Paul Mackarey, Author at Mackarey & Mackarey PT

April is National Parkinson’s Awareness Month

Part I of II

Parkinson’s disease (PD) is a chronic, degenerative disease that leads to slowness of movement, balance disorders, tremors, and difficulty walking. PD results from the loss of dopamine-producing nerve cells in the brain. Dopamine is critical to stimulate the nerves of the muscular system in the body. PD affects approximately 1.5 million people in the USA with 60,000 new cases each year according to the National Parkinson Foundation. Most people know someone affected by PD. PD typically affects those over 65 years of age and only 15% are under 50. However, actor, Michael J. Fox brought national attention to the disease in 1991 when he was only 30 years old. Juvenile Parkinson’s, those diagnosed under the age of 40, is rare and only represents 7% of all those with PD.

While there is no current cure for PD, exercise can relieve some of its symptoms. Although PD affects an individual’s ability to move, exercise can help keep muscles strong, joints mobile, and tissues flexible. Exercise will not stop PD from progressing, but it will improve balance, enhance walking ability, reduce muscle weakness, and minimize joint stiffness. In 2007, a study published in the Journal of Neuroscience revealed that exercise will benefit individuals with PD because exercise encourages the remaining dopamine cells to work harder to produce more dopamine. Also, the researchers discovered that exercise decreases the rate at which dopamine is removed from the brain.

Depending on the stage of the disease and the level of assistance required, exercise to improve strength, balance, flexibility and ambulation for those with PD, can be performed independently at home or supervised at a rehab or fitness facility. Supervised exercise can include physical therapy, recreational therapy, water therapy, yoga, and Tai Chi… AND DANCE! Physical therapy can improve walking ability, enhance balance, reduce fatigue, increase strength, promote flexibility and minimize pain. Physical therapy uses movement techniques and strategies as well as various pieces of equipment to enhance an individual’s level of independence and improve his quality of life. Recreational therapy incorporates leisure activities (e.g. golfing and ballroom dancing) to reduce the symptoms and associated limitations of PD. Recreational therapy adapts these activities to meet the specific needs of the person with PD. The modified activities are taught by professionals who have significant knowledge and experience in this area. Water therapy is especially helpful to people with PD because the water provides enough buoyancy to lessen the amount of balance required to perform essential exercises. The cushioning effect of the water allows for freedom of movement while providing the appropriate level of resistance necessary to achieve the desired results. Using a combination of physical and mental exercises, yoga promotes flexibility, reduces stress levels, and increases stamina and strength in individuals with PD. Tai Chi, a total mind and body workout, and is a series of individual dance-like movements linked together in a continuous flowing sequence. Particular benefits for people with PD include reduced stress, increased energy, improved concentration and focus, better circulation and muscle tone, and significant improvements in balance.

If you choose the convenience of a home exercise program, consult your physician or physical therapist for recommendations regarding: (1) the types of exercise best suited for you and those which you should avoid, (2) the intensity of the workout, (3) the duration of your workout, and (4) any physical limitations you may have.

The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Your exercise program should address not only strength but also flexibility and endurance and should include all body parts: face, mouth, neck, torso, arms, legs, hands, and feet. Some general exercise suggestions include:

Start with 10-minute sessions and slowly increase to 30 or 45 minutes
Include at least a 5 minute “warm-up” before exercise and a 5 minute “cool-down” after exercise
- Marching in place or stretching are good suggestions
Try to make exercising fun
- Exercise with friends
- Exercise to your favorite music
- Exercise using a favorite hobby or past time like swimming or dancing.

Since individuals with PD are at risk for falling and freezing (becoming rigid), work out in a safe environment and, if possible, when someone is present. Avoid slippery floors, poor lighting, throw rugs, and other potential dangers (e.g., watch out for the pooch because he might want to join in the fun). If you have difficulty balancing, exercise sitting down, lying on the bed or within reach of a grab bar or securely installed rail. Stop and rest if you feel tired during your exercise program since overexertion can make your PD symptoms worse.

Contributions: Janet Caputo, DPT, OCS,

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part II of II: Dance for Parkinson ’s Disease.

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.comPaul 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 associate professor of clinical medicine at GCSOM.

For all of Dr. Mackarey's articles visit: http://www.mackareyphysicaltherapy.com/forum

Exercise is Important in Prevention

In 2000, President Bill Clinton dedicated March as National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness of the facts about colon cancer – a cancer that is preventable, treatable and has a high survival rate. Regular screening tests, expert medical care and a healthy lifestyle, which includes a proper diet and exercise, are essential for prevention. Several studies have demonstrated that exercise can also help prevent colon cancer.

The American Cancer Society estimates that there will be approximately 150,000 new cases of colorectal cancer in 2021. Of these, 52,980 men and women will succumb to the disease. It is the second-leading cause of U.S. cancer deaths for both men and women combined. The good news is incidence and mortality rates are dropping both nationally as well as in northeast Pennsylvania. The bad news is northeast Pennsylvania still has increased incidence and mortality rates when compared to the national average.

Studies show that prevention of this disease is multifaceted and includes: engaging in daily exercise, eating a low-fat diet with little red meat, avoiding smoking, drinking in moderation and having regular colonoscopy screenings.

Early detection is the key to survival. Death from colorectal cancer can be eliminated if caught at the earliest signs of disease. Colorectal cancer progresses very slowly, usually over years. It often begins as non-cancerous polyps in the lining of the colon. In some cases, these polyps can grow and become cancerous, often without any symptoms. Some symptoms that may develop are: blood in stool, changes in bowel movement, feeling bloated, unexplained weight loss, feeling tired easily, abdominal pain or cramps, and vomiting. Contact your physician if you have any of these symptoms.

The risk of colon cancer increases with age, as 90 percent of those diagnosed are older than age 50. A family history of colon cancer increases risk. Also, those with benign polyps, inflammatory bowel disease, ulcerative colitis or Crohn’s disease are at greater risk and should be screened more frequently.

Prevention of Colon Cancer:

Colonoscopy – The colonoscopy is the most accurate screening test for detecting polyps and colorectal cancer. A long, thin, flexible tube with a camera is used to visually examine the lining of the colon. Polyps can be removed at the time of the exam if necessary. Most people should have this test starting at age 50, although high-risk populations (i.e. those with genetic predisposition or inflammatory bowel disease) may begin at age 40 to 45 or even younger.
Diet & Nutrition – Diets rich in fiber are generally considered beneficial for overall health, including colorectal health. Limit high-fat foods especially from animal sources. Limit red meat and dairy. A diet consisting of fish, fruit and vegetables is valuable. Some researchers theorize that Brussels sprouts, broccoli and cabbage may trigger a chemical process to turn on a gene to suppress tumors. Sunlight and vitamin D are thought to be important too.
Lifestyle & Personal Habits – Smoking and excessive alcohol use increases risk for colorectal cancer and other forms of cancer. Stress and anxiety can be cancer triggers
Exercise – While there have been many studies about the benefits of exercise for colon cancer, none have been more encouraging than a recent study from the Hutchinson Cancer Institute in Seattle. Patients with abnormal cells on the lining of their colons, as found by colonoscopy, demonstrated positive changes and reversal of these cells after engaging in four hours of exercise per week for one year. Some studies have shown that exercise can reduce the risk of colon cancer by 50 percent.

How Exercise Prevents Colon Cancer:

The intestine works like a sewage plant, recycling the food and liquid needed by your body. However, it also stores waste prior to disposal. The longer the wastes remain idle in your colon or rectum, the more time toxins have to be absorbed from you waste into the surrounding tissues. One method in which exercise may help prevent colon cancer is to get your body moving, including your intestines. Exercise stimulates muscular contraction called peristalsis to promote movement of waste through your colon.

Exercise to prevent colon cancer does not have to be extreme. A simple increase in daily activity for 15 minutes, two times per day or 30 minutes, once per day is adequate to improve the movement of waste through your colon. This can be simply accomplished by walking, swimming, biking or playing golf, tennis or basketball. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes four to five days per week, with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for five to 10 minutes, two to three times per day. Then, add one to two minutes each week until you attain a 30-45 minute goal.

Medical Contributor: Christopher A. Peters, M.D

Dr. Christopher Peters is a partner of Radiation Medicine Associates of Scranton (RAMAS) and serves as medical director of Northeast Radiation Oncology Centers (NROC). He is an associate professor of clinical medicine at GCSOM.

Sources: American Cancer Society/Northeast Regional Cancer Institute, and CA Cancer J Clin.

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 associate professor of clinical medicine at GCSOM.

Spring is just around the corner so it is time for running enthusiasts to lace up their sneakers, get outside and run! Runners are addicted to running for good reason. There is nothing like it! No exercise offers so much in such little time. For example, the caloric expenditure while running is higher than for most other exercises, including biking. Also, it allows for fresh air and beautiful scenery with a minimal investment in clothing or equipment. It requires little skill and time to learn. Runners suffer from less depression, colds and flu symptoms, and experience less pain due to an endorphine release (natural chemical in the brain associated with euphoria and pain control) that is greater than found in other sports and activities. These are some of the motives that cause people to run every day, in spite of the constant loading and wear and tear on the joints.

To be a competitive runner and have longevity in the sport, optimal form is necessary. Moreover, a recent study shows that a runner can decrease the stresses on the lower body and reduce the incidence of stress fractures when trained to run with proper form using visual feedback while on a treadmill. The application of this information has significant implications for training programs for runners for the prevention and recovery from injury. One such low impact method is called the “Pose Running Technique,” by Dr. Nicholas Romanov. It is a “soft landing” method which promotes; an S-like body position with slightly bent knees, a slightly forward lean at the ankles to employ gravity and momentum, lifting the feet up under the hips, and landing on the ball of the foot under the body to absorb the center of mass.

It is my opinion, that the best runners, with the least injuries, such as Jordan Hoyt, speedster from Abington Heights, employ these techniques naturally. Additionally, many of the world’s best runners use coaches and trainers to assist them in their quest for success and injury prevention by using perfect form. However, for the rest of us, we must learn to maximize the efficient use of the body as it works with, not against gravity. We must learn to run “soft” to prevent injuries.

PROPER FORM

Head Position

A slight upward tilt of the head to allow a view of the horizon ahead should be most comfortable. Avoid looking down or up to extremes. Do not rock or rotate the head while running.

Shoulder Position

Loose and relaxed shoulders set the tone for a good run. Keep them level without tilting side to side or rotating left to right. Avoid holding the shoulders in a tight and high position.

Arms

Loose and relaxed arms also set the tone for a good run. A good arm swing is always in forward motion in a linear direction and stays between the waist and lower chest. Never clench the fist. Do not rotate or twist the arms across the body.

Torso

If the head, shoulders and arms are in correct position, then the torso will be upright. An erect running posture is necessary to promote efficient movement and breathing. The posture that you assume when taking a deep breath is the correct torso position for good breathing while running.

Hips

The hips will follow the position of the parts above in a linear forward direction. However, if the torso leans forward because the head hangs down then the hips will tilt downward. If the arms swing and torso rotates side to side, then the hips will also rotate.

Legs/Stride

Sprinters need to lift the knees high to thrust the lower legs forward. Long distance runners cannot maintain a high knee lift for a long period of time, however, a slight knee lift with a shorter but quicker stride is more efficient. Proper running requires the foot to softly strike the ground with the knee slightly bent. If the knee is fully extended in front of the body upon impact, the stride is too long and the force too great.

Ankles/Feet

To excel as a runner, when the foot hits the ground it should land lightly, between the heel and the midfoot. The ankle is flexed and rolls quickly forward to the toes to push off the ground with maximum force. The calf muscle propels the runner forward. Efficient running has a quiet and springy landing. A loud foot slap on impact is a sign of poor form and results in excessive force transferred to the lower leg. The foot should spend as little time as possible in contact with the ground…thus a soft runner “floats” when they run.

SOURCES: Runner’s World, Pose Running Technique (www.posetech.com), Journal of Orthopaedic and Sports Physical Therapy.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

Pre-pandemic we saw increased popularity of local races such as the Steamtown Marathon and Scranton 1/2 Marathon. With that, local interest in running was exploding and will hopefully return to normal soon. However, during the pandemic, especially when fitness centers were closed, many took seasoned and beginner runners to the streets to improve fitness and alleviate stress. However, as a health care provider, I am seeing a significant number of first time runners visit my office with a wide variety of injuries that are very preventable with a modicum of good judgment.

Runners are addicted to running for good reason. There is nothing like it! No exercise offers so much in such little time. Caloric expenditure is higher than in most other exercises, including biking. Running also allows for fresh air, beautiful scenery, minimal investment in clothing or equipment, little skill and time to learn. Moreover, the benefits are many; runners suffer from less depression, colds and flu symptoms, and experience less pain due to an endorphin release (a natural chemical in the brain associated with euphoria and pain control.)

This column will be dedicated to those who are interested in beginning a running program for all the reasons mentioned above and more. The program is designed to promote a safe and gradual introduction or return to running as form of exercise. The initial goal is to help you attain 30 minutes (approximately 2 miles) of running at a slow, relaxed and safe pace. This 30 minute goal is the standard used in most research that shows improvement in weight control, cholesterol, heart disease, blood pressure and adult onset diabetes. The 8 week program is a simple and safe program that begins with more walking than running and gradually reverses the proportion. The first two miles are the hardest and once mastered; one can begin to build on mileage and intensity if desired. For those interested in advancing to a half or full marathon, I recommend the book “The Marathon” by Jeff Galloway who advocates a run/walk program as you increase distances. Visit his website at: www.jeffgalloway.com.

Before You Begin

Consult your physician: This is important if you have health issues, have not engaged in exercise for some time or you are 15-20 pounds overweight and over 40 years of age.

Plan a schedule: Get committed. Use a computer, calendar, or fitness Apps such as Endomondo Sports Tracker or Argus.

Get mentally prepared: You will have good and bad days. You have to do it, even on the bad days. Once you get to a certain level of fitness, it gets easier and more fun.

Buy the proper shoes for you: Just because the sneaker fits does not mean you have to wear it! Manufacturers entice prospective buyers with a multitude of colors, fabrics, styles and designs. Instead of focusing on aesthetics, focus on function!

The appearance of an arch in a weight bearing position does not automatically exclude the individual from excessive supination or pronation. Consult a podiatrist or an orthopedic physical therapist to determine the propensity toward supination, pronation or neutrality of the foot and ankle.

Note: New Balance, Brooks, Asics, Mizuno & Saucony all make quality running shoes to accommodate a supinated, pronated or normal foot.

Other equipment: DryTech is great fabric for running which wicks the sweat away from the skin and prevents chaffing. It can be found in shorts, pants, shirts and socks Also, weather and temperature options are important, such as compression shorts in cooler temperatures to prevent muscle pulls.