Happy Independence Day! Summer activities are in high gear…playing games, jumping, walking and running on grass, pavement and sand! And, with that, foot and heel pain is not unusual, especially for those who are not in shape, new to exercise, wear summer flats, sandals or shoes with poor support.
While man has spend thousands of years evolving to walk on two feet, some problems of bipedal weight bearing has not been worked out. Heel pain is a common complaint among adults over 40. Plantar fasciitis is the most common cause of heel pain but the diagnosis can be difficult and treatment approaches vary widely! In my experience, plantar fasciitis can be difficult to treat and the research on this condition has failed to provide sufficient evidence to determine the BEST treatment regime. Stretching, strengthening, icing, activity modification, oral and topical anti-inflammatory medications, steroid injections, orthoses, immobilization, extra-corporeal shock wave therapy, and surgery are all potential treatments mentioned in the literature. While all of these treatments have benefits, some have risks, and no single treatment has been the “proven winner”. It may be that an appropriate combination of treatments specifically tailored to the individual problem may be the best approach.
The correct diagnosis is essential. Other conditions such as tarsal tunnel syndrome, calcaneal stress fracture, and lumbar radiculopathy (sciatic nerve pain radiating down the leg) can mimic the symptoms of plantar fasciitis and must be ruled out as causes of your heel pain. People with plantar fasciitis typically report severe heel pain with the first few steps out of bed in the morning. Called “first step pain”, this classic symptom also occurs upon standing and walking after any period of recumbence such as sitting or reclining on the couch. Female gender, activities (occupational or recreational) involving prolonged periods of weight bearing (e.g. standing, walking, or running), improper foot and leg alignment, calf tightness, obesity, and age between 40 and 60 years old are factors that increase your risk of developing plantar fasciitis.
Even with the correct diagnosis, treatment of plantar fasciitis can be controversial because of differences in opinion regarding the CAUSE of plantar fasciitis. Amongst the medical community, there is continued debate about whether plantar fasciitis is an inflammatory condition of the fascia or the periosteum (i.e. the outer covering of the bone to which the fascia attaches) and whether the condition is inflammatory at all! Researchers discovered degenerative changes rather than inflammatory components in tissue samples taken from people with plantar fasciitis. Typically, treatments for degenerative and inflammatory conditions differ.
Despite the cause of plantar fasciitis, many remedies have been employed in various combinations and with varying degrees of success. First, many clinicians advocate calf and plantar fascia stretching. An inflexible calf muscle increases the tensile stress within the plantar fascia and a shortened plantar fascia, as in high arched people, builds up more tension in the heel. Also, strengthening muscles that provide dynamic support for the flat foot complements the stretching exercises. Some researchers believe that wearing shoes has made our foot muscles lazy! In addition, most practitioners consider an anti-inflammatory strategy as first-line defense and will typically prescribe an oral medication or topical application. If the pain does not respond or is severe, a steroid injection may be advised. A study from 2010 concluded that properly placed steroid injections for plantar fasciitis are safe and effective with minimal risk of complications (e.g. atrophy of the calcaneal fat pad) or fascial rupture. Moreover, because faulty foot mechanics are typically associated with plantar fasciitis, physicians and podiatrists often recommend orthotics (i.e. shoe inserts; over-the-counter or custom) and proper footwear, to either correct the mal-alignment or accommodate the deformity. Furthermore, to properly position the plantar fascia at night for optimal healing, some researchers advocate the use of a night splint to place the ankle at 90° and the toes at 30°. Finally, some stubborn cases of plantar fasciitis may require immobilization, and, as a last resort, surgery.
Despite differences, most clinicians advise stretching, strengthening, icing, orthotics, and anti-inflammatory medication as part of the initial management of plantar fasciitis. Some podiatrists recommend physical therapy so that their patients have access to all of these treatments at once, including manual techniques.
Websites: Plantar Fasciitis Night Socks: www.braceability.com www.orthoticshop.com
Source: Lower Extremity Review
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Times-Tribune.
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
For all of Dr. Mackarey's articles visit: https: //mackareyphysicaltherapy.com/forum/
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 in Scranton, PA. He is an associate clinical professor of medicine at GCSOM.
Age-related changes to your body are normal and expected. For example, loss of muscle tone, stiffness in joints, and loss of balance. With effort, some of these changes can be retarded and managed. The brain is no different…it can slow down and lead to memory lapses. However, for most of us, it too can be managed and with a little effort, be kept sharp and clear.
Many experts feel that exercise is the best method to maintain not only physical health but mental health. Regular exercise can prevent the things that contribute to memory loss with age such as; diabetes, high blood pressure, high cholesterol, obesity and stroke.
Specifically, aerobic exercise may be most beneficial. Aerobic exercise is any type of sustained exercise that strengthens the heart and lungs to improve the body’s use of oxygen. This may include running/jogging, brisk walking, cycling, swimming, rowing, and the use of a treadmill, elliptical, stepper or similar device, at light to moderate intensity which requires the use of oxygen to adequately meet the oxygen demands of the body for an extended period of time. The generally accepted time and frequency is at least 30 minute sessions performed three or more times per week. Two 15 minute or three 10 minute sessions are also valuable. For those with back, hip, knee and other lower body pain, consider low-impact or partial weight-bearing activities such as a recumbent bike or stepper or upright bike instead of a treadmill.
The benefits of a healthy diet are well-documented. Specifically, a Mediterranean-style diet is highly recommended. It focuses on plenty of fruits and vegetables with fish instead of red meat and olive oil instead of butter. Researchers found people who closely adhered to a Mediterranean diet were nearly 20% less likely to have thinking and memory problems.
Exercise your brain just as you do your body. Make time each day to challenge your brain. Learn something new to keep your mind sharp. Play cards, read a book, do crossword puzzles or other word games, take a class or learn play a musical instrument.
Human beings are social animals and in the right setting, we stimulate and challenge each other. Join a book club, fitness center, or a community center. Consider volunteering, taking an art or photography class. Social interaction can prevent isolation which can lead to depression and depression is associated with dementia.
Without adequate sleep, attention and concentration is compromised. Studies show that those who have normal restful sleep outperform those who are restless and sleep deprived. Some tips for better sleep are: avoid big meals before bed, keep a consistent sleep and wake up time, avoid nicotine, caffeine and alcohol close to bedtime. “
Consider an afternoon “power nap!” Recent studies show that an afternoon nap was rejuvenating to the mind and body. Participants improved on mental skills such as memory, calculation, orientation and attention.
Cortisol is the hormone associated with stress. Recent studies have found that elevated cortisol levels were associated with poorer overall cognitive functioning, including memory, language, and processing speed.
Try yoga, massage, breathing techniques to relax. Progressive muscle relaxation (PMR) techniques can be very effective…try it on YouTube!
Smoking is clearly one of the worst things you can do to your body AND MIND! Smoking can lead to early memory lose in part due to small strokes in the brain. Do whatever it takes to quit; nicotine replacement, medication, or counseling.
There are many medical conditions and medications associated with memory loss. Regular medical check-ups can prevent, diagnose and treat some of these conditions such as; depression, diabetes, thyroid disease, vitamin deficiencies, and drug interactions or side effects. For example, sleep aid and anxiety drugs are commonly associated with memory loss.
In addition to common tricks such as word association, sticky notes, use your smart phone for appointments and reminders. If you don’t know how to use a smart phone, than you can help your memory by exercising your brain to “learn something new!”
SOURCES: WebMD; Harvard Health
Read “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
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
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.
Guest Author: Gregory E. Cali, DO
Today is the first day of summer! Summer is a great time to enjoy the many beautiful lakes and rivers in our area. Many will spend time swimming, water skiing and tubing, boating, kayaking, and fishing in the lakes and streams while others will enjoy a refreshing dip in a pool or ocean. However, it is important to be aware of the risks associated with water sports. Statistically, every year 4000 people die from drowning in the US, many more worldwide. Drowning is defined as “respiratory impairment from submersion or immersion in a liquid medium”.
In the past there was a distinction made between salt water and fresh water drowning. Because of the amount of water inhaled, the distinction between fresh water and salt water drowning is not considered to be important.
Drownings occur more often in low and middle income countries worldwide. In the US, drowning is a major cause of death, affecting mostly those below age 45, especially children between one and five years of age, and is more frequent in Florida, Arizona, and California.
People who voluntarily hyperventilate before diving may blow off so much carbon dioxide, that there is no drive to breathe until oxygen levels are very low. This can lead to seizures, cerebral hypoxia (lack of blood and oxygen to the brain), and drowning. During the drowning episode, panic breathing leads to inhalation of water and laryngospasm. Pulmonary edema may occur, as well as brain swelling and increased intracranial pressure. Hypoxia leads to brain injury. Cardiac arrhythmias may occur, along with electrolyte imbalances and kidney failure.
CPR should be done following the established guidelines. It is critical to ventilate the victim as quickly as possible. Remember that cervical cord injuries may have occurred, and the patient’s neck needs to be stabilized if cervical injury is possible depending on the circumstances. Routine drowning without trauma may not need cervical stabilization. Ventilation with mask and intubation should be done as soon as possible. Transfer to the hospital should be expedited, and management in the hospital includes respiratory support, trauma evaluation, and intensive care monitoring.
Factors leading to outcome include duration of exposure, time to effective life support, resuscitation time, age and central nervous system level of function.
Prevention – Drowning is Preventable in Most Cases!
Also be mindful that parents need to stay awake and avoid sedating drugs or alcohol which may alter their consciousness when their children are swimming. Appropriate use of personal flotation devices (PFD) should be worn all the time when boating. Although the law in PA does not require that a PFD be worn, but just be present in the boat, there are numerous cases where a person is thrown from a boat and becomes unable to get to the PFD in time, or hit their head and becomes unconscious before they hit the water. Swimming alone is not recommended, swim with a partner. Finally remember that toddlers can drown in relatively small quantities of water.
Summer is short in NEPA, so, go out and enjoy the lakes, rivers, streams and oceans, but remembers, do so safely... respect Mother Nature!
Guest Author: Gregory E. Cali, D.O. is a local pulmonologist with offices in Dunmore, PA.
Read “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
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
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.
After enduring the challenges of a cold and snowy winter, late spring and early summer is the time of year when long distance runners ramp up their training in preparation for the some of the best half and full marathons in the fall: Steamtown, Philadelphia, New York, Marine Corps in DC to name a few. But, runners beware; overtraining can lead to stress fractures.
I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon to keep the intruders 26 miles away from their families in Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to the capital to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!
In the modern age, marathon and recreational runners enjoy testing their mental and physical stamina in pursuit of fitness and wellness. If not careful, many runners (and other competitive athletes) will develop pain in their shins (shin splints). Unfortunately, in many of these well-intended athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture. Some very good athletes have been hindered by this problem.
A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.
10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.
The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).
Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.
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
To read all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.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 associate professor of clinical medicine at GCSOM.
Human beings were designed to move…walk, run, climb, lift, hunt, and gather. Contemporary man has suffered greatly from a technologically driven inactive and sedentary lifestyle. Moreover, many people continue to work or school from home and studies have found that these people are sitting more with less activity during the day. Inactivity is associated with many health problems; obesity, adult-onset diabetes, high blood pressure to name a few. The problems associated with lack of movement are many.
The more you move your body, the more you colon moves! A regular and consistent exercise and activity regime, results in a more consistent bowel schedule, especially with age. Healthy muscle tone in your abdominal muscles and diaphragm is also key to moving waste through your digestive tract.
Osteoarthritis, rheumatoid arthritis and many inflammatory or auto-immune diseases can cause achy, and stiff joints. However, even healthy joints can also stiffen when you don’t use them enough. Put them to work so they get tight and cause pain.
All muscles get weak from lack of use, including the muscles that help your lungs expand and contract as you breathe if you don’t work them out regularly. The less exercise or activity you do, the more you experience shortness of breath, even during easy daily tasks.
Physical problems are not the only complication of inactivity. A lack of movement can also increase feelings of anxiety and depression. Aerobic exercises like walking, biking, swimming, or running, have been proven to stimulate endorphins to boost and steady your mood, and even improve your self-esteem.
Many studies have found that regular movement improves energy. Exercise helps deliver oxygen and nutrients to your tissues. When you sit or are inactive, tissues are not getting the same amount of fuel they need to keep you going.
Movement stimulates your metabolism. Hyperactive people burn more calories…just by fidgeting! Even if you are not hyperactive, the more active you are, the more calories you burn each time you move.
One of the first recommendations sleep doctors make to their patients suffering from insomnia is exercise. When you keep a regular exercise routine, you fall asleep faster, and you sleep deeper once you drift off.
Exercise stimulates the release of oxygen carrying blood and chemicals in your brain to improve function. The more blood that gets to your brain, the better you can think, remember, and make decisions.
Sedentary people have a higher incidence of high blood pressure and heart disease. Spending most of your time sitting raises your risk of heart disease. High cholesterol, high blood pressure, obesity, all related to inactivity, are major risk factors for heart issues like coronary artery disease and heart attack.
Inactivity and high blood glucose levels are closely associated. Regular exercise is essential to keep your blood glucose under control. Stable blood sugar levels helps you avoid type 2 diabetes danger zone.
A strong core is can prevent lower back pain. A weak core, associated with inactivity core muscles and lack of use, makes you more vulnerable to lower back pain from tweaking your back muscles during everyday movements like standing or reaching. Pilates, yoga, and other exercises that use stretching are good for building a stronger back.
While some people report an increase in appetite with exercise, research shows that aerobic exercise like biking, swimming, walking, and running can actually decrease your appetite because it changes the levels of certain “hunger hormones” in your body.
Studies show the more moderate activity you get, the lower your chance of catching a cold or other germs. When you make exercise a habit, your immune system gets stronger.
If your skin looks duller than usual, a lack of movement may be to blame. Some studies show that moderate exercise boosts your circulation and your immune system, which helps your skin keep that youthful glow.
Source: WebMD
Read “Health & Exercise Forum” – Every Monday Next Week Part II of II: Tips to Select a Good Cervical Pillow For You. 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.
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.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 in downtown Scranton, PA and is an associate professor of clinical medicine at GCSOM.
This week IS MEMORIAL DAY 2021…THE UNOFFICIAL FIRST DAY OF SUMMER! IT IS TIME TO GET THE HECK OUTSIDE! Research shows that spending time outdoors has many positive effects on your health. While there are many year-round activity options, in Northeastern Pennsylvania our short-lived summer is the inspiration to “suck the marrow out of a sunny day!” Summer in NEPA is enjoyed in many ways such as walking, running, hiking, biking, horseback riding, boating, kayaking, and swimming. Studies show that even less vigorous activities such as fishing, picnicking camping, barbequing, or reading a good book on the porch are healthier than being indoors.
It is reported that Americans spend 90% of their lives indoors and that number increases with age. Worse yet, for some, venturing outdoors is considered risky behavior with fear of the sun, ticks, wind, mosquitoes, and other creatures of God. Well, the truth of the matter is the risk of being one with nature is far less than the ill effects of a life stuck indoors.
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. It seems that the health concerns of ultraviolet light, sun burn, and skin cancer have created an overreaction to the point of Vitamin D deficiency in many. Balance and common sense go a long way. One can attain normal levels of Vitamin D by being outdoors in the sun and exposing their arms and legs for 10 -15 minutes a few times per week. Additional time in the sun warrants sunscreen and Vitamin D supplements can be used if necessary.
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. Some studies show that children in the United States spend an average of 6 ½ hours per day with electronic devices such as computers, video games and television. It is also reported that a child’s activity level more than doubles when they are outdoors. So, get out of the office, house, and gym as often as possible. Consider weight training at the gym and doing cardio by walking, biking, or running outdoors.
It is well documented that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health. Furthermore, studies show that exercising outdoors in the presence of nature, even for as little as 5- 10 minutes has additional mental health benefits. For those less active, read or listen to music in a hammock or lying in the grass.
Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term is supported by research that found children with ADHD focus better when outdoors. Furthermore, it was discovered that these children scored higher on concentration tests following a walk in the park than they did after a walk in their residential neighborhoods or downtown areas, showing the benefit of the “green outdoors.”
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. Next time you’re recovering from an illness, discuss this with your physician.
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. Many pulmonologists believe people with pulmonary problems would benefit from outdoor activities such as a 10–15-minute walk because they are prone to osteoporosis and Vitamin D deficiency. Local pulmonologist, Dr. Gregory Cali, DO, agrees, and also adds that studies do not show that high humidity is dangerous for respiratory patients, but it may be uncomfortable. In cold temperatures, those with pulmonary problems must avoid directly breathing cold air by covering up their mouths when walking outdoors. Overall, the benefits far outweigh the risks.
Read “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
For all of Dr. Mackarey's articles visit: mackareyphysicaltherapy.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 associate professor of clinical medicine at GCSOM.
There are many reasons why losing weight, the number one health goal, is the most elusive goal of all. Not the least of these reasons is the psychology of eating…because in the land of plenty, we eat mindlessly! Consider the facts; First, we thought the food was bad…but when we chemically modify the food such as removing or altering the fat or sugar and removing the calories, it failed to reduce our weight. In fact, it has been discovered that “fake sugar,” even thought it does not have calories, can still increase blood glucose levels. Next, we decided fat cells were the enemy but we failed to control our weight when we removed fat cells from our body through liposuction. Then, we decided the problem was our digestive system so we placed bands or staples in the stomach or by-passed the small intestine. While these efforts helped many in the short run, long term, without a change in behavior, it failed as a long-term solution. Many medical professionals have concluded that the problems people have with weight are not exclusively due to the food, fat cells, stomach or intestines, but rather, THE MIND!
Mindful eating, also referred to as intuitive eating, is based on Buddhist teachings in which focus is placed on the experience of eating, AND ENJOYING, our food. The concept was presented in a feature column in The New York Times written by Jeff Gordinier based on his time spent in a Buddhist monastery. He discovered that mindful eating practitioners ate in silence and chew small pieces of food very slowly and deliberately to experience its taste, texture and smell. It requires full attention to the experience of eating and drinking on the body and mind. It is often referred to as “the opposite of diets” because with mindful eating there is not right or wrong way to eat but rather varying degrees of awareness about WHAT WE EAT AND WHY. Furthermore, the goal of this exercise is to teach our mind and body to connect and communicate while eating so one can learn important cues such as: what are my hunger signals? What does my stomach feel like when it is half, three-fourths and completely full?
One study of 1,400 mindful eaters found that they enjoyed lower body weights, greater sense of well-being and suffered from fewer eating disorders. However, many feel the concept, while valuable, is very difficult to put in practice in the busy American family. Research shows that, even when not perfectly relaxed, the simple act of the family meal can have a powerful impact on mindfulness, health and wellness.
In a country that thrives on a fast pace with over-book schedules, families struggle to balance work and school and after school sports and activities. Consequently, fast food, eat-and-go habits have become the norm. According to some studies, most find it difficult find time to sit and relax for a family meal even once a week. Additionally, when families do pull off a family meal, it is often overwrought with school drama, sibling rivalry, and parental discipline about school, homework or social activities, making the situation stressful. Despite the family conflict, studies strongly support the health values of the family meal.
A recent study from Columbia University that received national attention found that children who participated in a family meal regularly were less likely to have problems with drugs or alcohol and more likely to excel in school. Moreover, those children eating with their families at least 5 times per week benefited most. Other studies have found that the there is a significantly lower incidence of teens who smoke, use alcohol, have sex at a young age, fight, get suspended from school or commit suicide among those who have meals with their family on a regular basis.
| Mindless Eating | Mindful Eating |
| 1. Eating past full and ignoring body signals | 1. Listening to your body and stopping when full |
| 2. Eating when emotions tell us to eat | 2. Eating when our bodies tell us eat |
| 3. Eating alone, at random times and places | 3. Eating with others, set times and places |
| 4. Eating emotionally comfort foods | 4. Eating nutritious and healthy foods |
| 5. Eating and multitasking | 5. When eating, just eat |
| 6. Considering a meal an end product | 6. Considering where food comes from |
EVERY 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
Read all of Dr. Mackarey's Articles at: https://mackareyphysicaltherapy.com/forum/
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 Geisinger Commonwealth School of Medicine.
Dupuytren’s Disease is a condition of the hand that was initially described in the 1600’s and named after a Swiss surgeon in the 1800’s. This condition reaches beyond quarterback greats and has affected a pope, prime minister, and a U.S. president.
Last week’s column (part one), presented the cause, incidence, progression and prevention of the disease. Part two will focus on treatment options.
Dupuytren’s disease is a benign condition that affects a normal structure in the hand called fascia. It often causes lumps on your palm and cords on the palm or fingers. These cords can begin to thicken and shorten and pull on the skin which causes a puckering or dimpling and eventually begin to cause the finger to bend into the palm. Typically, the lumps are not painful, although sometimes, in the early stages they can be tender. This can be concerning because of appearance and loss of hand function. The fingers most affected are the ring and little finger, but all fingers including the thumb can be affected.
Several available treatment options exist. Following an assessment of your hand, you, along with your surgeon, will determine which option is best for you. The goal with all treatment options is to reduce the deformity of the finger and improve hand function. The treatment options include the following:
Hand therapy following each of the procedures is beneficial. You may receive a referral for hand therapy a few days following any of the above procedures. You will begin range of motion of the fingers. Early motion is important to regain hand function and decrease the tendency for your fingers to return to a contracted position. Your surgeon may also suggest for a custom orthosis (splint) to assist in keeping your fingers straight which you will only wear at night for sleep. You can also use your hand for light activities. Your stitches will be removed in approximately 2 weeks.
Hand therapy will initially focus on managing swelling that may occur following any of the procedures. Wound care and bandage changes will be performed if you have had surgery. Scar management and exercises will include those that focus on restoring motion for straightening the fingers, however closing or flexing the fingers is also important to maximize hand function. You will also be shown exercises to perform at home to optimize your recovery. As you continue to progress your therapy routine will be upgraded to include hand strengthening and functional tasks to allow you to return to your daily activities at home and work.
A team approach which includes you, the surgeon and therapist is important to ensure that an optimal recovery and a return to your everyday functional tasks are achieved.
GUEST AUTHOR: Nancy Naughton, OTD, CHT, is a doctor of occupational therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA.
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
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
John Elway has an impressive resume, hall of fame quarterback, president of football operations for the Denver Broncos and more recently for something less glamorous, but still intriguing. He has a hand condition called Dupuytren’s contracture or Dupuytren’s disease. His recent appearance in a television commercial has brought to light this condition of the hand that was initially described in the 1600’s and named after a Swiss surgeon in the 1800’s. This condition reaches beyond quarterback greats and has affected a pope, prime minister, and a U.S. president.
Dupuytren’s disease is a benign condition that affects a normal structure in the hand called fascia. It often causes lumps on your palm and cords on the palm or fingers. These cords can begin to thicken and shorten and pull on the skin which causes a puckering or dimpling and eventually begin to cause the finger to bend into the palm. Typically, the lumps are not painful, although sometimes in the early stages they can be tender. This can be concerning because of appearance and loss of hand function. The fingers most affected are the ring and little finger, but all fingers including the thumb can be affected.
There is a genetic component to the disease and largely affects people of Northern European descent and is more common in men although does affect women. Dupuytren’s contracture can begin in your 40’s, but is more common in your 50’s and 60’s. According to the American Society for Surgery of the Hand, there is no known connection between Dupuytren’s disease and a specific occupation. The progression of the disease is difficult to predict and varies between each person. Some individuals remain with nodules and thickened cords in the hand while others progress to severely bent fingers. The condition may progress in months but generally takes years.
As the condition progresses, the fingers begin to bend in toward the palm and there is an inability to straighten the fingers. Dupuytren’s cannot spread to other fingers, but often there is more than on finger involved. As the deformity progressive it may affect your hand function. The activities that become most difficult are often; shaking hands, putting your hand in your pocket, putting on gloves, pushing up from a table, washing your face and clapping, as some examples.
There is no “cure” for Dupuytren’s and no specific treatment that will prevent someone from getting Dupuytren’s, however it is very treatable, and the intervention generally depends on whether the position of the fingers is affecting your daily activities.
Therapy is a conservative and safe option, however since the thickened cords in your hand are not elastic the likelihood of straightening the fingers is low. However, instruction for some basic exercises and education on how to monitor your symptoms may be temporarily helpful for some people. Hand therapy will be a more appropriate and helpful following surgery or another procedure. It is never too early to be evaluated by a hand surgeon and seeing a hand surgeon does not mean you need to have surgery. One sign suggested by the American Society for Surgery of the Hand is once you are not able to place your hand flat on a table surface may be a good time to be evaluated.
A team approach which includes you, the surgeon and therapist is important to ensure that an optimal recovery and a return to your everyday functional tasks are achieved.
GUEST AUTHOR: Nancy Naughton, OTD, CHT, is a doctor of occupational therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week read Dupuytren’s Part 2 of 2.
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
Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum/
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
“Everybody talks about the weather, but nobody does anything about it,” said Mark Twain. Just ask 93% of the arthritis sufferers who believe that the weather affects their pain level. History tells us that Benjamin Franklin, Leonardo da Vinci, and Christopher Columbus also felt this way about the weather.
Patients at our clinic have been particularly sensitive to joint pain on cold, damp days, especially during the past few weeks. In my clinical practice of orthopedic and sports physical therapy, an informal survey found that 95 out of 100 patients (95%) with arthritis reported increased pain with weather changes. While most people report that the coldness and dampness seem to irritate their joints, they also report more pain with weather changes in the summer. There is a reasonable explanation…
Joints in the body have a lining called synovium that secretes a lubricating fluid called synovial fluid. In joints with arthritis, there is an overproduction of synovial fluid. In theory, when the barometric pressure changes, so to will the pressure inside your joints, especially if it is already overfull with extra fluid from arthritis. This added pressure stimulates the nerve endings in the joint to produce inflammation and pain.
Despite this overwhelming response from patients, scientific studies vary in their support of this claim. According to the Mayo Clinic, in 1961, a famous arthritis doctor (rheumatologist), built a climate chamber and discovered that when high humidity was combined with low barometric pressure, patients reported increased joint pain and stiffness. A recent study found that changes in barometric pressure and cooler temperatures are associated with joint pain. However, other studies have found increased joint pain with high barometric pressure in both warm and cold weather while another study found pain with low pressure.
It means that patients with arthritis consistently report pain with weather changes but science has not found an accurate method to consistently support these claims. Some of these inconsistencies may be attributed to the fact that there are differences in sensitivity among individuals. For example, some patients have symptoms before the weather changes, while others notice symptoms during or after the weather changes. Still yet, some report more pain in colder conditions while others notice more pain in warmer weather. It appears that changes in the weather, such as a high to a low or warm dry to cold damp and vice versa is the culprit when it comes to irritating arthritis in a joint.
If I have arthritis, should you move to Arizona? Yes and no! Yes, the warm and dry climate of Arizona will probably make you feel better overall. However, it will not cure the degenerative changes in your joints and you may still have pain when CHANGES in the weather occur. This is proven to be true by the fact that there are many very busy rheumatologists in Arizona!
In conclusion, it is safe to say that there is some evidence to support the claim that most patients with arthritis have increased symptoms of joint pain and stiffness with CHANGES in the weather:
Therefore, each patient must be individually evaluated by their physician to determine the extent of their arthritis and its relationship to the changes in the weather. While the cause of their increased symptoms with changes in the weather may not be completely understood, each patient must determine the adjustments in their lifestyle and/or medications according to the particular weather patterns that affect their problem most.
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
Read all of Dr. Mackarey's articles at https://mackareyphysicaltherapy.com/forum/
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.
