Living with Lower Back Pain: Part III: Prevention of Lower Back Pain
This is the 3rd in a series of 3 articles related to lower back pain.
It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing posture, and using good body mechanics are essential in the prevention of LBP. At our office, great time and effort is spent emphasizing the importance of these concepts.
Kane Trucking is a perfect example of the merit and value of LBP safety and prevention. For the past 6 years, I have served as a rehab consultant for Kane Trucking. During this time, Kane has noticed a significant reduction in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonmics.
As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.
Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.
Perform postural exercises throughout the day. Most of the day you are sitting, standing and reaching forwards flexing your spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the traction of floor. Does it require two people to lift? Can I safely lift that high or bend that low?
Lifting: When bending to lift an object think about safety:
Sitting: When sitting, use an ergonomic chair and work station with a lumbar support and adjustable heights. Get close to your keyboard and monitor. Stand up and perform postural exercises every 45-60 minutes.
Walking: If you walk or stand most of the day, wear good shoes. Avoid high heels and shoes without adequate support like sandals.
Driving: If you drive long distances, use a lumbar support to keep an arch, sit close to your steering wheel to prevent bending forward and stop to stretch using the above postural exercises every 45-60 minutes.
Aerobic exercise will help prevent weight gain and stiffness for a healthier lower back. Perform mild aerobic exercise such as walking 3-5 times per week for 30-45 minutes.
Core stabilization exercises designed to strengthen the abdominal and lower back muscles will help prevent injury. Some examples of core exercises are: (Perform slowly, hold the pelvic tilt 5 seconds, repeat 10 times)
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.
Living with Lower Back Pain. Part II: Diagnosis, Non-Surgical & Surgical Treatment
This is the 2nd in a series of 3 articles related to lower back pain.
People with LBP represent a wide variety of presentations and outcomes. Studies show 85% are fully recovered in 3 months regardless of the intervention. Some of my LBP patients are fully recovered and live normal, active lives, such as Paul Ezbianski, who has run 10 Steamtown Marathons. Others have on occasional and short-term flare-ups of LBP, such as Dr. David Hazzouri, and comfortably golf, ski, weight-train and practice cosmetic dentistry. Unfortunately, others suffer through a life of chronic back pain that occurs more frequently and intensely each year, such as my mother, Angeline Mackarey.
Thorough examination and accurate diagnosis is essential in expediting your complete recovery.
(Rothman)
* Your physician will determine which test is most appropriate for your problem.
A comprehensive team approach includes your primary care physician, orthopedist, neurologist, neurosurgeon and physical therapist. A thorough history and physical exam are important components. The exam includes: muscle strength tests. postural assessment, functional testing, neurological examination of muscle function, reflexes and sensation. Further diagnositic testing may be necessary.
Assess the bones of your spine for abnormal anatomy and can rule out a fracture, slippage of the vertebrae. An x-ray with bending into flexion and extension can detect abnormal spinal motion.
An advance test to diagnose spinal problems involving the bones, discs, nerves and other soft tissues of the spine in more detail than an x-ray.
A special x-ray test used to examine the spinal cord, spinal canal, spinal cord, spinal nerves and discs. A radiologist injects dye into the spinal canal to enhance the view spinal structures. This test can determine if nerve compression from a disc or spinal stenosis and rule out spinal tumor or abscess. Also, a CAT scan can be performed with the myelogram.
A special test with a more detailed view than an x-ray. It is useful to identify boney spinal abnormalities, spinal nerves and fractures.
An electrical test used to identify problems with the nerves from the spine to the extremities. A needle is placed in the muscle to detect abnormal electrical responses from nerve damage from a disc, stenosis, or disease such as diabetes.
A special test using a dye injected into the disc to examine the structure and health of the disc and its relationship to the associated nerve. It is often used before fusion surgery.
(Rothman)
* Your physician will determine which non-surgical treatment is most appropriate for your problem.
Medication for LBP focuses primarily on pain and inflammation. In most cases, over-the-counter anti-inflammatory medications such as ibuprofen (Advil or Motrin) or aspirin (Bufferin) are very effective. These medications can reduce swelling and pain but should not be taken for longer than a few days without consulting your doctor.
Physical therapy (PT) by an orthopaedic physical therapist is recommended for the conservative management of LBP in most cases. Heat or cold, ultrasound, massage, electrical stimulation are often used to decrease pain and promote healing. Manual therapy (manipulation) and traction can be used to decompress the spine and reduce symptoms. Once pain is managed, mild range of motion, strengthening and stabilization exercises are employed. Instruction in proper body mechanics, ergonomics, exercises and a home program is an essential component to the PT program.
If the above conservative measures have failed to provide success in pain reduction and return to activity, often the next step is to consider injection therapy. Three primary injections are: steroid injections (decreases inflammation to the spinal nerve to reduce swelling and pain directly on the nerve), spinal nerve block injections, (interrupts the pain signal from the spinal nerve) and facet joint injections (reduce pain from degeneration and inflammation of the joints in your spine.
Many nontraditional therapies are not scientifically proven but may be worth a trial if the potential benefit outweighs the risk. Some of these include: acupuncture, acupressure, antidepression medication, and glucosamine chondrotin supplements.
(Rothman)
* Your physician will determine if surgical treatment is appropriate for your problem.
Please remember that most people suffering from LBP do NOT require surgery!
80-85% of people with LBP are better in 3 months.
You may be a surgical candidate if :
Discectomy
A surgical procedure performed on patients with a herniated disc in which the herniated part of the disc is removed to relieve pressure, swelling and pain. Once the nerve is relieved of pressure, healing can begin and function restored.
Laminectomy
A surgical procedure performed on patients with spinal stenosis. The lamina, bone that makes up the roof of the spinal canal protecting the spinal cord, is removed. This enlarges the opening for the spinal cord to pass free of impingement. A discectomy can be performed in combination with the laminectomy if necessary.
Spinal Fusion
A surgical procedure performed on patients with instability or abnormal motion in their spine. Two or more vertebrae a fused together using bone graft and/or instrumentation or hardware such as screws plates rods, hooks and wires. A discectomy and/or laminectomy may be performed with the spinal fusion.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” “Prevention of Lower Back Pain”
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.
Living with Lower Back Pain: This is the first in a series of 3 articles related to lower back pain: causes; diagnosis; non-surgical treatment; surgical treatment; prevention
One of the most common problems people come to my office with is lower back pain (LBP). Studies show that 80-90% of adults in the USA will experience lower back pain at one or more times in their lives. The spine consists of 24 moving vertebrae, a fused sacrum and tailbone, and shock absorbing discs between each moving segment. The spine is designed to provide support and protect the spinal cord while remaining flexible for movement and function. Spinal nerves exit the spinal cord at each segment to deliver messages from your brain to your extremities. Pressure on one of these nerves can cause pain, numbness, tingling, or weakness.
LBP can occur from many causes. Some of these include: muscle strain, disc degeneration, arthritis, scoliosis or curvature of the spine, instability from trauma or degeneration, acute trauma from a motor vehicle accident account or a fall. This column, with information from many local health care providers and The Rothman Institute will discuss many causes, tests, and treatment for lower back pain. Many workers are also at high risk for lower back pain. The Occupational Safety and Health (OSHA) and the United States Department of Labor list the following risk factors for LBP:
The following information is based on information from three local spine surgeons, Dr. Pamela Costello, Dr. Allan Gillick, Dr. Philip Hlavak and the Rothman Institute of Orthopedics:
The following is a list of the most common causes of mechanical and degenerative LBP. However, other medical problems such as peptic ulcers, kidney stones, and appendicitis, can cause LBP. Therefore, it is important that you see your family physician if LBP persists.
The disc is comprised of two parts: a soft, jelly like inside surrounded by a harder fibrous outer layer. If the outer layer is weakened and torn by trauma or degeneration, then the jelly-like inner layer can leak or bulge onto the spinal nerve and cause pain, numbness, tingling or weakness in usually one arm or leg. This is most common in the neck (cervical) and lower back.(lumbar) region.
Stenosis means narrowing. Spinal stenosis is a form of arthritis in the spine in which the spinal canal, where the spinal cord travels, narrows due the boney arthritic changes. Pressure on the spinal cord can occur at any level but is more common in the neck and lower back. Symptoms include pain, numbness, tingling or weakness often in both arms and legs.
Degenerative arthritis in your spine causes the discs and vertebrae to shrink. This is often due to the normal wear and tear of aging. Trauma or a history of disc herniation can accelerate this process. Symptoms include pain, stiffness, numbness, and tingling in the arms or legs.
One vertebrae slips in forward malalignment on another and if movement is too excessive may cause pain, numbness, tingling and weakness in the legs. Often this problem is congenital and minor and may not cause symptoms. However, a trauma or degenerative changes may aggravate the condition and cause symptoms.
An abnormal side-to-side curve develops and may cause uneven shoulders, hips, legs and twisted ribs/shoulder blades. Some cases are minor and not painful while more advanced cases may be problematic and require constant medical supervision and monitoring. It is usually a congenital problem.
An abnormal backward bending of the spine usually developing in the middle back (thoracic spine). Overtime, this problem can worsen and cause wedge shape changes in the spine. The deformity is a roundback or hunchback appearance. It is usually a congenital problem.
A spinal problem in which one vertebrae becomes unstable from trauma or degeneration. This may progress and cause deformity and loss of function. In severe cases, the instability may cause pressure on the spinal cord or nerves and lead to pain, numbness, weakness and nerve damage.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” “Diagnosis, Nonsurgical and Sugical Treatment”
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.
I have been advising my patients to exercise, keep active, and walk as long as they can in order to stay mobile and healthy. However, seniors often tell me activities that require prolonged walking is limited by knee pain from arthritis. They often ask, “What is arthritis of the knee? How does it happen? What can I do about it?" I will attempt to answer these questions. However, keep in mind that having knee joint arthritis is not a death sentence to an acitve lifesyle. Dr. Hugo Mori and Dr. Joseph Andriolie have severe osteoarthritis in their knees. Yet, both continue to be very active and enjoy retirement skiing, golfing and playing tennis.
Osteoarthritis is also known as degenerative arthritis. It is the most common form of arthritis in the knee. It is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the knee joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle.
Rheumatoid Arthritis is a form of inflammatory arthritis in which many joints of the body can be affected. It is very destructive to the cartilage, joint and tissues surrounding the joint. It can occur at any age and usually effects both knees.
Post-Traumatic Arthritis is a form of arthritis that can occur following a trauma or injury to the knee. It is a form of osteoarthritis that is triggered years after a fracture, ligament or cartilage injury.
Your family physician will examine your knee to determine if you have arthritis. In more advanced cases you may be referred to an orthopedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones in the knee is getting narrow from wear and tear arthritis. If rheumatoid arthritis is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if you problem if minor, moderate or severe.
In the early stages your treatment will be a conservative, nonsurgical approach, which may include; anti-inflammatory medication, orthopedic physical therapy, exercise, activity modifications, supplements, bracing, etc. You and your family physician, orthopedic surgeon or rheumatologist will decide which choices are best.
When conservative measures no longer succeed in controlling pain and deformity, improving strength and function then more aggressive treatment may be necessary.
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Viscosupplementation of the Knee
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.
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 attaches 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.
Some of you may know JJ Bolock, Abington Heights star tennis player. He came to my office with severe pain on the outside of his elbow after he had recently intensified his tennis workouts and changed his racquet string tension. Others may know Gene Donohue, who came to my office with chronic tennis elbow from golf. Usually, golfer’s elbow is associated with pain on the inside of the elbow. Gene’s problem was an example that golfer’s can also have tennis elbow. 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.
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 you 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!”
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.
Soon summer will be here. It is that time of year when kids begin playing summer sports and attending summer sports camps. It is also a time when injury rates are high due to extreme temperatures, poor conditioning, and poor hydration. One concern I have always had was the fact that well-intended coaches did not always have the information or staff to have an effective plan to prevent or manage injuries. While most little league fields have ice and a telephone, they do not have an adequate plan for warm-up and conditioning, a first aide kit and a lightening prevention and treatment plan.
Conditioning begins during the spring. It includes slow running to warm-up the body for 10 minutes followed by slow, static stretching of the arms and legs. Some examples are:
Proper hydration is essential for the comfort and safety of the recreational and serious athlete. Hydration is critical to maintain cardiovascular function, body temperature and muscle performance. As temperature, humidity, intensity, and duration of exercise increase, so too does the importance of proper hydration. Excessive sweating can lead to a loss of blood volume which requires the heart to work much harder to circulate you blood through your body.
Dehydration is a major cause of fatigue, loss of coordination, and muscle cramping leading to poor performance. Pre-hydration, (drinking before exercise) is the first step in preventing dehydration. Marathon runners, other long distance runners and cyclists often pre-hydrate 1-2 days before a big event. Re-hydration, (drinking during or after exercise) is the second step in preventing dehydration. While athletes may be more vulnerable to dehydration, all persons engaging in exercise would benefit from increased performance, delayed muscle fatigue and pain by maintaining adequate hydration. Proper pre-hydration would include drinking 12-16 ounces of water 1-2 hours before exercise. Athletes with other health issues should consult their family physician before engaging in long distance endurance sports.
A first-aid kit needs to be complete and available at all practices and games. Medical information cards should be completed, filed and available along with emergency contacts numbers of family, physicians, local police and emergency professionals. A first aide kit should include: exam gloves, resuscitation masks/shields, ice bags, cotton roll bandages, roll gauze & gauze pads (2 & 4 inches), elastic wrap (3 & 6 inches), eye wash, eye patch, athletic tape (2 inches), antibiotic ointment, antiseptic and alcohol swipes, shoulder sling, arm & leg air splint, scissors, sun block, insect repellent, and insect sting ointment.
Each year 100 to 600 people die and thousands more are injured due to lightning strikes.
All those participating in outdoor activities, especially baseball and golf are vulnerable. One individual must make the call regarding immediate removal of participants from the field. A coach involved in the game may not be the best person. Access to a phone is essential. A chain of command must be established, communicated and followed. Also, someone should be assigned the duty to watch the weather report and report potential problems to appropriate parties. A designated safe shelter must be provided. Use a 30 second flash-to-bang count system to determine danger and immediately get to a shelter. Do not allow the return to the field until 30 minutes have passed without a flash. Avoid the following: the highest point in an area, water, trees and poles. Assume a lightning safe posture (squat like catcher on balls of feet, feet together, lower head and cover ears) if you have sensations of skin tingling or hair standing on end.
If someone is hit by lightning, administer appropriate first aid and CPR. Immediately call 911 for emergency medical services.
Source: National Athletic Trainer’s Association
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!”
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 football, both American and European. Each fall, as the season begins, many players suffer from pain in the back of their thigh when they pull or strain the hamstring muscle. 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.
Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling.
Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range of motion exercises, strengthening exercises, and supportive compression strapping. Once painfree, a preventative training program is essential to prevent reinjury.
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.
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.
Gerry McNamara has created a wonderful sense of euphoria in Northeastern Pennsylvania! My sons and I have thoroughly enjoyed being part of the excitement. One week before the Big East tournament, many fans felt badly for G Mac because injuries, a poor record and no chance of an invitation to the NCAA tournament marred his senior year at Syracuse. All that changed quickly! First, at his last home game, G Mac experience what very few people ever will – 33,000 fans chanting his name in gratitude. Next, G Mac enters Madison Square Garden like an obsessed William Wallace leading Scotland to freedom in Brave Heart. The 2006 Big East Tournament is nicknamed “McNamara’s Tournament” in honor of its MVP. Wow, how quickly his senior year went from mediocrity to a Cinderella story! All of this adroit athleticism and leadership occurred despite several nagging injuries from wear and tear, bumps and bruises and overuse, including a nagging groin strain. As a result, several readers have asked about the nature groin strains or what I now call, “G Mac Thigh.”
A groin strain is a tear of the muscle fibers of the groin muscle. The groin muscle is group of muscles (adductor muscles) that run from the hip (inner pelvis) and attach to the thigh bone (femur). The adductor muscles work to stabilize the hip during weight bearing activities, such as running. They are very active when an athlete changes direction, especially side to side such as guarding an opponent with a defensive slide. This injury, like others, varies in intensity. Severe groin 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 your hip and groin to determine if you have groin strain. 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 you problem if minor, moderate or severe.
There are many conservative options. You and your family physician or orthopedic surgeon will decide which choices are best.
SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons
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.
Golf with Hip and Knee Replacements: Part I of II
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 the painfree 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. As a result, many active people are eager to use there new joint to continue their active lifestyle. The ability to remain active while not compromising the integrity of the new joint continues to be the source of some controversy. It will be the purpose of this column to review the literature and make recommendations to safely return to golf with a hip and knee replacement.
Over twenty years ago I worked with Paul Remick, and avid golfer who had knee replacements to both knees. After months of extensive therapy he was ready to play golf. However, he was very apprehensive. He decided to insure his safety by inviting the two surgeons who operated on his knees (Dr. Eugene Chiavacci and Dr. Carl Steindel) and me, his physical therapist, to a round of golf at the Country Club of Scranton. I am happy to say that he played well and his knees held up to the task! Since that time many people ask me to discuss playing golf with total joint replacements. Interestingly enough, I discovered Dr. Larry Foster, also known as Dr. Divot, an orthopedic surgeon and avid golfer who is the author of “Dr. Divot’s Guide to Golf Injuries – A Handbook for Golf Injury Prevention and Treatment.” Dr. Divot, who lectures to PGA and LPGA golf professionals, medical doctors and physical therapists across the country, has reviewed the medical literature to determine the safety of golfing with hip or knee joint replacements. This research, as well as surveys from the Hip and Knee Societies of the American Academy of Orthopedic Surgeons, has concluded some interesting and encouraging findings for golfers with hip or knee replacements:
Contributions: Eugene Chiavacci, MD, Rothman Institute, Philadelphia, PA
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” GOLFING WITH HIP & KNEE REPLACEMENT – PART II
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.
Having fun while getting fit are some of the most common concerns patients express to me about exercise. How long will it take? How many calories will I burn? How can I make it fun? Well, there is a new sport that may allow for fun and fitness in a time-efficient manner – Speed Golf!
Normally, a round of golf in a cart burns 240 calories/hour. Jogging burns 675 calories/hour. As a comparison, singles tennis consumes 549 calories/hour. It is fair to say that speed golf should consume between 650 and 850 calories per/hour, depending upon the speed at which you play. It makes golf an exercise for fitness. It does something else – it speeds up play!
Speed golf is a sport in which you combine the positive features of two sports (golf and running) for fun and fitness. A player carries a limited number of clubs to lighten his load and allow him to run while playing golf. While some speed golfers only take two or three clubs, serious players take 5 or 6; driver, 4 wood, 5 iron, eight iron, wedge and putter. Traditional golf limits a player to 14 clubs. Score is dictated by adding the total number of strokes and the total time it takes to complete the round but the scoring system favors the good golfer. It is easier to lower your score by making the shot over speeding up the run. You are required to play traditional rules, rake the sand traps, and take a penalty stroke for a lost ball. Running in a zig-zag and looking for a ball will cost valuable time. Locally, Todd Millett and his partners, Frank Lisk, and Matt Sullivan, can be seen playing a version of speed golf on Sunday mornings at 6:30 AM at The Country Club of Scranton. As a threesome, they play 18 holes in 1 hour and 45 minutes. They seem to have fun and someday I hope to join them for the adventure.
The world record was set 3 years ago at a speed golf tournament in Chicago by Christopher Smith with a six under par 65 in 44 minutes and 6 seconds. A typical round of golf takes approximately 4 hours. He accomplished this feat on a regulation course, carrying only 6 clubs and sprinting in between shots. Smith feels that the lack of time to think about the shot or the swing is a good thing because sometimes you think too much and ruin a good swing. Mr. Smith is a 45 year old PGA instructor in Portland, Oregon who has completed two marathons. One can say he has the advantage of being skilled in both golf and running, making him the perfect person for the sport.
Speed golf has some challenges. One, it must be played at a time when no one is on the course within 13 to 15 holes in front of you. Two, one must be relatively fit to play and run a typical 5 to 8 mile course. Three, one must be a fairly consistent golfer to hit a good shot under such physical stress. Four, putting is difficult to perform well when you are breathing heavy. Speed golf also has some advantages. One, you develop your own routine without a long ritual. Two, you become a better putter under pressure if you learn to “pull the trigger” with exhaling. Three, you can have both fun and exercise when you play speed golf. It has to be more fun, you cannot have high expectations when you swing while running. Lastly, with speed golf, you don’t have to go to the gym for exercise after a round of golf.
SOURCE: The Wall Street Journal
Visit your doctor regularly and listen to your body.
