(This is the first in a series of 2 articles related to diabetes: Definition/Causes; Treatment/Exercise)
Diabetes is disease in which the hormone insulin is not adequately produced or used by the body. Insulin is needed for cells to take up glucose after it is broken down from sugars, starches and other food that we eat. When working properly, this provides the fuel necessary for activities of daily living. While the exact cause is not completely understood, genetics is known to play a big role. However, environmental factors such as obesity and inactivity have been found to play a big role.
According to the American Diabetes Association (ADA), 7% of the population in the United States or almost 21 million adults and children has diabetes. Unfortunately, one-third of these people are not aware that they have the disease.
A Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT) can be used to screen a person for diabetes or pre-diabetes. Due to the fact that it is easier, quicker and cheaper, the FPG is the recommended test by the ADA. A FPG test between 110 and 125 mg/dl indicates pre-diabetes. A FPG of 126 mg/dl or higher indicates diabetes.
Type 1 diabetes occurs when the islet cells of the pancreas are destroyed to produce insulin. Without insulin the cells of the body are unable to allow glucose (sugar) to enter the cells of the body and fuel them. Without the hormone insulin, the body is unable to convert glucose into energy needed for activities of daily living. According to the ADA, 5-10% of Americans diagnosed with diabetes has type 1. It is usually diagnosed in children and young adults.
While type 1 diabetes is serious, each year more and more people are living long, healthy and happy lives. Some conditions that may be associated with type 1 diabetes are: hyperglycemia, hypoglycemia, ketoacidosis and celiac disease. Some things you will have to know: information about different types of insulin, different types of blood glucose meters, different types of diagnostic tests, managing your blood glucose, regular eye examinations, tests to monitor your kidney function, regular vascular and foot exams.
While symptoms may vary for each patient, people with type 1 diabetes often have increased thirst and urination, constant hunger, weight loss and extreme tiredness.
Type 1 diabetes increases your risk for other serious problems. Some examples are: heart disease, blindness, nerve damage, amputations and kidney damage. The best way to minimize your risk of complications from type 1diabetes is to take good care of your body. Get regular check ups from your eye doctor for early vision problems, dentist, for early dental problems, podiatrist to prevent foot wounds and ulcers. Exercise regularly, keep your weight down. Do not smoke or drink excessively.
Type 2 is the most common type as most Americans are diagnosed with type 2 diabetes. It occurs when the body fails to use insulin properly and eventually it fails to produce an adequate amount of insulin. When sugar, the primary source of energy in the body is not able to be broken down and transported in the cells for energy, it builds up in the blood. There it can immediately starve cells of energy and cause weakness. Also, over time it can damage eyes, kidneys, nerves or heart from abnormalities in cholesterol, blood pressure and an increase in clotting of blood vessels. Like type 1, even though the problems with type 2 are scary, most people with type 2 diabetes live long, healthy, and happy lives. While people of all ages and races can get diabetes, some groups are at higher risk for type 2. For example, African Americans, Latinos, Native Americans and Asian Americans/Pacific Islanders and the aged are at greater risk. Conditions and complications are the same as those for type 1 diabetes.
People with type 2 diabetes experience symptoms that are more vague and gradual in onset than with type 1 diabetes. Type 2 symptoms include feeling tired or ill, increased thirst and urination, weight loss, poor vision, frequent infections and slow wound healing.
Gestational diabetes occurs in about 4% of all pregnant women in the United States each year according to the ADA. If you develop diabetes during pregnancy there is a 50% chance you will develop type 2 diabetes later in life.
According to the ADA, pre-diabetes, or impaired glucose tolerance, occurs when blood glucose levels are higher than normal (110 to 125mg/dl) but below type 2 diabetes levels (126mg/dl). 54 million Americans have pre-diabetes in addition to the 20.8 million with diabetes.
* Your physician will determine which treatment is most appropriate for your problem. However, maintaining your ideal body weight is always important!
**This column is based on information from local physicians Kenneth Rudolph, MD, Gregory Borowski, MD and the American Diabetes Association.
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: Nancy N. Wesolowski, OT, MS, CHT
My colleague, Nancy Wesolowski is an occupational therapist specializing in rehabilitation of the hand and upper extremity. We have been working together for many years and I am always amazed by the variety of hand problems she encounters. I asked her to discuss the most common problem she treats in our office. This problem affects the carpenter, typist, truck driver, jackhammer operator, violinist, pianist and court stenographer. They all ask the same question, “Do you think I have carpal tunnel syndrome?” Over the past 10-15 years, carpal tunnel syndrome has moved to the forefront in medicine and has become water cooler conversation. So what is carpal tunnel syndrome and how is it treated?
Carpal tunnel syndrome (CTS) is a nerve disorder caused by compression of the median nerve at the wrist. The median nerve is one of three main nerves that provide sensation to the hand. This nerve specifically supplies sensation to the thumb, index, middle, and half of the ring finger. In CTS, compression on the median nerve occurs as it travels through a narrow passage in the wrist called the carpal tunnel. The carpal tunnel is formed by eight bones in the wrist (the floor of the tunnel) and the transverse carpal ligament, a strong ligament traveling across the roof of the tunnel. Within the tunnel there are nine tendons, which are a bit smaller than a pencil. These tendons share this space with the median nerve. In the case where there is swelling on the structures in the carpal tunnel, a person can experience pins and needles, numbness, and aching in the hand.
To be properly diagnosed, a physician will discuss your symptoms and medical history, and examine strength and sensation. A nerve conduction study, electromyography (EMG), and x-ray may be ordered to provide information regarding sensation in the median nerve distribution and confirm compression at the carpal tunnel.
Treatment focuses on the causes. Therefore treatment suggestions may include activity modification and postural changes during activities. Other suggestions may include frequent rest periods, elevation, and exercises or stretching. Wrist splints are effective in relieving compression at the carpal tunnel and are typically recommended for night wear. Appropriate fit of the splint is vital. Occupational therapists or certified hand therapists can check the fit of pre-fabricated splints or can fabricate a custom splint. The above mentioned treatments all focus on decreasing inflammation and compression on the median nerve.
Your physician may order pain relievers or anti-inflammatory medication. A cortisone injection into the carpal tunnel may also be recommended to assist with decreasing inflammation near the carpal tunnel.
A referral to an occupational therapist or certified hand therapist may be made. A therapist can provide information regarding the diagnosis, appropriate treatment, and symptom reduction. They can make recommendations to introduce into daily activities to allow appropriate positioning of the upper extremities. A therapist will also instruct individuals on helpful stretching exercises or fabricate a wrist splint. Other treatments include ultrasound, iontophoresis, and massage. The focus of therapy is to introduce changes and interventions that reduce inflammation at the carpal tunnel to assist with symptom relief.
Surgery, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.
Read Dr. Mackarey’s 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: Dr. Gregory Cali
In response to an email inquiry about exercise for people with lung disease, I have asked a local pulmonologist (lung doctor), Gregory Cali, DO, to address this topic as a guest columnist.
Chronic obstructive pulmonary disease (COPD) has become the fourth leading cause of death and is one of the only major chronic diseases which has seen an increase in mortality rates. COPD includes emphysema, chronic bronchitis and asthma.
Patients with COPD suffer from progressive shortness of breath, cough, wheeze, and sputum production. Most patients with emphysema have been cigarette smokers.
Patients with emphysema develop obstruction to airflow as a result of narrowing of bronchial tubes due to excess mucous, smooth muscle constriction, and destruction of lung tissue. Eventually, the lungs become overdistended, which leads to overexpansion of the chest itself. This process leads to the so-called''barrel chest'' appearance of patients with advanced COPD.
The most common symptom of COPD is shortness of breath. Initially the patient complains of shortness of breath only with exertion, but symptoms progress over time to include difficulties even at rest. Eventually the disease worsens to the point that oxygen is required and the patient may become severely disabled. Treatment of COPD starts with smoking cessation, and, when symptomatic, patients are started on inhaled bronchodilator medications. Some of these medications include albuterol, ipratropium, titotropium, and inhaled steroids. Long-acting bronchodilators such as formoterol or salmeterol and theophylline
medications may be added. Oxygen is added when the patient's own oxygen level falls to a certain point. In fact, oxygen is the only therapy that has been shown to prolong the life of patients with COPD.
Over time, patients with COPD decrease their level of activity due to the sensation of shortness of breath. This downhill slide eventually leads to a very sedentary existence. Recent studies have shown that COPD not only affects the lungs, but is a condition which affects the diaphragm and the peripheral muscles. Patients with COPD have been shown to have abnormal limb muscles as a result of deconditioning and systemic inflammation.
Pulmonary rehabilitation has been shown in numerous studies to decrease the shortness of breath associated with COPD. Exercises to strengthen the arms are helpful to assist patients in performing activities of daily living such as combing hair, cooking, and reaching objects above their heads. Walking and riding a stationary bike are helpful to exercise the leg muscles, especially the large thigh muscles.
Despite the fact that exercise programs may not improve lung function, the patients overall level of function is almost always improved. Patients who participate in rehab programs have less shortness of breath, are less likely to be hospitalized, and have improved functional capacity. These patients have lower rates of healthcare utilization, and improved overall health status and quality of life scores.
The ideal pulmonary rehabilitation program includes smoking cessation training, breathing and relaxation exercises, nutritional information, and training in proper use of medications. The most important feature of a pulmonary rehab program, however, is aerobic exercise involving the arms and legs. Pulmonary rehabilitation is an integral part of the treatment of a patient with COPD, and should be considered in any patient who can tolerate exercise. A cardiac stress test should be done to ensure that there are no occult coronary artery blockages or cardiac rhythm abnormalities.
In summary, COPD is a growing cause of disability, morbidity, and mortality. Medications, oxygen, and pulmonary rehabilitation can help to improve symptoms and quality of life. The combination of bronchodilator medications with pulmonary rehabilitation is the most effective approach when treating patients with COPD. Pulmonary rehab should be offered to every patient with COPD to attempt to improve their functional status.
Some simple suggestions for beginning an exercise program are:
AEROBIC EXERCISE:
WEIGHT TRAINING:
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, 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.
Guest Columnist: Matthew Scalese, DPT
Pittsburgh Steelers Head Football Coach Bill Cowher recently drew harsh criticism for deciding to start injured quarterback Ben Roethlisberger just one week after sustaining a concussion and being knocked momentarily unconscious. That criticism was fueled by the fact that Big Ben preceded to throw 4 interceptions in the game (2 returned for touchdowns) and single handedly lost the game to the hapless Oakland Raiders. Sorry Raiders fans - but your team does stink!!! The Roethlisberger concussion was his second in a few month span (the first occurring when he crashed his motorcycle in June ) and has Steelers fans hoping their star quarterback’s career won’t be prematurely derailed like other former quarterback greats - Steve Young and Troy Aikman. As an avid Steelers fan, Dr. Matthew Scalese has an obvious interest in this topic and was eager to author this column on concussion and safe return to sport.
Concussions occur when a person’s brain is violently rocked back and forth inside of the skull because of a blow to the head or neck. Severe concussion, although rare, can lead to brain swelling, blood vessel damage, and even death. According to the University of Pittsburgh Medical Center, approximately ten percent of all athletes involved in contact sports, such as football, hockey, and soccer, suffer a concussion each year. In high school sports, there are 60,000 concussions each year with 63% occurring in football. Even in contact sports, some concussions can be prevented by teaching proper playing and tackling techniques and by wearing proper headgear. Symptoms of concussion are not always definite and knowing when it is safe for an athlete to return to play is not always clear. Severe concussions display obvious symptoms and removal from participation is obvious. However, the athlete with a mild concussion can display symptoms that are less clear. There are serious repercussions of early return following even a mild concussion due to the long term effects of multiple mild concussions. The recognition and management of concussion in athletes can be difficult for a number of reasons:
Athletes who have experienced a concussion can display a wide variety of symptoms. Classic symptoms of loss of consciousness, confusion, memory loss, dizziness and/or balance problems may be present in some athletes with mild concussion, while others may not show obvious signs that a concussion has occurred.
Post-concussion symptoms can be quite subtle and may go unnoticed by the athlete, team medical staff, or coaches.
Many coaches and other team personnel may have limited training in recognizing signs of concussion and therefore may not accurately diagnose the injury when it has occurred.
Many players may be reluctant to report concussive symptoms because of fear that they will be removed from the game, or that it may jeopardize their status on the team or their careers.
Methods and tools used to detect concussion and help make accurate return-to-play decisions are inadequate. Traditional neurological and radiological procedures, such as CT and MRI, although invaluable in discerning more serious head injuries, are not consistently useful in evaluating the effects of mild head injuries.
Allowing enough healing and recovery time following a concussion is crucial in preventing further damage. Research suggests that the effects of repeated concussion are cumulative. Most athletes who experience an initial concussion can recover completely as long as they are not returned to contact sports too soon. Following a concussion, there is a period of change in brain function that may last anywhere from 24 hours to 10 days. During this time, the brain may be vulnerable to more severe and permanent injury. If the athlete sustains a second concussion during this time period, the risk of permanent brain injury increases. The long term symptoms resulting from multiple concussions may include chronic headaches, sleep difficulties, dizziness, cognitive impairment and personality changes.
To assist in accurate diagnosis and safe return to sport, The University of Pittsburgh Sports Medicine Center developed a special computer program. The program uses diagnostic tools developed at the school such as the ImPact (immediate post-concussion assessment and cognitive testing). This computerized software can help to make safe return-to-play decisions by comparing an athlete’s brain function before and after a suspected concussion. The ImPact is a sophisticated, though easy to use, soft-ware program that has been specifically developed to help clinicians objectively evaluate recovery following concussion. The test is a 20-minute computerized test battery that can be administered in the preseason for a baseline and post-injury to track a concussion. The ImPact allows for proper determination that the athlete has fully recovered from a concussion, thus ensuring a safe return to play. Hopefully, this program will become affordable and accessible to small communities such as ours in the near future. For more information, call the University of Pittsburgh Sports Medicine Concussion Program at 412-432-3668.
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 Expert: C. Everett Koop, MD, Former American Surgeon General
People have theorized for many years that obesity must be genetic. Scientific research has validated this theory and more importantly, a recent study has shown that while there is an obesity gene that may predispose one to obesity, one can control the outcome with exercise. The fat mass and obesity gene (FTO) is linked to a high body mass index according to a new study in the Archives of Internal Medicine. More importantly, this study found that exercise can offset a genetic predisposition for obesity. Aerobic exercise 30-45 minutes 3-5 times per week coupled with mild weight training and other physical activities can overcome the FTO. With new knowledge, it becomes apparent that it is critical to promote a healthy lifestyle with exercise and physical activity at an early age to prevent childhood obesity.
C. Everett Koop, MD, the former American Surgeon General, is widely known for his landmark proclamation in 1988 that the addictive properties of nicotine are similar to those of heroin and cocaine. He is an acquaintance of former Scrantonian, David Madison. Now in his 90’s, I am grateful for the opportunity to ask for his sage advise and comments on this matter. He said:
Childhood obesity is defined as an excessive accumulation of body fat, as determined by skinfold measurements, when the total body weight is more than 25 percent fat in boys and 32 percent in girls. While some define it as a weight/height in excess of 120 percent of the ideal, skinfold measurements have been found to be much more accurate.
Childhood obesity has reached epidemic proportions in the United States. Moreover, childhood obesity is on the increase as found in a 54 percent increase in body fat measurements among 6-11 year olds since the 1960’s. The American Physical Therapy Association has taken an active roll through its membership to educate, advise and treat children with weight problems:
Obesity increases with age and its prevalence among obese children will continue to be obese with age. Childhood obesity is the leading cause or is associated with: hypertension, Type II diabetes mellitus, coronary heart disease, lower extremity joint stress and pain, lower self-esteem and other psychological problems.
As with adult obesity, childhood obesity is most often caused by multiple problems including: nutritional, psychological, familial, and physiological.
The risk of becoming obese is very high for those children with two obese parents. Strong genetic factors as well as parenting habits of eating and exercise may play a role.
The average child in this country spends several hours watching TV or playing video games. Childhood obesity is greater among those who exceed this average not only because of low-energy expenditure, but also due to the consumption of high-calorie snacks and drinks while watching TV. Previous generations spent this time engaging in physical activity. Only one-third of grade-school children have daily physical education in school.
Not all children who eat badly and lack physical activity are obese. As shown in the Archives of Physical Medicine study the FTO gene has shown that there are other causes for obesity, such as heredity.
Weight loss is not the primary role of a good childhood obesity program. The goal is to limit or stop weight gain so the child will eventually grow into their body weight over a period of many months or years. One study suggests that it requires 1 ½ years of body weight maintenance for every 20 percent excess in ideal body weight for a child to ultimately attain ideal body weight.
Increasing physical activity or engaging in a formal exercise program is essential to burn fat, increase caloric expenditure to lose and/or maintain weight. However, studies show that exercise alone is not nearly as effective as when it is combined with proper nutrition/diet and behavior modification. Physical activity is also critical for the health of the child. Blood pressure and lipid profiles improved in children/adolescents who engaged in 50 minutes of aerobic exercise, 3 times per week, even when weight loss was only minimal. In view of this, I recommend 45-60 minutes of exercise and physical activity a minimum of 5 days per week and prefer 7. If necessary, promote physically active video games such as the Dance, Dance Revolution (DDR) or Wii Fitness to excite you kids into healthy activity. Furthermore, some exercise and fitness clubs specialize in programs exclusively for children. In Northeastern Pennsylvania we are fortunate to have Fitwize 4 Kids, a kid’s health club that offers an assisted 45 minute program featuring cardio, strengthening, flexibility, agility and nutritional counseling for ages 6 ½ to 15. www.Fitwize4Kids.com
Extreme dieting and fasting is not appropriate for children. It is emotionally stressful and physically harmful to the growth and development of a child/adolescent. A balanced diet with moderate caloric and portion restrictions coupled with exercise and counseling is the proper combination.
Behavioral strategies are found to be very successful in children/adolescence. Self-monitoring and keeping a record in a journal of food intake, activity and exercise are helpful. Also, rewards and incentives can be effective. Parent/child counseling programs are most effective.
In conclusion, childhood obesity is a serious epidemic. It is physically and emotionally stressful for the child/adolescent and family. This problem requires a comprehensive team approach including: physician, educator, dietitian, psychologist, and exercise specialist. Lastly, to be successful, it must be a lifetime lifestyle change 7 days a week with regard to diet and exercise, not a 3 to 6 month fad. It must be a long-term program with long-term goals.
(While there are many causes of childhood obesity including a more sedentary lifestyle, a recent study at the Mayo Clinic has found that children expended significant energy when they play video games that require activity, such as the “NintendoR Wii” that uses a camera to virtually “place” them in a game to simulate hitting a tennis ball etc. or performing the “Dance Dance Revolution” or “DDR” game. The study found that kids expended three times more energy as compared to traditional video games played while sitting or when compared to watching TV while walking on a treadmill. There may be hope for our kids!)
Visit: www.NintendoWii.com, www.dance-revolution.com, www.fitwize4kids.com
Archives of Physical Medicine, 2008, Vol 168, 1791 – 1797
Visit your doctor regularly and listen to your body.
Last week, a mother from Old Forge asked me if I thought video games contribute to childhood obesity in this country. I told her that a recent study suggests that video games can be the problem and the solution!
While there are many causes of childhood obesity including a more sedentary lifestyle, a recent study at the Mayo Clinic has found that children expended significant energy when they play video games that require activity, such as the Nintendo Wii that uses a camera to virtually ìplaceî them in a game to simulate hitting a tennis ball etc. or performing the Dance Dance Revolution or DDR game. The study found that kids expended three times more energy as compared to traditional video games played while sitting or when compared to watching TV while walking on a treadmill. There may be hope for our kids!
Childhood obesity is defined as an excessive accumulation of body fat, as determined by skinfold measurements, when the total body weight is more than 25 percent fat in boys and 32 percent in girls. While some define it as a weight/height in excess of 120 percent of the ideal, skinfold measurements have been found to be much more accurate.
Childhood obesity has reached epidemic proportions in the United States. Moreover, childhood obesity is on the increase as found in a 54 percent increase in body fat measurements among 6-11 year olds since the 1960ís. The American Physical Therapy Association has taken an active roll through its membership to educate, advise and treat children with weight problems:
Obesity increases with age and its prevalence among obese children will continue to be obese with age. Childhood obesity is the leading cause or is associated with: hypertension, Type II diabetes mellitus, coronary heart disease, lower extremity joint stress and pain, lower self-esteem and other psychological problems.
As with adult obesity, childhood obesity is most often caused by multiple problems including: nutritional, psychological, familial, and physiological.
The risk of becoming obese is very high for those children with two obese parents. Strong genetic factors as well as parenting habits of eating and exercise may play a role.
The average child in this country spends several hours watching TV or playing video games. Childhood obesity is greater among those who exceed this average not only because of low-energy expenditure, but also due to the consumption of high-calorie snacks and drinks while watching TV. Previous generations spent this time engaging in physical activity. Only one-third of grade-school children have daily physical education in school.
Not all children who eat badly and lack physical activity are obese. Studies have shown that there are other causes for obesity, such as heredity.
Weight loss is not the primary role of a good childhood obesity program. The goal is to limit or stop weight gain so the child will eventually grow into their body weight over a period of many months or years. One study suggests that it requires 1 Ω years of body weight maintenance for every 20 percent excess in ideal body weight for a child to ultimately attain ideal body weight.
Increasing physical activity or engaging in a formal exercise program is essential to burn fat, increase caloric expenditure to lose and/or maintain weight. However, studies show that exercise alone is not nearly as effective as when it is combined with proper nutrition/diet and behavior modification. Physical activity is also critical for the health of the child. Blood pressure and lipid profiles improved in children/adolescents who engaged in 50 minutes of aerobic exercise, 3 times per week, even when weight loss was only minimal. If necessary, promote physically active video games such as the DDR or Wii to excite you kids into healthy activity.
Extreme dieting and fasting is not appropriate for children. It is emotionally stressful and physically harmful to the growth and development of a child/adolescent. A balanced diet with moderate caloric and portion restrictions coupled with exercise and counseling is the proper combination.
Behavioral strategies are found to be very successful in children/adolescence. Self-monitoring and keeping a record in a journal of food intake, activity and exercise are helpful. Also, rewards and incentives can be effective. Parent/child counseling programs are most effective.
In conclusion, childhood obesity is a serious epidemic. It is physically and emotionally stressful for the child/adolescent and family. This problem requires a comprehensive team approach including: physician, educator, dietitian, psychologist, and exercise specialist. Lastly, to be successful, it must be a lifetime lifestyle change with regard to diet and exercise, not a 3 to 6 month fad. It must be a long-term program with long-term goals.
Visit: www.NintendoWii.com and www.dance-revolution.com
Visit your doctor regularly and listen to your body.
Guest Columnist - Janet M. Caputo, PT, OCS
“Ashley’s Law,”named for Ashley Burns who died from a cheerleading stunt, would require EMTs and protective gear at games, competitions, and practices. In response to safety concerns, some schools are prohibiting stunts and keeping cheerleaders grounded.
Cheerleading includes gymnastics, tosses, partner stunts, and pyramid building. These challenges pose increased risk of injury. Injury prevention and safety precautions are essential help prevent injuries.
Here are several key points for injury prevention in cheerleading:
Complete rules can be found at www.aacca.org
Pre-season physicals identify chronic injuries to be treated or conditioning deficiencies to be remedied. Non-musculoskeletal health issues are addressed: cardiac arrhythmias, dizziness, and seizures. If present an aggressive work up should be done before participation is allowed.
Women participating in aesthetic sports are at increased risk for eating disorders. Carefully evaluate daily eating patterns and menstrual irregularities. Any athlete with a new stress fracture or overuse injury should also undergo screening. Abnormalities addressed immediately!
Any injury should be promptly evaluated and diagnosed to determine the extent of damage. Performing any sport with an injury can cause further trauma and long term complications.
Coaches must understand the risks of each maneuver. Safe performance is emphasized. Educating athletes about safe practice patterns will reduce injuries.
Gradually increase intensity of practice. Riskier maneuvers must be approached gradually with emphasis on mastery of the preceding skill.
Poor overall conditioning plays a huge role in injuries. Cheerleaders should participate in a year round conditioning program that consists of strength training, aerobic conditioning, and enhancing flexibility. “Base” athletes should concentrate on strengthening the shoulder and rotator cuff. All athletes should concentrate on strengthening the lower back and abdomen.
The best form of injury prevention is proper technique when executing skills. Proper landing technique helps in the prevention of knee and ankle injuries. Good form during routines promotes safety for all athletes involved in the performance.
Practicing on hard floors without mats leads to overuse injuries, and to more severe injuries when falls occur. If mats are unavailable, practicing outdoors on the grass or using well-cushioned shoes can reduce impact. Adequate space and height and access to athletic trainers should be provided.
Shoes should be well-fitted and comfortable. Broad soles may reduce the risk of ankle sprains. Cross-trainers or running shoes are excellent choices. Shoes should be chosen for function, not solely for aesthetics.
Spotters assist in the development of new skills and decrease risk of injury. Spotters correct body position and form and develop confidence in performance.
Most injuries occur in practice. Loss of concentration contributes to injuries. Focus is essential especially during the execution of skills.
Athletes should work within their level of ability. Advanced skills require time to master. There is a progression to developing new skills. Athletes should acknowledge their limitations in order to prevent injury.
Finally, emergency procedures and plans should be carefully outlined prior to any practice and performance. Coaches and supervisors should know first aid and the location of the nearest telephone. Emergency transportation should be available.
Cheerleading carries some unavoidable risk. Participants must take responsibility for their own safety and that of their fellow squad members. Nonetheless, safety precautions can reduce the severity and frequency of injuries.
Visit your doctor regularly, and listen to your body.
Guest Columnist- Janet M. Caputo, PT, OCS
In the past week, three people have asked me to write a column on cheerleading injuries: Sally Davis, team and squad specialist at Battaglia’s Sporting Goods in Scranton, Mari LaBelle, whose daughter Caroline is suffering from lower back pain as a cheerleading base and lifter at Scranton Prep, and Michelle Knowles, whose daughter Susan suffered and ankle injury early in her cheerleading career at Prep. Many of these injuries require medical attention and rehabilitation similar to those of an athlete.
Cheerleading originated in1898 at a Minnesota University football game to raise school unity through leading the crowd in cheers. Since 1980, cheerleading progressed to include highly skilled and competitive athletes. Increased injury rates occurred in response to this evolution. Research indicates that injuries increased 110% from 1990 through 2002, while participation increased only 18%.
Ligament sprains and muscle strains related to overuse are the most prevalent. Most common injury sites are ankle (22%), knee (15%), hand (13%) and back (12%). Head and neck injuries comprise only 7% of injuries but can be the most severe.
Most injuries occur during gymnastic maneuvers and partner stunts. Partner stunts can produce the most catastrophic injuries resulting in death or permanent, severe disability. Overuse injuries of the arms are common because of its use for weight bearing. Ankle and knee ligament injuries occur in the landing and impact phase of tumbling runs. Low-back injuries result from hyperextension. Shoulder and wrist problems develop in athletes at the base of pyramids or in partner lifts which require significant upper body strength. Athletes at the top of pyramids and lifts have the greatest fall risk resulting in catastrophic injury, fractures and dislocations.
Knowledge of the origin of injuries will assist in future prevention. This article will explore several reasons why injuries occur:
Cheerleaders are susceptible to overuse injuries because their sport is year-round. Cheerleaders perform through three seasons, peak for nationals and attend training camps in summer.
Experience plays a role in the frequency, type, and severity of injuries. Experienced cheerleaders attempt complex stunts. Less experienced cheerleaders have more frequent but less severe injuries because of poor conditioning, inadequate supervision, or attempting difficult maneuvers prematurely.
Immature coordination and strength and open growth plates account for certain age-related injuries. Head and neck injuries are more prevalent in youngsters due to larger head size and higher center of gravity causing them to fall head first.
Pyramid formations and basket tosses increase fall-related injuries. Decisions to abolish these stunts are controversial. If not taught proper fall technique, young children and participants in non-contact sports tend to brace with their arms instead of falling to diffuse the impact.
Current research proves that strong, flexible athletes with good coordination sustain fewer injuries. Without good preseason training, cheerleaders can not endure the weight bearing and pounding throughout the season.
Cheerleading is not considered a sanctioned sport by the majority of schools. Therefore, cheerleading is not subject to the same safety regulations. Coaches are not trained properly to deal with or prevent injuries. Squads even exist without coaches!
Competition is fierce since many cheerleaders are seeking college scholarships and participate in complex stunts to impress scouts. Many cheerleaders and coaches feel that basket tosses and human pyramids “wow the crowd” and provide the excitement and entertainment expected.
Many cheerleaders wear fashionable shoes that lack cushioning and stable bases. These shoes can not accommodate a cushioned insert or custom orthotic.
Cheerleaders practice in hallways with inadequate space and insufficient height. They perform on hardwood floors and turf without mats. The uneven surfaces on football fields increase the incidence of ankle sprains.
Peer pressure to stay slender heightens injury from weak bones from poor nutritional habits by excessive dieting. Weak bones are susceptible to stress fractures from jumping and pounding.
Maneuvers are more aggressive and individuals are participating at younger ages. The popularity of televised competitions may encourage attempts to mimic difficult maneuvers before adequate training. Consider age, physical ability, skill level and experience before attempting complex stunts.
To avoid risk without reason, join us next week for several approaches recommended to make the sport of cheerleading safer!
Visit your doctor regularly, and listen to your body.
Why wear a cast or splint?Casts or splints are used to support and protect bones and soft tissues after injury or surgery. A broken bone or severe ankle sprains are two good examples. The immobilization provided by a cast or splint protects the injury, allows healing with proper alignment, and reduces pain, swelling and muscle spasm.
Casts, half- casts or splints are made of plaster or fiberglass. A doctor or assistant individually makes them for each person and injury. Also, custom-made splints are often made by occupational therapists for the hand or physical therapists and certified prosthetists for other body parts such as the trunk or limps. Fiberglass splints are made with Velcro straps and are removable. You may have seen these used for the wrist for carpal tunnel or the foot for ankle sprains.
Both plaster and fiberglass comes in rolls and fiberglass comes in different colors. The rolls are dipped in water and wrapped around the injured part. It is often necessary to apply the cast to the joint above and below the injury. The material will dry and harden in minutes. The cast must fit the shape of the injured part snuggly but comfortably. If a cast is applied to a new injury or immediately after surgery, the cast will be too big once the swelling subsides. Then, a new cast is applied. Padding is used under the cast to protect the skin. Sometimes special padding can be used under fiberglass to allow the cast to get wet in the shower or pool.
Most fractures or severe sprains require 4-6 weeks of casting, sometimes less, sometimes more. Often, once the cast is removed, a removable half-cast or splint is applied. This allows the injured part to be washed and exercised several times a day without the splint and then reapplied.
The American Academy of Orthopaedic Surgeons offers the following recommendations for cast care a and warning signs of cast problems:
Warning signs: if the above recommendations fail to provide a reduction in swelling or pain or if you have the following warning signs, contact you doctor:
Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, exercise regularly
Did you ever wonder how Lance Armstrong gets back on his bike at the Tour de France every day after several days of intense biking without time for recovery? How can he pedal another day? Aren’t his quads sore? Exercise enthusiasts often inquire about the best method to reduce muscle soreness following intensive training from lactic acid buildup. A recent study in The Journal of Pain found that caffeine can be very effective in the relief of muscle soreness associated with vigorous exercise and training. Subjects were given the equivalent of two cups of coffee 24 and 48 hours after intensive exercise. Caffeine was found to be more effective than naproxen (Aleve) and aspirin. However, it was most effective in those who were not regular caffeine users.
Lactic acid accumulates in the muscles when glucose is burned for fuel during exercise when a chemical called pyruvate is produced. If you perform a mild to moderate workout you are able to provide enough oxygen during the activity to convert the pyruvate to carbon dioxide and water which can be removed by the lungs. However, if the workout is very intense then you do not have enough oxygen to allow all of the pyruvate to be removed by the lungs. The excessive pyruvate is converted to lactic acid and accumulates in the muscles and bloodstream. Lactic acid causes a painful burn in the muscle and limits complete contraction of the muscle.
Dehydration
Poor Nutrition
Poor Training
Inadequate Rest
Mental Stress/Anxiety
Illness (flu)
Excessive Competition
A combination of proper hydration, nutrition, and training (interval and endurance) will allow for high intensity performance without the negative effects of lactic acid accumulation:
Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, and exercise regularly
