“I can’t comb my hair.” “I can’t wash my back.” “I have a difficult time putting on my jacket.” “It’s hard for me to tuck my shirt in.” “I can’t reach for things on a high shelf.” These are all very common complaints from people with frozen shoulder. Also known as adhesive capsulitis, frozen shoulder is a condition that results in a tightness of the shoulder reducing its overall movement.
The bones which make up the shoulder joint are held together by a lose capsule of connective tissue. The connective tissue is loose to allow maximal movement of the shoulder, the most mobile joint in the body. With frozen shoulder, this loose connective tissue capsule tightens which restricts the overall movement of the shoulder. Another way to understand frozen shoulder is to look at the construction of the shirt or blouse you are presently wearing. All shirts have extra fabric in the armpit. This extra fabric allows for freedom of movement for the shoulder. Try this: grab the extra fabric under the armpit of your shirt and tightly squeeze it. Now, try to raise your arm over your head. You will notice that you will be unable to raise your hand over your head due to the restriction of the tight fabric. The fabric of the shirt is very similar to the connective tissue of the shoulder. A tightening of the connective tissue will restrict movement of the shoulder.
How does this connective tissue become tight? This is not completely understood. While some conditions are due to trauma, prolonged tendonitis or bursitis, most patients with frozen shoulder will state that “it just happened.” They indicate that they did not fall on it or suffer an injury; however, a gradual loss of movement occurred over the past several months. They do typically indicate that certain movements are painful such as reaching overhead or reaching behind their back. It is known that middle aged women are most prone to this condition and that individuals with diabetes are more commonly affected. Interestingly, right-handed individuals more commonly get frozen shoulder on their left side.
Treatment for frozen shoulder is varied. Most cases require some form of medical intervention. Physical therapy is commonly used to decrease pain, improve strength and range of motion and ultimately function. The physical therapist makes the tight connective tissue more pliable usually with moist heat and ultrasound immediately followed by manually stretching the connective tissue. As the connective tissue is stretched the movement of the shoulder gradually returns. This is a gradual process and treatment may last for several weeks or months. In severe cases, a surgeon will stretch out the connective tissue while the patient is under anesthesia. Following this surgical stretching, the patient is typically sent to physical therapy to maintain the stretch.
As indicated above, most cases of frozen shoulder require medical intervention. If you suspect that you might have frozen shoulder, it is recommended that you see your family physician or orthopedic surgeon and get a referral to a physical therapist.
Movement Is Your Best Friend - If you think you have frozen shoulder, you need to move the shoulder and move it a lot. If you baby the shoulder and protect it from movement the condition will get worse.
Pain Is Your Worst Enemy Yes, move the shoulder as much as you can but do not move it to the point of pain. If you move the shoulder to the point that it is now painful – the frozen shoulder will typically get worse. The bottom line is you want to move the frozen shoulder as much as possible without causing pain.
Warm-Up The Shoulder Before Movement – Use a heating pad, hot shower or bath, or brisk walking to warm up the shoulder before you perform range of motion exercises.
Use a Cold Pack or Ice – after the exercises to control pain and inflammation. Do the exercises 10-15 times each within the limits of pain 3-5 times per day.
Contributions: Gary Mattingly, PT, PhD, Professor, University of Scranton, Department of Physical Therapy, Associate, Mackarey Physical Therapy (deceased).
Read Dr. Mackarey’s Health & Exercise Forum – every Monday – next week: “The Throwing Shoulder”
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 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.
Patients frequently ask me about the purpose of colorful tape worn by athletes on their shoulders, elbows, knees and other areas during the competition. It turns out that this look is more than “just a fashion statement!” Medical researchers have studied and published on this topic to assess its value.
The tape worn by competitive athletes is called Kinesio Tape (KT). It has become very popular in athletes using repeated overhead use of their shoulder as in volleyball, basketball and tennis. It is also used for other joints and muscles such as elbow, wrist, knee, calf and ankle. It is a special flexible tape designed to mimic the qualities of human skin. KT is very different that other forms of athletic tape. It is latex free with acrylic adhesive that is heat activated. It can be worn in the shower or pool. The cotton fibers allow for quick drying and evaporation and can be worn for 3-4 days. KT is approximately the same thickness as skin and can be stretched 30% to 40% of its length at rest.
Some reports propose that the tape has several benefits. It provides stimulation of the muscles and tissues that support the shoulder, improves space in the joint to limit pain and inflammation from impingement, and improves sensory stimulation to improve coordinated movement of the arm. Studies have found that those athletes using KT on the shoulder reported significantly less pain with overhead activities as compared to a sham tape application. No differences were reported in range of motion or ability to perform daily activities.
Impingement – when one or more of the rotator cuff muscles gets pinched between two bones. This is very common and very painful especially when you attempt to raise your hand over your head.
Rotator Cuff Tear – the rotator cuff is made up of muscles which hold the joint together. A rotator cuff can become torn (partially or fully) due to trauma such as falling on the shoulder or following wear and tear from years of overhead activities. Rotator cuff tears are common both in athletes and in the older population.
Rotator Cuff Tendonitis – inflammation of one or more of the rotator cuff tendons is often caused by overuse. Repetitive overhead activities can cause this problem.
Bursitis – inflammation of a fluid filled sack that tries to lubricate and protect the shoulder from impingement.
This is just a partial list of some of the more common problems, which can result in shoulder pain from impingement. All of these conditions are uniquely different and need to be treated differently. Some of these conditions respond well to oral medications, others to injection, others to physical therapy and still others may need surgery. If you have shoulder pain that lasts for more than three days or you notice that you cannot raise your hand over your head, you need to see either your family doctor or an orthopedic surgeon.
Read Dr. Mackarey’s Health & Exercise Forum – every Monday next week “Frozen Shoulder”
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/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 a long, cold and snowy winter, complicated by COVID 19, we look to spring as a time of renewal. It is a time for great hope and optimism; trees are budding, flowers blooming and more people are doing their civic duty and receiving vaccinations…all contributing to a sense of promise for a fresh start!
Spring can also be a time of personal renewal…a time to reestablish goals for health and wellness. However, to be completely healthy, one must have a healthy mind, body and spirit. A healthy mind requires intellectual stimulation, a healthy body requires eating well and engaging in physical activity and a healthy spirit, requires faith, hope and prayer and meditation. This spring, consider the following tips to promote a healthy mind, body and spirit throughout the year.
Begin your meal with healthy vegetables and salads will fill you up and reduce the temptation to over-indulge in high-fat, high-calorie foods. Drinking plenty of water throughout the day is also very important for good health.
Physical activity is one of the most important factors in improving a lifestyle in a positive way. But, it does not have to be complicated. A minimum of 30 minutes of physical activity, 3-5 days per week will have many positive effects on your body.
One cannot be completely healthy without a healthy mind. Like your body, you must continue to challenge your mind in order for it to remain strong, learn, expand, and grow. Read a good book, do crossword puzzles or try something new...piano lessons! Emulate my mentor, Dr. Gino Mori, who has been taking classes (and takes the exams) in art, science and history since his retirement more than 20 years ago!
Prayer, meditation, or chanting has been known to reduce your heart rate, blood pressure and stress level. These activities can lead to a sense of peace, serenity, joy, and faith. Remember, those who are spiritual and faithful live longer.
Those who love themselves are more likely to take care of their bodies. People who are not comfortable in their own skin are never satisfied with their appearance and often attempt to change their body. For example, men use steroids to appear “bigger and better” or women have cosmetic surgery to appear “younger and better.” It is impossible to love others if you don’t love yourself. You must learn to accept and embrace change in your body and life in order to have a healthy mind, body and spirit.
Get the appropriate amount of uninterrupted sleep. A good sleep promotes healing and refueling for your body. When needed, sit, rest, or take a short nap to recharge.
Countless hours are wasted on feelings of anxiety, regret or worry about a past or upcoming event. This can be a waste of precious life time and adds stress to the body, which makes you more susceptible to disease. Stay focused on the beauty of the present moment!
When you associate with healthy people, you take on their healthy habits. You will drink less, eat healthier and exercise more if you are hanging around with those who engage in these habits...they will have a positive influence on you! Bob Knowles, local insurance broker, is my health and wellness role model. He has tremendous discipline; exercises every morning before work, eats and drinks in moderation and makes time to reflect for self-improvement.
The camaraderie of good friends is essential for a healthy mind, body and spirit. Make it a priority to associate with people who “celebrate life!” The health benefits from these positive-minded, healthy people who appreciate you for who you are will provide you with the support, love, and respect necessary to survive any challenge. Find people who know how they celebrate life! My role model for optimism is Steven Scheinman, MD, President and Dean of Geisinger Commonwealth School of Medicine. He demonstrates a keen instinct to find good in others and maintain a positive and optimistic attitude in challenging situations.
Studies show that laughter has health benefits and assist the body in healing. Laughter is contagious, so hanging around with people who are fun and funny, will bring fun and laughter into your life. Try to look for humor in every situation and keep laughing. Spend more time with people that spread joy and laughter. Silly sisters, Rosemary Quinn Malloy, Melissa Quinn LeStrange and Rebecca Quinn Walsh bring a smile to my face whenever I see them or hear their names!
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician.
For further inquires related to this topic email: drpmackarey@msn.com
See 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.
A myth is a traditional story, idea, or belief, especially one concerning early history of a people or explaining a natural or social phenomenon. It is a widely held but false belief or idea. In medicine, health myths are also widely held beliefs about health issues such as medicines, herbs, treatments, cures, antidotes, etc. which are partially or totally false and unsubstantiated in the scientific literature. This is a partial list of the most common health myths.
You don’t need to search very long to find copious information purporting the value of water to maintain good health. Sources suggest between 8 and 15 cups of water per day! Despite the plethora of contradictory information, there is no research to support an exact amount. In fact, most scientifically validated research suggests that healthy adults do not need to count cups and those who drink water when thirsty receive adequate hydration for good health. Remember, there are many water-rich foods to provide hydration; soup, fruit, vegetables, juice, coffee, and tea. However, be aware that if your urine is dark yellow you need more hydration. And, if you are very physically active or live in a warm climate, you may require more water.
In the late 70’s, eggs received a bad reputation when high cholesterol in the blood could increase the risk of heart disease. The love-hate relationship with eggs and egg products has continued to grow since. However, recent findings suggest that eating an egg or two a day will not raise the risk of heart disease in healthy adults. While egg yolks do contain cholesterol, the amount is relatively small and is offset by the fact that eggs also have many nutrients such as omega-3’s which are associated with lowering the risk of heart disease.
Some research attempted to link the preservatives (parabens) used in some deodorants and antiperspirants with the activity of estrogen in the body’s cells because these parabens are found in breast tumors. However, there is no scientific evidence that parabens cause breast cancer. So, don’t sweat it!
Sometimes “old wives tales” are true…but not this one! Grandparents and parents have been telling their grandchildren and children to button up and don’t spend too much time in the cold. In fact, one study found that healthy men who spent several hours a day in cold temperatures (just above freezing) had an increase in virus-fighting activity in their immune systems. Moreover, it is well documented that spending too much time indoors, especially during winter flu season, puts you at risk for getting the flu…so circulate fresh air or get outdoors!
While it is commonly believed that everyone needs a multivitamin to supplement for nutrients not in your diet, research does not supported this theory. In fact, most medical experts agree that healthy adults receive all necessary nutrients and vitamins from a well-balanced diet including; fruits, vegetables, whole grains, nuts and healthy oils. However, if your physician recommends a vitamin, do so. It may be that you are insufficient or at risk due to other medical conditions. If you are pregnant, for example, you will need to take folic acid to lower the risk of birth defects.
Some diets purport that eating breakfast is necessary to stimulate your metabolism in order to lose weight. This theory is not confirmed, and for those who enjoy breakfast, it may limit hunger sensation and prevent unhealthy snacking. However, a study from Cornell University found that those who did not eat breakfast did not overeat at lunch and dinner and consumed approximately 400 fewer calories per day. So, for some healthy adults, eliminating breakfast can help lose weight…the premise of “intermittent fasting.”
Most would agree, the slimy green mucus in your tissue is disgusting. However, without a lab test, it is not a sure sign of an infection or need for antibiotics. Often, a sinus infection is associated with clear mucus and a common cold presents with green mucus.
Sugar making your kids hyper? Maybe it’s just kids being kids! It is widely accepted that sugar is not good for kids (unhealthy calories leading to obesity, etc), but, believe it or not, research shows that it is not the cause of hyperactivity (caffeine or chocolate may). It may be that parents are so focused on their behavior after sugar intake that they expect their kids to be wired when it may just be attributed to the normal behavior of kids just being kids!
Believe it or not, toilet seats are not the most unsanitary item in the bathroom. So, if you can’t cover it, don’t sweat it. Bathroom doors, door handles, and floors, however, are covered with bugs such as E. coli, norovirus, and other flu viruses. Thorough hand washing is essential and use a paper towel for door handles.
One thing is certain…cracking your knuckles is annoying to everyone around you! But studies show that it is not harmful to your joints or causes arthritis. The popping noise is not because the bones are grinding together; it is due to movement of gas bubbles in the joint capsule.
Total elimination of fat from your diet is not only unnecessary to be healthy and lose weight, but is unhealthy and harmful. Fat provides essential nutrients and is an important component of a healthy diet. Due to the fact that fats have more calories per gram than protein or carbohydrates, limiting fat intake is necessary to avoid extra calories. Instead, chose low fat dairy products (milk, yogurt, cheese) and consider eating small amounts of food with healthy fats, such as avocados, olives, or nuts.
Vaccines do not cause autism. Despite much controversy, there is no scientific evidence that supports a connection between autism and childhood vaccines. In fact, the original study that started the debate years ago has been disproven and retracted. Fact: childhood vaccines protect children from a variety of serious or potentially fatal diseases.
SOURCES: WebMd; National Institutes of Health, Mayo Clinic
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
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.
Rehabilitation is defined as the process of restoring something that has been damaged to its former condition. Recovering from joint replacement surgery involves intensive rehabilitation to attain full recovery. In recent years, however, the concept of rehabilitation “before” surgery or “prehabilitation” has been encouraged by most physical therapists and other rehab professionals as an opportunity to expedite the post operative rehabilitation process.
A recent study revealed that strength training before a surgical procedure can counteract muscle wasting associated with bed rest and limited mobility after a procedure. Two systematic reviews revealed that “prehab” exercise decreased pain and complication after the surgery and improved rehabilitation following the procedure. The studies also noted that individuals rehabilitated and attained goals faster, saving time and money. Due to these findings it is our opinion that prehab is an essential part of a comprehensive rehabilitation program for total knee (TKR) or total hip replacement (THR) surgery.
Therefore, it is important to plan ahead and discuss the best “prehab” program for you with your orthopedic surgeon and physical therapist.
“Prehabilitation” enables individuals preparing for a total joint replacement to maintain or improve range of motion, strength, and endurance prior to going for a surgical procedure. We recommend doing at least 4-6 of these exercises 2 times a day to help improve the conditioning of the body prior to surgery and the overall recovery and rehabilitation process following. When completing these exercises, it is important that the movements are symptom and pain free. Should you experience any pain or discomfort with an exercise, you should not continue to perform that exercise. The goal of “prehabilitation” is to prepare the body for your surgical procedure and improve the outcomes and success of the surgery, not further injure or hurt yourself in the process. Therefore, you may not be able to complete all the exercises listed, which is okay, just do your best and what you can! In conclusion, performing exercises prior to having a total joint replacement can enhance your recovery and post-op rehabilitation, so put your best foot forward and take the right steps toward a better total joint replacement with “prehabilitation!”
More Information: For a complete list of these exercises, visit our website at www.mackareyphysicaltherapy.com or call to see how Mackarey Physical Therapy can help you!
Guest Authors: Paul Mackarey, Jr, PT, DPT, clinic director at Mackarey & Mackarey Physical Therapy and Andrea Molitoris, PT, DPT, associate at Mackarey & Mackarey Physical Therapy.
Read Dr. Mackarey’s Health & Exercise Forum – Every Monday
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
Total knee replacement surgery or total knee arthroplasty (TKA) is one of the most commonly performed orthopedic surgeries in the U.S. for individuals older than 40. Given historical trends, these procedures are anticipated to increase in volume by an estimated 143% by 2050.
In part 2, we examine contributing factors that might predispose a patient to an increased likelihood of excessive scar tissue formation after surgery which may lead to a manipulation under anesthesia (MUA) as discussed last week in this column. Along with muscle weakness due to disuse and immobility, scar tissue formation is thought to be a major cause of persistent pain and limited functionality after TKA. We will also consider some risk-reducing strategies.
Scar tissue is described as excessive collagen production and adhesions. Causing contractions in the joint that limits movement and is associated with pain and discomfort. In the knee, symptoms are intensified when walking and standing and are often more debilitating than the original condition. This negatively and severely impacts patients' well-being.
Numerous potential factors have been studied. Still, no clear consensus is reached on which factors increase the likelihood of excessive scar tissue formation after surgery. Some studies indicate that being female or younger in age might suggest a stronger immune response leading to increased scar tissue formation. Similarly, but inconclusively, early-onset osteoarthritis might be a risk factor. A higher body mass index (BMI), previous knee surgery, diabetes, pulmonary disease, depression all have been evaluated to differing degrees, none showing clear causation.
Surgery outcomes are multifactorial and individual. But, an appropriate risk-reduction strategy is progressive range of motion and strengthening exercises through physical therapy (PT). Physical therapy should ideally be initiated before surgery and continued after surgery to aid better outcomes. This approach is shown to reduce the incidence of additional interventions needed to release scar tissue adhesions, like manipulation under anesthesia (MUA/ Article-1).
It is important to get a head start on PT. The rationale is that the pre-surgery range of motion and strengthening of the joint is predictive of the final outcome. It also allows you to establish a relationship with your PT healthcare team and understand what the path ahead requires. It helps you set-up your support group and will increase your odds of success. About 25% of patients will fear using the joint after surgery; having established your PT relationship, discussed, and tried out your exercise program beforehand greatly reduces this risk of post-operative complications.
Outpatient physical therapy should be highly individualized and needs to be performed in a clinic under the supervision of a licensed physical therapist, preferably one who specializes in orthopedics. Your program will include strengthening, stretching, and functional exercises with the incorporation of balance training. Stretching and movement allow the range of motion to be increased and helps prevent scar tissue formation. Strengthening addresses the concern of quadriceps' weakening in the first weeks after surgery. Quadriceps strength is a strong predictor of functional performance. Balance training is important to reduce the risk of falls and further injury. Complimentary to outpatient PT is a home program or telerehabilitation, which requires the patient to carry-over their PT program on the days not receiving formal PT or in the case of illness or inclement weather. Hard work, dedication, and compliance are a vital to prevent complications and produce good outcomes.
An estimated 82 - 89 percent of first time TKA patients are satisfied with their outcomes. This data suggests that several patients are not achieving their goal of relieving pain and restoring functionality. It is important to establish clear and realistic expectations for your individual outcome. This requires frank and open discussion with your healthcare team, allowing you to be an empowered participant in regaining your best joint functionality. Most patients attain satisfactory recovery in 4-6 months; however, full recovery from total knee replacement surgery can take up to two years for some. The best long-term results are found in those initiating PT for range of motion and strengthening before surgery and continued immediately after surgery.
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Author: Hendrik Marais, MD, MS
Hendrik Marais, MD, MS, received his Doctor of Medicine degree from Geisinger Commonwealth School of Medicine in 2015 and his Master of Science degree in Global Medicine from Keck School of Medicine at USC in 2019. He is passionate about creating positive and empowered patient health outcomes. He grew up in South Africa and currently calls Scranton, PA home – where he enjoys cycling, swimming, and discovering the beauty of NEPA. He is a member of the American Medical Association, American Public Health Association, and the International Society of Physical and Rehabilitation Medicine. He plans to pursue a clinical career in physiatry.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Read Part III of III on Recovery from Knee Surgery “Prehab.”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.
Total knee replacement surgery is one of the most commonly performed orthopedic surgeries in the U.S. for individuals older than 40. Given historical trends, these procedures are anticipated to increase in volume by an estimated 143% by 2050.
Knee replacement surgery is widely considered a safe and effective surgical option for patients with end-stage osteoarthritis or inflammatory arthritis of the knee. The surgery aims to maximize the quality of life for patients by reducing pain and improving joint functionality. Unfortunately, research estimates between 1 and 10 percent of patients may experience persistent pain, limited range of motion and loss of function after surgery. This rare but devastating outcome is thought to be associated with arthrofibrosis or scar tissue build-up around the joint which ultimately has a negative impact on an individual’s daily activities and affecting emotional well-being and satisfaction. Thankfully there are remediation treatment options to consider in this situation. One non-invasive, safe, and effective possibility is manipulation under anesthesia (MUA).
Manipulating the knee joint under anesthesia aims to forcefully release fibrous adhesions formed after surgery. It is considered a simple and effective medical procedure performed under general or regional anesthesia, ensuring complete muscle relaxation without any pain experienced. The procedure uses force to overcome adhesions in a controlled manner. While lying on their back, the patient's hip is flexed to a 90-degree angle, and the lower leg is used as a lever to bend the knee until a firm endpoint is reached. Force is also applied to the kneecap to free adhesions found there. These movements are repeated several times until the best range of joint motion is achieved.
Sam, a 44-year old mother and second-grade school teacher suffers from painful osteoarthritis. She underwent knee replacement surgery for both knees. However, 3 months after her surgery, she continued to experience intractable pain, swelling, and an inability to fully bend her knee. She was using a walker to assist her and could not tolerate long periods of standing. She struggled with basic daily activities and became increasingly despondent. Clinical evaluation showed that Sam was not able to bend either knee to 90 degrees. At this point, the healthcare team suggested Sam consider the MUA procedure to release the scar tissue to help move her recovery forward.
Over time, we know that adhesive tissue tends to increase in quantity and maturity. This leads to progressively worsening pain and loss of joint mobility. Literature suggests that earlier MUA intervention provides better outcomes and is more effective. Still, there is no clear consensus on the timing, and MUA may still be effective when performed later. Because clinical improvement after replacement surgery should occur between 6-12 weeks — orthopedic practices often apply a generic 90 by 90 rule of thumb. The rule signifies the ability to bend your knee to 90 degrees within 90 days after surgery. If unable to attain the 90 by 90 goal, MUA is often recommended. This is not a hard and fast rule, and each patient is individually assessed throughout the recovery period.
Not everyone will be a candidate for MUA, and there are risks involved. Since force is being applied to the joint during the procedure, there is a possibility of bone fracture. Patients with osteoporosis or any other bone-weakening illness might be cautioned against the procedure. Other risks include bleeding into the joint and wound rupture. It is also important to recognize that any procedure involving anesthesia is taxing on the body and carries additional risks. It is prudent to discuss all risks and benefits with your surgeon and healthcare team fully.
MUA intends to relieve pain and discomfort and help further increase the functional range of motion in the knee joint. Biomechanically we require a knee to flex or bend, ranging from 67 degrees for walking through to 105 degrees to rise from a low chair; and 115 degrees to squat or kneel. Immediately following the procedure, joint mobility is notably improved. Research studies have recorded an average increase in flexion of 29 degrees immediately after MUA, with continued improvements over time. Individual outcomes do vary. Current literature indicates having had two or more prior knee surgeries or injury to the joint, or a stiffer knee with less than a 70-degree bend 90 days after your replacement surgery, might yield less favorable outcomes.
Sam underwent her MUA 4 months after her initial knee replacement surgery. Physical therapy is started immediately following the MUA to ensure the best outcomes. During her initial evaluation less than 24 hours after the procedure, Sam could bend both knees by herself to 90-95 degrees, something she could not do before. Less than a month after her MUA, and with continued physical therapy, she reached a 115/120 degree bend. Sam had several risk factors; early-onset osteoarthritis, high body mass index (BMI) and previous knee surgeries. These factors complicate Sam's recovery and may have lead to her failure to attain the 90 by 90 goal. Still, she told me if given a choice again; she would make the same decision. Sam smiled and told me she no longer relies on her cane to walk, can walk up and down stairs almost normally and she is eager to start driving again.
The American poet Sheldon Silverstein wrote in his poem "Stop Thief!", "...Help me please. Someone went and stole my knees. I'd chase him down but I suspect my feet and legs just won't connect." Our knee forms such an integral part of daily life and activities— yet we seldom appreciate that it is one of our most stressed and complex joints, needing 10 muscles for movement and stability, and requires varying degrees of flexibility to get us through the day.
Next Monday, in part 2 of this article, we examine factors that might predispose a patient to scar tissue induced persistent pain and limited functionality after knee replacement surgery; and possible steps to avoid this.
This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Author: Hendrik Marais, MD, MS
Hendrik Marais, MD, MS, received his Doctor of Medicine degree from Geisinger Commonwealth School of Medicine in 2015 and his Master of Science degree in Global Medicine from Keck School of Medicine at USC in 2019. He is passionate about creating positive and empowered patient health outcomes. He grew up in South Africa and currently calls Scranton, PA home – where he enjoys cycling, swimming, and discovering the beauty of NEPA. He is a member of the American Medical Association, American Public Health Association, and the International Society of Physical and Rehabilitation Medicine. He plans to pursue a clinical career in physiatry.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Part II of III on Recovery From Knee Surgery
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 Geisinger Commonwealth School of Medicine.
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.
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.
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.
Heart Rate, or pulse, is the speed or number of times the heart beats (measured by the number of contractions of the heart) per minute. It can be detected in areas of the body where the artery is close to the skin: the palm side of the wrist, side of the neck, groin, back of the knee, or top of the foot. In healthy adults, a resting heart rate is between 60 and 100 beats per minute, however, in conditioned athletes, it is often well below 60. When the heart rate is not within normal parameters, it can be an indication of what is happening around you…fear, anxiety, fatigue, contentment, or a medical problem.
The first step to determine the status of your heart rate (HR) is to measure your resting heart rate. A normal resting heart rate for a healthy adult is between 60 and 100 beats per minute. The best time to measure it is immediately after you wake up in the morning before you get out of bed (or when sitting and relaxing). Place your index and middle fingers on the side of your neck or on the palm side of your wrist. Then, count the number of beats you feel for 60 seconds.
Whether you determine that your HR is too high or too low don’t panic. Take your HR repeatedly and document results so you can discuss it with your primary care physician. It is not unusual to find a wide range of numbers which varies individually. For example, it is not unusual for a conditioned athlete (marathon runner) to have a resting HR of mid to high forties or low fifties. More common in the general population, however, is a high resting HR and this can be an indication of a potential health problem. When your resting HR is high it indicates that your heart is working harder than it needs to…especially if you are at rest! Remember, your heart is a muscle and it doesn’t work very efficiently when it is deconditioned…it has to work harder than it should to pump blood through your body, even at rest!
All is not lost! The good news is that you can lower your resting heart rate and improve heart health with a few lifestyle changes.
Probably the best way to lower your resting HR is to avoid a sedentary lifestyle and get moving. Inactivity leads to a downward spiral of poor health …obesity and its associated problems of high blood pressure, and diabetes.
Remember, you don’t have to run 26.2 miles to be fit and healthy. The American Heart Association recommends 150 minutes of moderate-intensity aerobic exercise per week. And, it can be broken down into 10-15-20 minute sessions once, twice or three times per day.
The negative impact of stress and anxiety on health and wellness is well document. While avoiding stress may not be possible, one can learn to manage it. Exercise is one effective way but there are others. Meditation, breathing exercises and yoga are a few. Visit a YouTube video on Progressive Muscle Relaxation (PMR).
Caffeine and nicotine are stimulants and can raise your heart rate.
Losing weight will lower your HR. A healthy diet that maintains a body mass index (BMI) between 18 and 25 for adults is an essential component to a lower HR and overall good health. A BMI over 25 is considered overweight and over 30 obese. Use the BMI calculator from the CDC at: www.cdc.gov>adult_bmi
Dehydration can lead to thicker blood. Thicker blood requires the heart to work harder to circulate blood throughout the body. Drinking plenty of water, (15.5 cups for men and 11.5 cups per day for women), will adequately hydrate the body.
For many, getting 8 hours of sleep per night is easier said than done. But, adequate sleep contributes to overall good health and a lower heart rate.
Lowering your resting heart rate is an essential component to good health. The steps necessary to attain a lower heart rate such as exercise, eating healthy, maintaining a healthy BMI, hydrating, and getting adequate sleep will also contribute to overall physical and mental health and wellness. Discuss how you might begin your journey to a healthier lifestyle with your primary care physician or health care professional.
SOURCES: Cleveland Clinic; Johns Hopkins University, Centers for Disease Control
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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.
Whether you are a student, athlete, or just trying to live a healthy life, we could all benefit from a routine of adequate sleep. However, according to the Centers for Disease Control and Prevention, 1 in 3 American adults get less than seven hours per day, which is the recommended amount to maximize wellness. William Dement, M.D. argues in his book, The Promise of Sleep, that our patterns of rest are the single most important determinant of our length of life. But what is a “healthy” sleep schedule? It turns out that while inadequate sleep is common in the US, there can indeed be too much.
The National Sleep Foundation (NSF) has recommendations depending on your age group. The average for adults is 7-9 hours. As you get older, they recommend a shorter amount of time needed for sleep each night. However, they urge each person to reflect on how they feel each day and adjust their habits accordingly.
If you are one of the 33% of Americans not getting enough sleep you have probably tried or are willing to try anything to avoid staring at the ceiling for hours before falling asleep. For these unfortunate people, the moment the lights go off, their brain switches on…tossing and turning, wrestling and twitching until they reach exhaustion. One new product that has been receiving plenty of attention is a weighted blanket.
While sleeping with a weighted blanket may seem a little extreme at first, many believe that sleeping with the equivalent of a 30 pound toddler evenly distributed across their body, is very effective in calming anxiety, promoting relaxation and sleep.
A weighted blanket is filled with plastic pellets or glass beads that add weight to the blanket. These blankets range in weight from five to 30 pounds. The sensation is similar to the lead vest worn during dental x-rays and the extra weight provides deep pressure to relieve anxiety and reduce insomnia.
Choosing the optimal weight or type of blanket is not an exact science. Manufacturers recommend adults use a blanket that is equal to 10% of their body weight. The filler determines the thickness and texture. Glass beads are smaller and produce a thinner blanket as compared to plastic pellets.
For those concerned with temperature, some blankets use bamboo as a cover for cooling, while others offer additional filling for warmth.
The theory behind the use of weighted blankets for anxiety and insomnia rests on previous research related to deep pressure stimulation…gentle pressure applied over the entire body (like being wrapped in a swaddle or sharing a prolonged hug).
The concept of deep pressure for stress and anxiety reduction is not entirely new. Occupational therapists working with children with autism spectrum disorders have used deep pressure to promote a calming and relaxing effect.
Research supporting the efficacy of weighted blankets is limited and varied. While some studies suggest weighted blankets offer promise for those suffering from anxiety, far less support their effectiveness for insomnia.
One study of 32 adult volunteers, reported 63% lower levels of anxiety after lying under a 30 pound blanket for 5 minutes. In another study, 30 participants who were hospitalized for a mental health crisis demonstrated 60% reduction in anxiety after using the blanket.
Luxome: Made from bamboo and hypoallergenic glass beads with fibers known for moisture-wicking and cooling. Rated #1 with 6,000 five-star Reviews. $119.99 (luxome.com)
Layla: Made from high density micro glass beads with cotton, polyester and mink outer materials. Sized for one or two people. $129.00 (queen size) (laylasleep.com)
YNM: Made from bamboo and hypoallergenic glass beads. Sized for one or two people. $79.90 (amazon.com)
Reviews: While the research may be lacking, the testimonials and customer product reviews are very favorable for satisfaction, durability and effectiveness.
It may be too early to tell according to the scientific literature. However, there is some indication that weighted blankets may reduce anxiety in some. It is less certain that these blankets will reduce insomnia. There are no studies that indicate that weighted blankets are harmful and may be worth a try for those who have exhausted more traditional options for anxiety and insomnia as a replacement or adjunct.
Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
See 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.
