed over the end of the hip ball-shaped bone. Two advantages of this technique are: preservation of the bone allows the use of a much larger ball size. This permits greater stability of the hip joint leading to a dislocation rate of 10 times less than traditional replacement. Secondly, the resurfaced hip, with less bone loss, has a greater success rate in the event of a revision. Therefore, younger, active patients, who may wear out the prosthesis sooner, will be less likely to dislocate and have a better outcome when they have a second hip implant. Previously, one would encourage patients to wait until they were older to have a replacement. In part, due to the fact that they would be less active and less likely to live long enough to outlast their new hip. Resurfacing changes the outlook.
As with the traditional hip replacement, the risks are small. Some include loss of blood, blood clots, and infections. To a lesser degree than traditional hip replacement, there is a risk of dislocation and implant wear or loosening. A risk unique to the surface replacement is due to the metal-on-metal bearings. While this may lessen wear and tear of the implant, it has been shown to cause metal ions to be dispersed through the body. It is measured in the bloodstream and has not been shown to cause cancer or other disease in humans. There is a 2% risk of fracture due to the preservation of more bone in the femur. However, if the patient maintains partial weight bearing status for 3-4 weeks after surgery for the bone to heal, this is rare. There is also a 1% chance of injury to the sciatic nerve due to increase work around the bone by the nerve. This may lead to transient weakness of the leg muscles. Stiffness may occur in some patients due to extra bone forming around the hip. Medications are used to limit this risk.
As with any new technology or procedure, it is unclear what the long term outcomes will be. The short term results at 4-6 years are very encouraging given the young age and increased activity level of the patient. However, it is too early to tell if this new technique is superior to the traditional total hip replacement long term.
Improvements in hip implant design and materials continue to be introduced. To decide which implant is best for you, discuss the details with your orthopedic surgeon. It will be dependent on your goals, activity level, general health, and age.
Sources: Rothman Institute, Philadelphia, PA, Hospital for Special Surgery, New York, NY. www.mayoclinic, www.health.harvard.edu, www.hss.org
Visit your doctor regularly and listen to your body.
Read Part 2 on hip resurfacing.
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.
Walking upright is one of the most fundamentally unique skills of human beings. This basic skill, along with the ability to reason, distinguishes Homo sapiens from other mammals. In fact, the development of the human brain was only realized through the advancement of and ability to walk with an erect posture to free the hands for the manipulation of tools. From birth, walking is considered a developmental landmark. In time, we perfect walking and advance to running and jumping. This attitude continues throughout adulthood to be the “gold standard” of health and wellness until our last breath. For example, the first question patients ask me when recovering from surgery or injury is “when can I walk?” As we age, we fight hard to maintain the ability to independently walk and be mobile. We use crutches, walkers, wheelchairs and scooters to keep mobile. Walking is essential for our physical and emotional well-being, preventing blood clots, pneumonia and depression. Now, thanks to new technology, a computerized walking assistance device may be the answer for many who are too weak to walk and climb stairs independently, yet too strong and determined not to try.
At the risk of sounding like a commercial, I think it is important to understand the history and mission of the company that developed this new technology. In 1946, Soichiro Honda established his company in Hamamatsu, Japan to produce small motorcycles and 2 years later it became Honda Motor Co. Ltd. In 1959 Honda opened its first store in Los Angeles where it continued to produce innovative motorcycles until 1973 when it produced the Honda Civic automobile in response to America’s first energy crisis. The global corporate mission has always embodied building dreams by producing products that improve human mobility, Honda recently applied technologies from their research and development to enhance the safety and mobility of people with gait dysfunction.
In April of 2009, after 10 years of research, the American Honda Co. Inc. introduced its prototype walking assist device in the US. The device is intended to provide additional support while walking for the elderly or those with weak leg muscles. The company offers two walking assist devices; the Stride Management Assist and the Bodyweight Support Device.
The Stride Management Assist is a lightweight device targeted for those with weak leg muscles but can still walk on their own. Using sensors at the hip, it gathers information and calculates the appropriate timing and stride assistance necessary for the individual to walk with less effort.
The Bodyweight Support Assist also provides support to those with weak leg muscles to improve walking. Additionally, it provides support during physically demanding daily activities such as ascending or descending stairs. The load on the leg muscles at the hips, knees and ankles is reduced while the individual maintains a semi-crouched position. While also being light-weight, it has a simple seat, frame and shoe components and allows walking at a rate of 4.5 mph.
For photos of the Honda Walk Assist, visit this link.
Honda® Walking Assist Prototype Device's Features:
Why all this effort? Research strongly supports the benefits of walking and physical activity for mental and physical health. Some of the more important benefits are:
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.
Participating in spring sports in the cool temperatures of NEPA presents many challenges, not the least of which are hamstring injuries. New research shows that these injuries can be prevented by following a specifically designed intensive training program. Last week we presented the definition, cause and symptoms of the problem while this week will be dedicated to diagnosis, treatment and prevention.
A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating.
Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from you lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.
There are many conservative options. You and your family physician or orthopedic surgeon will decide which choices are best.
A recent study in the British Journal of Sports Medicine determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:
SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
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.
Hamstring strains are very common in almost all sports. Moreover, participating in spring sports in the cool temperatures of NEPA presents additional challenges. Each March our clinic has many players limp in with pain in the back of their thigh when they pull or strain the hamstring muscle during track and field, baseball, and tennis. New research shows that these injuries can be prevented by following a specifically designed intensive training program.
A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating. This injury, like others, varies in intensity. Severe hamstring strain occurs when many muscle fibers are torn. In very severe cases, the boney attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.
Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from you lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.
There are many conservative options. You and your family physician or orthopedic surgeon will decide which choices are best.
A recent study in the British Journal of Sports Medicine determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:
SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
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.
Thank you for reading “Health & Exercise Forum!” Special thanks to those corresponding with constructive comments and sage questions. The column should reflect your interests. This column is in response to an inquiry of one such reader on the training supplement, creatine. A few weeks ago, I received a request from a concerned mother of a local high school football player. Her son is spending the winter and spring weight training for next football season. He has been using protein shakes and wants to use creatine supplements to improve his size and strength. His mother is concerned and asked if I would address the use of creatine in strength training and make recommendations based on the literature.
As long as I can remember, young athletes would take or do anything that they believed would improve their speed, strength, agility and athletic edge in order to succeed in sports. Running with weights wrapped around the ankles, drinking raw eggs and whole milk, and consuming copious amounts of beef, pork, and chicken were not unusual. Today, it may not be much different. However, the products do not come from our kitchen cabinet and tremendous misinformation is associated with it. Creatine is one example that was purported to enhance performance as early as the 1970’s but only gained popularity in the 1990’s. 40% of all college athletes and 50% of professional athletes admit to using creatine at some point, despite a lack of scientific evidence to support its effectiveness or safety.
Creatine is a natural substance that turns into creatine phosphate in the body. Creatine phosphate helps produce adenosine triphosphate (ATP), which provides energy for muscles to contract. While the body produces some creatine, it can also be found in foods rich in protein such as meat and fish. Manufacturers claim that creatine use will improve strength, increase lean muscle mass and aide in the recovery from exercise induced fatigue.
While creatine is popular among young people due in part to its availability, very little research has been done in people under 18 years of age. Even in the few studies conducted on adults, the results regarding efficacy are mixed. Some studies show that creatine may improve strength performance due to the recovery cycle of ATP. In theory, the use of creatine is purported to allow one to recover more quickly from exercise. For example, shortly after lifting heavy weights to failure, a quick recovery might allow the weight lifter to lift an additional set of repetitions to increase the duration of intensive training. Therefore, based on this theory, one must work out to complete failure during training to benefit from creatine. However, it is important to remember, there is no evidence that this purported benefit is realized in performance improvement. Furthermore, no studies support the notion that it improves performance in endurance sports. Also, research does show that not all users are affected by creatine the same way. Most users fail to find any benefit at all. More concerning to this author is the fact that there are no guidelines for safety or disclosure of side-effects from long term use. Make no mistake, based on the research and current wisdom, CREATINE IS AN UNPROVEN TREATMENT SUPPLEMENT!
If one decides that creatine is a product they would like to use, despite the lack of evidence for its effectiveness, there are recommendations that one should follow for proper use. But, there is no established dose.
Remember, an average adult in the United States receives 1 to 2 grams of creatine each day from a normal, well-balanced diet. Creatine is naturally found in meat, poultry and fish. Manufacturers recommend 10 to 30 grams per day with a maintenance dose of 2 to 5 grams per day for athletic performance. Creatine is available in many forms; tablets, capsules and powder. It should be kept in a cool, dry place out of direct sunlight.
There are many reported side effects associated with creatine use such as; water retention, nausea, diarrhea, cramping, muscle pain and high blood pressure. It is recommended that one use large quantities of water when taking creatine to prevent dehydration. It may be very dangerous to use creatine when dehydration or weight loss is associated with an activity such as wrestling or summer sessions during football. Furthermore, some studies show that large amounts of carbohydrates may increase the effects of creatine and caffeine may decrease the effects. Users are warned that using creatine with stimulants such as caffeine and guarana (a Brazilian plant extract similar to caffeine found in energy drinks) can lead to serious cardiac problems. The effects of creatine supplements on the many organ systems of the body are unknown. Furthermore, it is also not known how it may interact with other supplements, over-the-counter medications and prescription drugs.
I had the opportunity to interview Coach Jack Henzes, legendary coach of the very successful Dunmore High School football program. It is obvious why he has enjoyed many winning seasons. He insists that his players avoid supplements and practice good nutrition with intensive strength training. He has signs posted in the gym that clearly state, “Creatine is NOT Permitted!” To insure that his players are not influenced by poor practices and supplements available in gyms, he requires all players to exercise under the supervision of the coaching staff. His son, local orthopedic surgeon, Jack Henzes, MD has counseled his father on this and other matters related to dietary supplements and has served as a medical reviewer for this column.
In conclusion, creatine is a popular, easily available supplement purported to improve strength, endurance and performance in athletes. However, the research and current wisdom clearly fails to support these claims. CREATINE IS AN UNPROVEN TREATMENT SUPPLEMENT!
Sources: University of New England; Medicine & Science in Sports & Exercise; Jack Henzes, Sr., Football Coach, Dunmore High School
Medical Reviewer: Jack Henzes, MD, orthopedic surgeon, Scranton Orthopaedic Specialists
Visit your doctor regularly and listen to your body.
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.
The last two weeks have been dedicated to the signs, symptoms, prevention and treatment of blood clots. This column is specifically for the health and wellness of the long distance traveler. Just last week the risk of blood clots while traveling in an airplane was brought to my attention by Catherine Adamo. Catherine made this inquiry while preparing for her first trip to Europe where she plans to spend 9 days in Italy this next month. While I am very excited for her, I want her to travel safely!
Have you noticed that being on an airplane for five or more hours causes neck, back and legs soreness and stiffness? It is important to prevent this problem on long trips, especially with air travel. Also, as people age and/or develop other health problems, they are more vulnerable to develop deep vein thrombosis (DVT). I present some valuable tips from research and personal experience on how to prevent neck, back and leg pain and stiffness and prevent DVT.
A DVT is a blood clot that forms in a deep vein. The deep veins pass through the muscles and cannot be seen like the veins just under your skin. While it may occur in your arms, it is much more common in the legs, especially the calf muscle when traveling. When a blood clot forms in a leg vein it usually sticks to the vein wall. Often, pain and swelling lead you to the doctor and treatment is rendered before serious complications develop. However, there are two possible complications. One, a pulmonary embolus, occurs when a part of the clot logged in your deep vein of the calf breaks off and gets lodged in the lung. This is a very serious problem that can be fatal. Two, post-thrombotic syndrome, occurs when you have pain and swelling in the calf after a DVT.
The following risk factors for DVT significantly increase the potential for problems when traveling on long trips by air more than 5 hours. Trains, cars and buses also create a risk, but air travel creates a greater risk for the following reasons: reduced cabin pressure, reduced cabin oxygen levels, dehydration and alcoholic drinks, which may increase dehydration and immobility.
Airplane seats are “C” shaped and force you to round your neck and back forwards. These exercises are designed to stretch and extend your back in the opposite direction. Please perform slowly, hold for 3-5 seconds and repeat 10 times each hour.
Sitting: When sitting in an airplane seat, take the neck pillow in the overhead compartment and place it in the small of your lower back. While sitting or standing up, perform postural exercises every 30-45 minutes.
Visit your doctor regularly and listen to your body.
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.
