Congratulations to more than 1,000 courageous runners who finished the 27^th Annual Steamtown Marathon today. Most, if not all of you are waking up this morning with a little less jump in your step than you had yesterday.

As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom, based on science, to encourage you to adequately rest and allow your body to recover.

GREAT EXAMPLE OF REST AND RECOVERY:

With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks, while an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident…following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.      

RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body:

(RunNow.com - Jim Peskett)

Muscle-Skeletal System:

One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!

Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!  

Cellular Damage:

Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness. 

Immune System:

It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

• If I don’t have pain, then I did not damage my body and I can run again soon after the marathon.

FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.

• Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.

FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.

• If I don’t run, I will lose all of my conditioning in one week.

FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi! 

Expedite Your Recovery:

• Rest – Take it easy for a few days. Let you muscles/body heal. Take short walks.
• Elevate – Elevating your legs to allow blood/fluid in you muscles to return to the heart without using gravity.
• Massage – This can be an effective method of relaxing muscle spasms, cramps and mobilizing fluids from your muscles to your heart after the marathon. It should be very comfortable. You may find even more benefit from massage 24-48 hours after the race to assist in the recovery of delayed onset muscle soreness from lactic acid build-up in your muscles.
• Slowly Reintroduce Exercise and Running – Gradually introduce longer walks and slow jogging after a few weeks. Cross-training is good for less joint compression and allows the use of other muscles. (Elliptical, bike, swim)
• Listen to your body!

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Provisional Bag/First Aide Kit

It is one week away from the 27^th Steamtown Marathon. This column is dedicated to all the runners preparing for the big day. One small piece of advice; start slowly, avoid the first mile adrenaline sprint downhill, and enjoy the journey! Remember, only one Olympic marathon winner (Juan Zabala, Argentina, 1932) was in the lead at the 5 mile mark. Lesson: The last miles matter more than the first!

Today, I hope to address some common questions for the novice marathon runner or for those coming from other locations to run in the race. What should you pack? How should I dress? What supplies will I need?

Elite runners are so experienced that they know exactly what to pack in preparation for the big marathon day. However, those, running in marathon for the first or second time usually have lots of questions. First, what you need and what you can bring will depend on your support team. If you are running alone and will not have family or friends meeting you along the way, then you are limited to a fanny pack and a few supplies. If you have a support team, then they can carry a bag with supplies, meet you along the course and you can have a sense of security.

Remember; do not do anything different on race day. Try out special clothing, water with supplements and snacks on a practice run. Also, experiment with your best pre-race meal. You will be getting up at 5-6:00am to catch the bus from Scranton to Forest City. You may want to pack breakfast to eat in the high school gym such as; bagel, peanut butter, jelly, banana and coffee or Gatorade. Moving your bowels before the race is a must.

Dress: Columbus Day Weekend in NEPA could bring 30 to 40 degree temperatures when you catch the bus in Scranton and at the 8:00 am race starting time in Forest City.

Clothing:

• Hat and Gloves: Wearing a hat, light gloves can be a good idea. DryTech materials are best to prevent retention of sweat.
• Long Sleeve Shirt and Light Jacket may be necessary. Wearing old items are best so they can be discarded along the way once you are warmed up.
• Remember, any extra items can be placed in a labeled bag at the starting line and will be transported to the finish line for your convenience. So, if it’s a cold morning, wear a jacket and warm up pants on the bus to the starting line and “bag it!”

Accessories:

• Sunglasses and Sunscreen: If sun and warm temps are forecasted, sunglasses are best placed on top of your hat until needed and sunscreen applied before the race.
• Skin Lubrication: Lubricate your skin with petroleum jelly in areas of potential friction such as arm pits, nipples, thighs and feet.
• Dry Tech Clothing: Wear dry tech protects, including shirt, underwear and socks, to prevent excessive moisture and friction.
• Favorite Water Source and Snack: Water and light snacks will be provided every 2 miles but sometimes it is good to have your own favorites, especially in the high school gym before the race.

MARATHON FANNY PACK – Especially for those running without a support team

If you don’t mind the little pack on your butt, a fanny pack can be valuable. In it, you will want supplies such as: small bandages, small roll of medical tape, ibuprofen, antacid tablets, small tube of lubricant, favorite running snack, and extra shoe laces. One might also consider packing a little money, credit card, ID, emergency contact numbers and medical insurance cards. A cell phone is optional.

MARATHON SUPPLY BAG – For those with support team

your supply bag. In the bag, you might consider all of the above fanny pack items and: A change of clothes such as: extra running shoes, socks, shorts, shirt, water proof wind breaker, according to the weather, especially if rain is predicted.  Towels, ace bandages, gauze pads and wrap, antibiotic cream, mole skin, sunscreen, petroleum jelly, safety pins, extra water and favorite sport drink, favorite sport snacks, extra ibuprofen, antacid, anti diarrhea medicine, chemical ice pack, mobile phone, money, credit cards, ID, medical insurance cards.

For those with allergic reactions, remember to pack: epinephrine, antihistamine, and other important medications.

Don’t Forget:

Map and directions to the bus or starting line, course map, race number, and get your timing chip.

Enjoy! Enjoy! Smell the roses, take in the fall foliage and chat with a fellow racer. Savor the moment enjoy the day…you are doing something very special!

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Like many of you, I have always enjoyed the outdoors...walking, running, biking, hiking etc. However, recently, I have been more concerned about being safe, (getting older and more cautious, distracted drivers) when doing these activities on the side of the road.

Almost 15 percent of all motor vehicle injuries to people happened to those not in cars but while walking, running or hiking, so one needs to be safe. In fact, over 4,000 walkers or runners were fatally hit by a motor vehicle according to the Centers for Disease Control (CDC). These statistics continue to increase as the number of distractions to drivers increases (phone calls, texts, etc). Consequently, walkers, runners and cyclists must be more aware than ever to prevent injury from motor vehicles and stay safe.

Five high risk factors for walkers, runners and cyclists:

• After dark
• At rush hour in high traffic
• Walk or run “with” instead of “into” traffic flow
• More than one other person with you
• Headphones

 “Runner’s World” offers the following recommendations to stay safe:

• Leave word. Tell somebody or leave a note at home about where you plan to go and how long you plan to be out. That way your loved ones will know to come look for you if needed.
• Protect yourself: If your route is in a high crime area, avoid dawn and dusk, carry self-defense spray, exercise with a partner, leave jewelry at home and vary your route and routine.
• Identify yourself. Run with proper ID, and carry a cell phone with emergency contacts taped to its back.
• Pretend you're invisible. Don’t assume a driver sees you. In fact, imagine that a driver can’t see you, and behave accordingly.
• Face traffic. Except for cyclists, walking and running “into” oncoming traffic is best. It’s easier to see, and react to, oncoming cars. And cars will see you more clearly too.
• Make room. If traffic gets heavy, or the road narrows, be prepared to move onto the sidewalk or shoulder of the road. When walking or running into traffic, stay as far left as possible. When biking, favor the far right side of the road.
• Be seen. Wear high-visibility, brightly colored clothing. When out near or after sunset, reflective materials are a must. (If you don't own reflective clothing, a lightweight reflective vest is a great option.) And use a headlamp or handheld light so you can see where you're going, and drivers can see you. The light should have a bright LED (drivers see blinking red as a hazard).
• Unplug your ears. Avoid using iPods or wearing headphones—you need to be able to hear approaching vehicles. If you do use headphones, do so with the volume low and just one earbud in.
• Watch the hills. When they crest hills, drivers' vision can suddenly be impaired by factors like sun glare or backdrops.
• Beware of high-risk drivers. Steer clear of potential problem areas like entrances to parking lots, bars, and restaurants, where there may be heavy traffic.
• Watch for early birds and night owls. At odd hours be extra careful. Early in the morning and very late at night, people may be overtired and not as attentive.
• Mind your manners. At a stop sign or light, wait for the driver to wave you through—then acknowledge with your own polite wave. That acknowledgement will make the driver feel more inclined to do it again for the next walker or runner. Use hand signals (as you would on a bicycle) to show which way you plan to turn.

CYCLISTS -

• Stay on the right and obey traffic rules.
• Wear a helmet
• Use hand signals when turning
• Wear visible clothing and have reflectors on your bike
• Carry a tire patch and first aid kit
• Maintain your bike
• Watch for pedestrians, parked cars, loose gravel and cracks and potholes.

Source: http://www.runnersworld.com

Visit your doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Have you ever noticed high level athletes warming up before a game or competition walking or running backwards? You may also see fitness enthusiasts in gyms emulating these athletes to improve their fitness or performance. I found the concept of backward walking, (also called retro walking) interesting and decided to research the topic for more information and validation. Walking backward does have many therapeutic benefits, however, before you attempt this activity on a treadmill or elliptical, please consult your physician and physical therapist and have a spotter nearby.

Strength Improved in Leg Muscles

At a recent meeting of The American College of Sports Medicine, several studies were presented on the topic of backward waking. Most of the research was conducted while moving backward on a treadmill and an elliptical machine. When comparing two groups recovering from knee injuries, the backward motion group showed significant improvement in strength in the quadriceps (front thigh) and hamstring (back thigh) muscles when compared to the traditional forward walking group. Furthermore, the muscles of the front (tibialis anterior) and back (gastro/achilles) of the shin/ankle also demonstrated an increase in strength and endurance with backward walking. One explanation is that forward motion is routine in daily living that it has become very efficient and does not tax or stress the muscles the body. While this efficiency prevents fatigue in daily activities, it may not stress the muscles enough to gain strength as quickly as an unfamiliar exercise.

Cardiovascular Benefit/Calorie Expenditure

Due in great part to the increased strain of performing an unfamiliar exercise, backward walking on a treadmill or backward pedaling on an elliptical, offered a greater cardiovascular benefit and caloric expenditure than forward motion at all levels. Specifically, walking backward on a treadmill at 2.5 mph at grades of 5% - 10% has been found to significantly increase cardiovascular endurance than walking forward under the same conditions. This knowledge is useful for healthy individuals in need of greater cardio exercise. However, it may also serve as a precaution for those with cardio problems and should consult their physician prior to engaging in this activity.

Weight Loss

A recent study in the International Journal of Obesity, found that those who performed new activities or increased the intensity of an activity, even if for a short duration (interval training) expended more energy and burned more calories than those who worked out at the same pace consistently for a longer duration. Moreover, when engaging in a new activity such as backward walking, even more calories were burned. This phenomenon may be due to the fact that routine activities such as forward walking are performed more efficiently and easily.

We challenge our body when we inefficiently perform a new motor skill such as backward walking and burn more calories. In other words, if you want to burn more calories without exercising for longer periods of time, than try a new activity and engage in higher intensity, intermittently, for part of the time. For example, walk backward on the treadmill for 30 minutes at 2.5 mph, but do so at a 5 – 10% incline for 1-2 minutes every 5 minutes.

Protection for Your Muscles, Tendons and Joints

Some studies show that using other muscle groups by performing different exercises not only prevents boredom, but also protects your muscles and tendons from overuse and joints from wear and tear. Specifically, the knee joint and the patella joint (the joint where the knee cap glides on the knee), benefits from backward walking due to less stress and compression forces on the joint. The thigh and ankle/foot muscles benefit from using a different form of contraction while lengthening the muscle. Some authors propose that this may also prevent strains and pulls and may be valuable to strengthen those with a history of shin splints and flat feet (pronation).   

Prevents Boredom

Mixing up your program prevents boredom. As a rule, those willing to change their exercise routine are more compliant and continue to exercise longer than those stuck in the same routine. A new challenge to improve distance, speed, and resistance while exercising in a different direction will be refreshing to your program.

Improved Balance and Coordination

Prevention of falls by improvement in balance and coordination has received a great deal of attention in the past few years. This is not only valuable to the athlete but may be even more important to those over 50. With age, balance centers are slow to react to changes in inclination, elevation, rotation and lateral movements. This slow reaction time leads to falls that may cause fractures, head injuries and more. Working on this problem by challenging the vestibular and balance centers before it is seriously compromised is important and backward walking is one way for this to be effectively accomplished.

• NOTE: When walking backward, hold on to the grab bars on the treadmill and make sure to have a spotter to supervise the new activity until you become accomplished.
• NOTE: Reduce the treadmill speed and elliptical resistance until you become more familiar with this new technique.

Visit your doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

As summer fads and cool fall nights are upon us, many of us will prepare to put away some of our warm weather toys…closing the pool, storing kayaks and boats and packing up the “slip and slide.” However, one activity that can last well into the fresh breeze of fall is cycling. In fact, many feel that fall is the best time of year to jump on a bike and enjoy the ride! If you are looking for a kick start to riding your bike this fall, consider the 20^th and final Tour de Scranton on Sunday, April 15, 2024. It is a fun-filled, noncompetitive bike ride through Scranton and neighboring communities. Tom and Betty Moreken, with the help of dedicated friends and countless supporters have raised over $400,000.00 to benefit addiction treatment and prevention in honor of their daughter Erin, a victim of drug addiction. I have had the privilege to know Tom and Betty and have always admired their resilience and selflessness to turn a negative into a positive and do something good for others. They and their friends truly represent everything that is good about the people of NEPA!

So dust off your bikes and join the fun at Tour de Scranton. Hopefully, it will entice you to ride the many beautiful and well-maintained trails that are available at the Countryside Conservancy and other locations in the Abingtons and the Lackawanna Heritage Valley Authority.

Tour de Scranton is the official “kick off” to biking season in NEPA. This year, on Sunday, September 15^th, the 20^th annual and final Tour de Scranton will offer a selection of several routes and distances for the novice and experienced rider at its non-competitive bike ride for riders of every age and skill level. This event supports “The Erin Jessica Moreken Drug & Alcohol Treatment Fund” which provides charitable gifts to qualified local organizations or individuals struggling with the disease of addiction. For more information visit: www.tourdescranton.com.

WHY BIKE?

There are many obvious reasons to bike…cardiovascular fitness, burn calories, improve leg strength and others. But, the real question is, “what are the advantages of biking over other forms of exercise?” Glad you asked…

BENEFITS OF BIKING:

1. INEXPENSIVE – while not as cheap as running, biking can be much cheaper than other sports. Starter bikes can be less expensive than high end running shoes.
2. EASY – most people can learn to ride a bike. Kids begin with training wheels and adult tricycles are available.
3. FAMILY FUN – something the whole family can enjoy in your neighborhood, at the beach or on one of the trails.
4. PRACTICAL EXERCISE – it is an opportunity to exercise while traveling to work, store, lunch etc…bike it!
5. CARDIOVASCULAR FITNESS – good for the heart and all that goes with it: burns calories, lowers blood pressure, lowers LDL, and elevates HDL and boosts the immune system.
6. LEG STRENGTH – pedaling a bike is a great way to improve leg strength.
7. CORE STRENGTH – core muscles of the neck, middle and lower back and the associated arm strength will improve while biking in order to maintain your torso on a bike on hills and turns.
8. IMPROVES BALANCE/COORDINATION/FALLS PREVENTION – riding a bike requires some balance and coordination and therefore will improve balance as a form of falls prevention.
9. GOOD FOR YOUR JOINTS – bike riding only requires partial weight bearing to the spine and lower body joints so it is more comfortable and gentle to your joints than walking or running. For this reason, it is often recommended to pregnant women suffering from leg or lower back pain as a safe alternative to running.   
10. MENTAL WELLNESS – biking, like all aerobic exercise, is a great source of stress management as it releases endorphins and serotonin which improves mental health. With the added feature of being outdoors in the sunshine and fresh air, biking keeps you smiling!

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be 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, calves 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, padded biking shorts, c-out and gel pad saddle seats, and wider tires.

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. 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 improperly fitted and poorly maintained equipment is preventable. Excessive workouts and training rides should be kept to a minimum and consider cross-training in between.  

BIKING SAFETY:

EQUIPMENT: Helmets are a must! Also, keep your bike in good condition. Road bikes should have mirrors and reflectors. Use hand signals and obey traffic rules. Dress for weather and visibility. Have a first aid and tire patch kit, tire 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. 

SOURCES: American Physical Therapy Association

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

“When is it safe for my child to start weight training?” This is a very common question asked by parents of young athletes who are looking for advice regarding their children’s participation in weight training. This month, for example, I received three such inquiries. While some who are eager to get a “competitive edge” may not be satisfied with the answer, these recommendations are grounded in the scientific literature and medical specialist with the hope to prevent injury and dispel fear and fallacy.

Weight training, weight lifting or resistive training all describes the use of a resistive force on a muscle to improve strength. While much attention has been given to the benefits of weight training in adults, much less has been written about its application in children.

Optimal Age to Begin Weight Training:

According to the Journal of Pediatric Orthopedics, children less than 12 years old are considered prepubescent or before puberty. Teenagers who are between 12 and 19 are considered to be adolescents. Studies consistently demonstrate that strength gains are much more significant in adolescents than in preadolescents. It is important to note that these strength gains are not only from the enlargement of muscle fibers (hypertrophy), but also from the improvement in the coordination and efficiency in muscle contraction and the recruitment of motor units and fibers within the muscle.

Preadolescents lack the hormones necessary to develop masculine characteristics. Adolescents begin to produce the hormones of testosterone and androsterone to develop secondary sexual characteristics such as pubic hair and enlarged genitalia. In view of this, age 13-14 is the optimal age to safely begin and benefit from a well-designed weight training program.

Benefits of a Well-Designed Weight Training Program for Adolescents:

• Increased Strength
• Improved Sports Performance
• Improved Injury Rehab
• Improved Overall Health & Wellness

Risks From Poorly Designed or Unsupervised Program:

• Risk level increases if the program is not developed or supervised by a qualified adult for technique, safety, intensity and frequency
• Lower Back Pain – from poor technique and overload
• Muscle/Tendon Strain – from overuse and overload
• Tendonitis – from overuse and overload
• Growth Plate Stress – (Osgood Schlatter’s Disease “ bump on the knee) from overload

How to Begin A Weight Training Program for Adolescents:

• Pediatrician/Family Physician – get medical clearance to make sure that you are not at risk, especially if you have medical issues such as juvenile diabetes or juvenile arthritis
• Orthopedic Physical Therapist – your doctor may think you would benefit from a few visits with an orthopedic PT to make sure your program is well-designed for your specific goals and your specific sport (track, football, basketball, baseball, soccer, tennis)
•  Avoid Competitive Weight Lifting – it sets you up for injury! No Clean-Jerk, Overhead Press, Full Squats. Don’t compete to lift to your maximum. Keep lifting FUN! Make training sport specific because soccer fitness is different than football fitness and runners differ from swimmers.
• Technique
  • Slowly lift and lower weight 4 seconds up, 4 seconds down
  • Breath – inhale lifting weight up and exhale down
  • Never hold breath!
  • Exercise major muscle groups:
  • Upper body: shrugs, rows, lats, biceps, triceps, chest press, wrist curls – all with light dumbbells and bands to start
  • Lower Body: hip hike, leg extension, ham curl, step ups, 45 degree squat, calf raise – all light with sandbags and dumbbells to start
• Lift 3 times per week on alternating days – 30 to 45 minute sessions
  • Warm up
  • Cool down
  • Work upper body/lower body
  • Can alternate days for upper body and lower body
  • Can alternate days for weight lifting with aerobic exercise (swim, run, bike)
• Concentrate on low weights (3-5#)/high repetitions(10-15 times)
  • Once master technique add 1-2 # and 3-5 reps
• • Never advance weight or reps if you overstrain and compromise technique

**STOP:

• If you have pain
• If you get lightheaded or dizzy
• If you experience lower back pain or joint pain
• If you have muscle or joint pain that lasts more than 2 days

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

...Labor Day is also the start of the school year

While many people celebrate the Labor Day holiday by firing up the grill, others will be shopping to get their students ready for the school year. One item on the shopping list should be a good quality and well-fitted backpack…to prevent lower back pain!

In 2018, the government of India announced a ban on homework and recently in Poland; the government ministers did the same. Can you imagine…a ban on homework? In an effort to promote student health and address recent surges in the incidence of back pain in the young, there will be no homework for students in grades one and two.

It was estimated that the majority of students ages 7 – 13 in India were carrying almost half their body weight. Not surprisingly, medical practitioners noticed a dramatic increase in reported cases of back pain among this group and decided to take action. In addition to the homework ban for grades one and two, Indian authorities have also implemented a limit of 10% of the student’s body weight.

Back pain in students seems to be universal. Each year, as students in the United States prepare to return to school from summer vacation, the subject of backpacks arises. The good news: when compared to purses, messenger bags, or shoulder bags, backpacks are the best option to prevent lower back pain. The bad news is, most of the 40 million students in the USA using backpacks, are doing so incorrectly.

Studies have found more than 33% of children had LBP that caused them to miss school, visit a doctor, or abstain from activity. Also, 55% of children surveyed carried backpacks heavier than the 10-15% of their body weight, which is the maximum weight recommended by experts. Additionally, the study noted that early onset of LBP leads to greater likelihood of recurrent or chronic problems. Backpacks that are too heavy are particularly harmful to the development of the musculoskeletal system of growing youngsters. It can lead to poor posture that may lead to chronic problems.

The following information on backpack safely is based, in part, by guidelines from The American Physical Therapy Association. Parents and teachers would be wise to observe the following warning signs of an overloaded and unsafe backpack:

WARNING SIGNS:

• Change in posture when wearing the backpack. The weight of the pack forces the child to tip forward to compensate. Weak or poorly fitted straps force the child to tip to the side to compensate
• Struggling when putting on or taking off the backpack due to a pack that is too heavy or straps that don’t fit properly.
• Pain when wearing or after wearing the backpack due to a that is too heavy or straps that don’t fit properly
• Tingling or numbness – in the arms or hands
• Red marks – under the armpits or on the back

Consider the following suggestions to promote backpack safely and prevent back injury:

12 SUGGESTIONS for Backpack Usage:      

1. Limit Weight of Pack to 10-15% of Body Weight (100lb child = 10-15lb pack)
2. Padded Adjustable Shoulder Straps - Use both straps to distribute weight evenly. Using one strap may look cool but it will lead to back pain.
3. Waist Belt – Proper Fit - An adjustable waist belt will distribute pack weight from back to hips and legs. Top of pack should be below the neck and bottom 2-3 inches above the waist
4. Pack Weight Distributed to Small of Back/Hips – using adjustable straps - Not all the weight on shoulders and upper back
5. Wheeled Backpack – if unable to make above adjustments - This is an option for some children; however, you may have problems     carrying/lifting it on the bus etc.
6. Purchase Extra Set of Books And Use Your Locker - Get list from teachers and use the internet to buy extra books to leave at home. Teachers and students might consider downloading text books on the iPads or electronic tablets. Also, put unnecessary books in your locker between classes
7. Remove Pack When Possible - While waiting for bus, hanging out between class, etc
8. Put Pack On/Off From Chair/Table/Bench – Not Floor - It is much easier to lift a pack up from a table and put it on your back than bending over to get it from the floor
9. Stand Erect and Arch Small of Back - The correct posture while carrying heavy items is to make a hollow or arch the small of your back
10. Perform Posture/Stretching Exercises - Pinch shoulder blades together and extend and arch your spine backwards intermittently throughout the day – especially every time you take your pack off
11. Consider a pack with multiple compartments - Use several compartments to carefully load your backpack and distribute the weight more evenly…and eliminate accumulated/unnecessary junk.
12. Use a back with reflective material to enhance visibility.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what type of exercise is best for those suffering from osteoarthritis (OA). 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 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. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity and weakness with loss of function due to disuse.

However, OA is not an excuse to avoid exercise but it is important to be smart about it. Regular exercise is essential to maintain a normal lifestyle for those with OA. However, if you do the wrong exercise, use poor technique, or are too aggressive, you could flare-up your joints and do more harm than good.

Benefits of Exercise for Those with OA:

When performed correctly, exercise for those with OA has many benefits:

Pain Control

Exercise controls OA pain by releasing natural pain control chemicals in the body called endorphins. It also controls pain by assisting in weight loss and improving range of motion.

Weight Control

We all know how well exercise burns calories and that increased body weight creates increase stress on the joints.

Prevention of Joint Stiffness

Exercise will help maintain joint range of motion. A stiff joint is a painful joint.

Prevention of Muscle Weakness

Exercise will help maintain muscle strength. Weak muscles will allow or increase in joint wear and tear.

Maintain Lifestyle

If a joint is stiff and weak, then they become painful which negatively impacts your lifestyle. Exercise can prevent this problem.  

Tips How To Exercise With Osteoarthritis:

Start Slowly

Wean into exercise because if you advance too quickly, you will flare up the joint and have increased pain. For example, walk for 5-10 minutes the first session. If you do not have pain, add 1-2 minutes each session.

Lose Weight

Every pound lost equates to less stress on your joints. For example, a loss of 5 pounds of body weight translates to 20-30 pounds of stress through the knee, according to David Borenstein, MD, President of the American College of Rheumatology. Also, body weight has a direct impact on daily activities. For example, walking upstairs creates stress through the knee equal to 4 times body weight and seven times body weight going downstairs. Therefore, less body weight equals less stress.

Low Impact Workouts

Low impact exercise creates less stress on the joints while strengthening leg muscles and those who those who maintain leg muscle strength have less stress on their joints. It is even important not to load your arms with heavy objects when walking or using stairs to limit joint stress.

Some examples of low-impact exercises are: walking, swimming, elliptical trainer, and biking. Strength training is also low-impact and should be performed with low weight and high repetitions. Water therapy is great for those with OA, especially in a heated pool. It is a great low-impact exercise with less gravity and stress on the joints. Walk, swim and do mild resistance exercises in the water. Use a snorkel and mask for swimming to limit excessive neck turning and back extension.

Walking is a great form of exercise; however, walking softly is important for those with OA. Wear good running shoes and orthotics if necessary. Discuss this with your physical therapist or podiatrist. When possible, use soft surfaces like cinder, mulch or rubber. Avoid grass and soft stand due to instability and torsion that may irritate your joints.  

Warm-Up

Warming up your body is critical to prevent injury to the muscles and tendons. This can be done by marching in place or using aerobic equipment such as a bike for 5 to 10 minutes before exercise. Always perform the warm-up activity at ½ your normal pace.

Balance & Relaxation Techniques

Tai Chi and ballroom dancing are two good examples of activities which promote balance and relaxation. Studies showed that those with OA who participated in Tia Chi two times a week for eight weeks reported less pain, increased range of motion and improved daily activities and function. They also noted less low back pain and better sleeping.

Proper Clothing

Stay warm in winter and consider wearing compression shorts. Be cool in the summer months with Drytech^R type material.

Pre/Post Exercise First Aid

If you are sore for longer than 12 to 24 hours after exercise, then you overdid it and must make adjustments next time. Otherwise, use hot packs, bath or shower before you exercise to loosen up and apply ice to your joints after exercise, especially if they are sore.

Post Exercise Stretch

Gentle, active range of motion stretches after exercise is important to maintain mobility. Do not bounce or cause pain. For example: Low Back – knees to chest; Arms – row –the – boat, arms behind head, arms behind back; Legs – wall lean calf stretch, bend and extend knees, open and close hips.

SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons; www.lifescript.com

Visit your doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Gardeners and Computer Mouse Users Be Aware!

Tennis elbow, also called lateral epicondylitis, is an inflammation of the lateral (outside) bony protuberance at the elbow. It is at this protuberance that the tendon of the long muscles of the hand, wrist and forearm attach to the bone. As the muscles repeatedly and forcefully contract, they pull on the bone, causing inflammation. The trauma is irritating when working the muscles in an awkward position with poor leverage like hitting a backhand in tennis.

It is not unusual for a patient to come to my office with severe pain on the outside of their elbow. Especially, after intensifying their tennis workouts or changing the racquet string tension. Others come to me with pain on the inside of the elbow (“golfer’s elbow”) from wrist action that advanced golfer’s use at impact. However, this problem is not only for tennis players and golfers. Laborers working with wrenches or screwdrivers with an awkward or extended arm can also develop tennis elbow. Others who are vulnerable are: those working for hours at a computer using a mouse as well as those working hard maintaining their lawns and gardens.

In a more chronic problem, lateral elbow pain may arise 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:

• Age: Any age but - risk increases in 30-50 year old age group
• Racquet Sports: 50% of all athletes playing racquet sports: tennis, racquet ball, squash, fencing
• Repetition: Any activity with repetitive use of the hand, wrist, elbow – not a specific trauma
• Occupation: Meat cutting, plumbing, painting, raking, weaving, brick laying
• Decondition: Poor fitness level and sudden increase in upper body activities

Symptoms:

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.

Treatment Options:

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 may be advised. Ergonomic changes in equipment, tools, technique and work-station may be necessary. Improvement should occur 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 may be necessary prior to a gradual return to activity. Deep friction massage can assist healing.

Exercises performed in a particular manner to isometrically hold and eccentrically lengthen the muscle with contraction.

New Conservative Treatment: Platelet-Rich-Plasma (PRP) is a new treatment for the conservative management of degenerated soft tissues that has recently received great media attention. In great part, due to its success in several high profile athletes. According to the Journal of the American Academy of Orthopaedic Surgeons,(JAAOS), platelet-rich plasma (PRP) is autologous (self-donated) blood with an above normal concentration of platelets. Normal blood contains both red and white blood cells, platelets and plasma. Platelets promote the production and revitalization of connective tissue by way of various growth factors on both a chemical and cellular level.

The actual PRP injection requires the patient to donate a small amount of their own blood. The blood is placed into a centrifuge (a machine that spins the blood at a high velocity to separate the different components of blood such as plasma, white and red blood cells), for approximately 15 minutes. Once separated, the physician draws the platelet-rich plasma to be injected directly into the damaged tissue. In theory, the high concentration of platelets, with its inherent ability to stimulate growth and regeneration of connective tissue, will promote and expedite healing.  

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. Recently, arthroscopic surgery developed to perform this technique. However, research does not support the value of one over the other at this point. Physical/occupational therapy is used after surgery. Return to work or athletics may require 4-6 months. More recently, a surgical technique using ultrasound to guide a needle to debride (clean) the area of scar tissue has been developed. If eligible for this procedure, the time required for healing, rehabilitation and return to activity is much shorter.

If you feel you suffer from tennis elbow, ask your family physician which of these treatment options are best for you.

Visit your doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

There is plenty of summer remaining … so make time to get to the water! Research shows that spending time outdoors has many positive effects on your health. Moreover, new research has found that being near a body of water makes us calmer and healthier. You know that special feeling you get when you drive to the lake or the beach and jump out of the car and smell the fresh air and hear the sound of splashing in the lake or the waves of the ocean? Well, it is not just because you’re on vacation…the water makes your muscles relax and breath deeper. Your brainwaves slow down to simulate the gentle roll of the water…lake or ocean! These “blue environments,” not to be confused with “blue zones” are the subject of extensive research at the University of Exeter Medical School in the UK.

Time spent near water promotes physical activity, general fitness and well-being. In addition, noted for reducing the incidence of diabetes and other diseases associated with obesity. Additionally, time near the water slows down our heart rate, reduces stress hormones and improves mental health. In fact, the study also found that subconsciously, people consistently preferred pictures of natural environments (rivers, lakes, oceans) even when compared to attractive urban landscapes. In fact, urban landscapes with water (rivers, fountains etc) were far more popular than those without. Also, health disparities between coastal and inland communities are more noticeable for low-income individuals who do not have the means to venture to the coast. This may be one of the reasons that four out of the five “Blue Zones” discovered by Dan Buettner are islands.

WHY BEING IN, ON, OR AROUND THE WATER IS HEALTHY

• WATER STIMULATES ALL 5 SENSES -Water provides a totally immersive experience.  We feel the coolness trickling on our skin, we taste the salt, smell the seaweed, hear the waves and splash of the water, and see the sun glistening on the water.
• WATER STIMULATES OUR NERVOUS SYSTEM -Water impacts our physiology in that it triggers our parasympathetic nervous system to lower heart rate and blood pressure which promotes relaxation. Even the act of drinking a glass of water can promote relaxation and wellness.
• WATER IS BLUE…BLUE IS THERAPEUTIC -If the rolling blue waves in the lake and ocean aren’t enough, the blue light waves will work to promote further relaxation. Additionally, the beautiful backdrop of a blue sky is the icing on the cake to make you chill out! Similar to “white noise” used by millions of parents to promote sleep for infants and toddlers, “pink noise” (the noise associated with natural sounds) is more smooth, soothing, ongoing and natural as it reduces brain wave activity…have you ever experienced a “beach nap?”
• WATER STIMULATES OUR INNATE BIOPHILIA - The biologist and naturalist Edward Wilson coined the term “biophilia” to describe the theory that humans have an instinctive bond with nature. As a species, our origins have begun on open savannahs and endless shorelines. These natural environments instinctively return us to a simpler time and place.
• WATER IMMERSION BALANCES OUR HORMONES -Did you ever notice the inner harmony of swimming underwater or total floating? When you are doing these activities, your body sends signals to balance stress hormones similar to the bodies response to meditation or relaxing.
• WATER ACTIVITIES STIMULATE ENDORPHINS -Whether you are swimming, surfing, kayaking, paddle boarding, fishing, clamming, walking the shoreline, digging a water hole or making a sand castle, these activities will stimulate endorphins. These natural chemicals associate with increased levels of with happiness, pain management and overall well-being.

In addition to the benefits of being by a body of water, just being outdoors promotes better health and wellness:

• Nature’s Vitamin D – Current research suggests that Vitamin D (The Sunshine Vitamin), may offer significant disease prevention and healing powers for osteoporosis, some forms of cancer and heart disease. Of all the methods of getting an adequate amount of Vitamin D, none is more fun than spending time outdoors in the sunlight.
• Increase Activity Level – While exercising indoors in a gym is valuable, research shows that time spent indoors is associated with being sedentary and being sedentary is associated with obesity, especially in children
• Improved Mental Health – Documentation reveals that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health.
• Improved Concentration – Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term, supported by research, found children with ADHD focus better when outdoors.
• Improved Health and Healing – Researchers at the University of Pittsburgh found that patients recovering from surgery recovered faster with less pain and shorter hospital stays when they were exposed to natural light.
• Improved Breathing – In general, breathing fresh air is good for you. Some exceptions might be those with severe allergy problems when the pollen count is high. Despite this, it may be better to take allergy medicine and enjoy the benefits of being outdoors than to be stuck inside.

Sources: NIH, Global News, Plume, L, University of Exeter Medical School in the UK.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!