More than 65 million people, almost 30% of the population in the United States, are actively involved in providing 20 or more hours of care for a chronically ill, disabled, or aged family member or friend each week. As our population continues to age, this number is expected to grow rapidly.

The role of a caregiver is multifaceted and often involves tasks and skills beyond the education or comfort level of most providers. Some examples include; managing money, paying bills, shopping, cleaning, maintaining and repairing a home, dispensing and injecting medications, cleaning wounds, changing dressings, catheter management, bed baths, assisting in position changes, transferring from the bed to the chair, ambulation, stair climbing, bathroom assistance for toileting and showering and many other responsibilities. Consequently, a caregiver is often at risk for mental, spiritual and physical fatigue or breakdown. It is no surprise that depression, illness and injury often plague a caregiver and eventually, the caregiver is in need of a caregiver. One of the most common injuries suffered by a caregiver is back pain.    

Lower back pain (LBP) is one of the most common problems in our society. Over 90% of all Americans will suffer from it at least once in their lives. It is generally agreed that prevention is the best treatment for LBP.

TIPS FOR THE PREVENTION OF BACK PAIN FOR THE CAREGIVER:

• Maintain Health & Fitness Level
  • As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well and exercise regularly.
• Aerobic Exercise
  • Aerobic exercise will help prevent weight gain and stiffness for a healthier lower back. It will also help with the stress and depression associated with providing care for a loved one. Perform mild aerobic exercise such as walking 3-5 times per week for 30-45 minutes. You can also use an elliptical or bike at home while your loved one is resting. Get outdoors and take multiple short walks …go around the block a few times per day.
• Core Exercises
  • Core stabilization exercises designed to strengthen the abdominal and lower back muscles will help prevent injury. Some examples of core exercises are:
    • Pelvic Tilt - lying on your back and performing a pelvic tilt as you flatten you lower back into the floor.
    • Pelvic Tilt and Heel Slide - lying on your back, hold a pelvic tilt as you slide your one heel up and down and repeat with the other heel.
    • Core on Ball - Perform arm exercises such as biceps and triceps with light weight while sitting on a therapeutic ball while simultaneously trying to hold an isometric contraction of your abdominal and lower back muscles.
• Do Not Smoke
  • Smoking effects natural healing because it constricts the small blood vessels. Smokers have a much higher incidence of LBP and failure from lower back surgery.
• Practice Good Posture & Body Mechanics
  • Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.
  • Caregivers spend much of the day with their spine bent over a bed or chair feeding, bathing, and lifting a loved one. Postural exercises are designed to stretch your back in the opposite direction of this forward flexed position. Examples include:
    • Chin Tucks - tuck your chin back to bring head over shoulders.
    • Shoulder Blade Pinch - pinch your shoulder blades together.
    • Standing Arch - while standing put your hands behind back, extend lower back 10-20 degrees.
      • Perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
• Ergonomics
  • Sitting - When sitting, use an ergonomic work station and chair with a lumbar support and adjustable heights. Get close to your desk, keyboard and monitor.
  • Driving - If you drive long distances, use a lumbar support to keep an arch, sit close to your steering wheel to prevent bending forward.
  • Bending – Get an adjustable bed and raise it to a comfortable height when feeding, dressing or bathing your loved one.
  • Lifting - Think twice. First bend your knees and arch your back. Then, brace your abdominal muscles. Bend your spine forward as little as possible to lift the patient.
• From Lying to Sitting in Bed - Bend your knees, maintain an arch in the back with head up, and bend over as little as possible. Bend the knees of your loved one; roll their trunk toward you to get their legs over the edge of the bed as you pivot their weight on their butt to get them sitting upright.

• From Sitting in Bed to Sitting in Chair - Bend your knees, maintain an arch in the back with head up, and bend over as little as possible. Place your hands around the waist or on a transfer belt. Use your legs, turn with feet, and do not twist spine. Block the feet and knees of your loved-one with your feet and knees and use them to pivot and transfer from the bed to the chair. Be sure the chair is along side of the bed and arm of chair removed if possible before the lift.

• Transfer Belt - Use a transfer belt around the waist of the patient. Grip the transfer belt, instead of the patient or clothing, during the lift or when ambulating.
  • Lower Back Lifting Belt - Also, if you have a back problem, consider using a lifting belt or back brace to protect your back when lifting the patient. Immediately following the lift, stand up straight and stretch lower back into extension.
    • Transfer belts and lower back lifting belts can be found online or at your local pharmacy.
  • Lift Chair – For patients that require maximum or moderate assistance and only one caregiver is available to lift or transfer, an electric lift chair should be considered.

MODELS: Andrea Molitoris Kozlowski, PT, DPT, Associate Mackarey Physical Therapy, Doris Koloski, Scranton

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

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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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

The “First Thanksgiving” was in 1621 between the Pilgrims of Plymouth Colony and the Wampanoag tribe in present day Massachusetts to celebrate the harvest and other blessings of the previous year. In 1789, President George Washington, at the request of Congress, proclaimed Thursday, November 26, as a day of national thanksgiving. In 1863, Abraham Lincoln proclaimed the national holiday of Thanksgiving to be the last Thursday of November.

Americans and Canadians continue to celebrate this holiday as a time for family and friends to gather, feast, and reflect upon their many blessings. Like most, I am very grateful for the simple things, family, good friends, food, shelter, and health. I am also thankful for the dedicated scientists who develop vaccinations and medications so we can safely enjoy Thanksgiving with our families. It turns out that being grateful is not only reflective and cleansing; it is also good for your health!

Grateful people are more likely to behave in a prosocial manner, even when it is not reciprocated. A study by the University of Kentucky found those ranking higher on gratitude scales were less likely to retaliate against others, even when others were less kind. Emmons and McCullough conducted one of the most detailed studies on thankfulness. They monitored the happiness of a group of people after they performed the following exercise:

There are many things in our lives, both large and small, that we might be grateful about. Think back over the past week and write down on the lines below up to five things in your life that you are grateful or thankful for.” The study showed that people who are encouraged to think of things they’re grateful for are approximately 10% happier than those who are not.

7 Proven Health Benefits of Being Grateful:

1. Being Grateful is Contagious!
   • Studies show that something as simple as saying “thank you” to a stranger holding a door open for you or sending a co-worker a thank you note for helping you with a project makes them more likely to continue the relationship. Showing gratitude can improve your life by fostering solid friendships.
2. Being Grateful Improves Physical Health
   • Research has found that those who are grateful experience fewer aches and pains and tend to report that they feel healthier than most people. Moreover, grateful people are more likely to be health conscious and live healthier lifestyles.
3. Being Grateful Improves Psychological Health
   • Multiple studies have demonstrated that gratitude reduces many negative emotions. Grateful people have less anger, envy, resentment, frustration or regret. Gratitude increases happiness and reduces depression.
4. Being Grateful Fosters Empathy and Reduces Aggression
   • Participants in a study by the University of Kentucky found that those who scored higher on gratitude scales were less likely to retaliate against others and were more sensitive and empathetic when compared to low gratitude scorers.
5. Being Grateful Promotes Better Sleep
   • A study published in Applied Psychology, found that 15 minutes of writing down a gratitude list before bed led to better and longer sleep.
6. Being Grateful Improves Self-Esteem
   • When studying athletes, it was determined that those who scored high on gratitude scales demonstrated improved self-esteem which led to optimal performance. Conversely, those athletes who were not grateful and resented contemporaries making more money, for example, had lower self-esteem and negative performance outcomes.
7. Being Grateful Improves Mental Strength
   • Research has repeatedly shown that gratitude not only reduces stress, but also improves one’s ability to overcome trauma. For example, Vietnam veterans who scored higher on gratitude scales experienced lower incidences of post-traumatic stress disorder. Recognizing all you have to be thankful for, even during the worst times of your life, fosters resilience.

Conclusion:

Amy Morin, psychotherapist, mental health trainer and bestselling author offers this advice: “Developing an “attitude of gratitude” is one of the simplest ways to improve your satisfaction with life. We all have the ability and opportunity to cultivate gratitude. Simply take a few moments to focus on all that you have, rather than complain about all the things you think you deserve.” So…be grateful and have a happy Thanksgiving!

Source: NIH, Forbes, Amy Morin “13 Things Mentally Strong People Don’t Do.”

Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, exercise regularly, and live long and well!

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Guest Author: Paul Mackarey, Jr. PT, DPT is clinic director and partner at Mackarey & Mackarey Physical Therapy Consultants, Scranton and Clarks Summit, PA.

The 2025 Pennsylvania rifle deer season begins November 30^th and continues through December 13, 2025. Opening day is considered a holiday in the state of Pennsylvania as approximately 750,000 hunters from age 12 to seniors (including myself) will hike through the woods in search of a whitetail.

I am a whitetail, turkey, small game hunter, and an avid outdoors enthusiast with great passion for mountain biking, kayaking, hiking and mountain climbing in our state and national parks. After an extended period away from hunting (in the off season), I am eager to be back in the woods. When possible, I try to make time to shed hunt and scout in preparation for the upcoming season. While I am active during the summer, I am not necessarily in “hunting shape” and certainly not acclimated to cold, wet and windy conditions. I offer health and safety tips for hunters based on the knowledge of experts in the field and my expertise as a health care provider. Good luck and be safe!

Common Health Problems for Hunters:

• Chest Pain/Shortness of Breath – overweight and deconditioned people must be very careful when overexerting themselves in the woods while hunting. This is especially true for those with a history of heart disease. Make sure you take your medication and drink plenty of fluids 24 hours before and while hunting. Eat a good breakfast with a balance of protein and carbohydrates. A bagel with peanut butter is a good quick start. Pack healthy snacks and water to sustain you.
• Knee Pain- in the front of the knee or kneecap is common with hunting. This can happen from excessive hiking on uneven or hilly terrain in the woods, especially if there is weakness in the leg muscles. When walking downhill try this simple trick to keep your knees safe. Slightly bend at the knees and bring your buttock back so your knees stay over (or slightly behind) your toes to reduce stress on the joint.
• Neck, Lower or Middle Back Pain- can be caused by prolonged hiking with a heavy load or prolonged sitting in a tree stand in slouched positions, especially if one has tight hamstrings. Field dressing and carrying the deer out of the woods is also very stressful on the back. Take multiple breaks and stretch backwards, (the opposite direction of bending over to drag the deer). Also, consider where you want to position your hunt, avoid large hills that you may have to drag the deer up on the way out.

• Shoulder Pain- can occur from recoil of a gun shot or the overhead activity of climbing a tree.
• Hamstring Pain- can occur if the muscle is tight or weak. Prolonged walking, bending over and large steps over fallen trees can contribute to this problem. When free walking in the woods, look for the path of least resistance.
• Ilio-Tibial Band Pain- when walking on the side of a hill there is a difference in the length of the legs. Overtime, this can lead to pain on the outside of the hip and leg.
• Foot Numbness or Pain- can occur from prolonged squatting or poor fitting shoes/boots. However, lower back pain can also be associated with these symptoms.
• Hand Numbness or Pain- can be caused by repeated recoil of the gun on the shoulder. Also, this may be associated with prolonged pressure of a shoulder strap or leaning on something under the arm.

Preparing Your Body for Hunting:

• Prevention is the best management of most musculoskeletal and safety problems associated with hunting. First, one can prevent many of the above problems through proper fitting of equipment, clothing and shoes/boots.
• Fitness - Be sure to maintain a fairly good fitness level in order to hunt safely. Begin an exercise and walking program 2-3 months before hunting season. If you are a beginner, start slowly. Warm up and slowly walk for 10 to 15 minutes and build up over time. Slowly add hills to your walking program.
• Clothing - Wear your hunting clothing, such as boots to break them in while walking for exercise. Drytech clothing instead of cotton can keep you warm and wick moisture away from the body.
• Move & Stretch - As hunters, we sit in our stand or blind and stay still for long periods of time in cold temperatures. This results in a cold and stiff body. When leaving your setup, give your body time to wake up before you start hiking out. Bend the knees or perform small squats repeatedly to get blood and warmth back into the legs. Stretch your spine backwards (the opposite of sitting) to prepare your spine for your heavy pack and do some heel raises for the ankles.
• Strength Exercises - Work on the strength and flexibility of the quadriceps, calf and gluteal muscles. Instead of using the elevator, climb stairs throughout the day to work these muscles. Be careful not to progress too quickly because a drastic change from inactivity to over activity in a short period of time can create problems.

• Be Aware - Know your limitations and adapt to them. Injuries most commonly occur when we overestimate what our body can do or choose to push through pain. Listen to your body, if you have pain, stop and modify your activity. In addition, scout areas that are more easily accessibly in the woods that will still attract deer. This will lead to less stress on your body and when successful, you have an easier drag!
• Use technology to your advantage. Using hunting apps and maps such as HuntWise, OnX or HuntStand, can help give you an idea of the terrain you will be exposed to prior to entering the woods. It will be easier to map out a less strenuous approach into the woods and minimize the load you place on your body.
• Remember, hunting should be fun! Pain from poorly fitted and improperly maintained equipment and clothing can be avoided with good planning. Moreover, injury and death from inactivity and poor fitness is also preventable. 

Sources: www.pgc.state.pa.us

Visit your doctor regularly and listen to your body.  Keep moving, eat healthy foods, exercise regularly, and live long and well!

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

November is National Alzheimer’s Disease Awareness Month. It is appropriate that it is also National Family Caregivers Month, since many people afflicted with Alzheimer’s are physically well and often rely on caregivers. It would be very unusual to find a person whose life has not been affected by someone with Alzheimer’s disease (AD). AD is a form of dementia. It is sometimes referred to as Senile dementia/Alzheimer’s type (SDAT). Currently, more than 4 million people in the USA have AD. Approximately 10% of all people over 70 have significant memory deficits. The number doubles each decade after 70. The risk increases with age and family history for the disease.

AD is a progressive degenerative disease of the brain that affects memory and thought process. Memory impairment is the hallmark of this disease. Also, those suffering from AD present changes with the following: language, decision-making, judgment, attention, and other personality or aspects of mental function. AD progresses differently in each case.

Two types of AD have been identified, early onset and late onset. In early onset, symptoms appear before the age of 60 and progress very rapidly. It accounts for 5-10% of all cases. Autosomal dominant inherited mutations have been found in early onset AD.

The cause of AD is not completely understood; however, most experts agree that both genetic and environmental factors are involved. It is important to rule out other medical causes before a final diagnosis of AD can be made. Only a post-mortem microscopic examination of brain tissue can confirm the diagnosis. Structural and chemical parts of the brain disconnect as the brain tissue shows twisted fragments of protein that clogs up the nerve. Clusters of dead and dying nerve cells block the transmission of information and communication from one nerve cell to the next. AD causes a disconnection of areas of the brain that normally work together.

RISK FACTORS:

• Family History; Age
• High Blood Pressure – over a long period of time
• History of Head Trauma
• High Levels of Homocysteine (a chemical in the body related to heart disease and depression)
• Female Gender – as women live longer

The Greater Boston Physicians for Social Responsibility and the Science and Environmental Health Network offer the following guidelines to reduce the Risk of Developing AD:

• Practice Good Nutrition All of Your Life
  • Provide and teach youngsters good eating habits. High calorie foods and drinks should be discouraged to prevent obesity and diabetes.
• Eat Lots of Fresh Fruit and Vegetables
  • Fruits and vegetables, especially those that are deep green, provide essential antioxidants, vitamins, and other important micronutrients. Many contain healthy omega-3 fatty acids.
• Avoid Saturated and Trans Fat. Use Vegetable Oils Instead
  • A low-fat, plant-based diet with small amounts of dairy, lean meat and chicken is preferred. Avoid frequent use of oils high in omega-6 such as corn, safflower, sunflower, and peanut oils.
• Eat Foods High in Omega-3s
  • Eat fish at least once a week. For those who do not like fish, try fish oil. Limit use of fish that are high in mercury and PCB’s such as: swordfish, king mackerel, albacore and fresh tuna. Less contaminated fish are: haddock, Pollock and wild Alaskan salmon.
• Avoid Routine Consumption of Sugar
  • Table sugar, corn syrup, maple syrup, honey high in fructose cause rapid blood sugar elevation which is linked to obesity, type II diabetes, and heart disease.

• Consume Low-Glycemic Carbohydrates
  • Whole grains and legumes (chick peas and lentils) can help prevent sudden increases in blood sugar. Other examples are: brown rice, barley, oats, rye, buckwheat, fruits, non-starchy vegetables, pasta, winter squashes and tubers (yams, sweet potatoes).
• Get Food From Local and Organic Sources
  • Local growers and Co-ops tend to offer fresher foods with higher levels of nutrient and less pesticide use. NEPA has some great seasonal local farmer markets.
• Modest Consumption of Alcohol
  • Evidence supports the use of one-half to two drinks per day for adults. Red wine and green tea are recommended. Some studies show that caffeine may reduce the risk of Parkinson’s and AD.
• Avoid Food Additives, Such as Aluminum
  • While the evidence of the danger of cooking in aluminum pots may not be valid, recent evidence suggests that dietary aluminum may increase the risk of AD. For example, some baking powders, pancake and waffle mixes contain high levels of aluminum.
• Reduce Exposure to Toxicants
  • Toxic chemicals in the home, workplace and community can increase the risk of AD. Lead, solvents used in building and remodeling, and lawn and garden chemicals may be harmful.

• Increase Physical Activity
  • 30 minutes of moderate aerobic exercise each day is very beneficial for physical and emotional wellness. It improves blood flow, releases endorphins and prevents obesity.
• Increase Social Activity
  • Social activity on a regular basis has been found to reduce the risk of AD. Volunteer, join a club, play a sport or game with a group, take classes and keep in touch with friends and family.
• Reduce Stress
  • Technology has put us on sensory overload. We must learn a new technological skill every week to keep up. Demand for immediate communication increases daily. We cannot escape for a moment. Make time every day to relax, breathe deeply, listen to relaxing music, exercise or sit quietly.
• Exercise Your Brain
  • Some studies show that maintaining a healthy mind requires some work. Do crossword puzzles, word games, board games, and read books. Current wisdom suggests that learning something new is the most important thing to keep your mind healthy…time to learn to play the piano!

Source: The HealthCentralNetwork, Inc

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

What is an Ice Bath?

Ice baths have become a new trend or fad in health and fitness, especially among elite athletes and some celebrities. In fact, it is impossible to scroll through social media without encountering someone “taking the frigid plunge!” However, it is far from a new treatment modality. The Ancient Greeks employed cold-water immersion for fever, pain relief, relaxation and socialization. In fact, Hippocrates documented the use of cold for medicinal purposes for its analgesic benefits. 

Ice baths, a type of cryotherapy, is also referred to as cold water immersion (CWI) or cold-water therapy, involves immersing your body in ice water for approximately 5-15 minutes from the neck down at a temperature of 50-59 degrees. The ice baths are commonly used for pain, delayed-onset muscle soreness (DOMS), and inflammation and mood elevation. 

In theory, the cold water lowers the temperature of your skin and body by vasoconstriction (narrow) of the blood vessels. When you get out of the cold water the vasodilatation (widen) of the blood vessels immediately brings fresh oxygen and nutrient-rich blood back to the tissues to warm the body and in the process, reduce pain, inflammation and promote healing.

Types of Cold Water Therapy:

• Ice Bath/Cold Water Immersion (CWI) - immersing your body in ice water for approximately 5-15 minutes from the neck down at a temperature of 50-59 degrees.
• Cold Showers – Standing under a cold shower at the coldest setting (as close to 50-59 degrees as possible) for 5-15 minutes. It is often recommended as a good introduction to CWI.
• Contrast Water Therapy (Contrast Baths) – Alternating between soaking or showering in hot water for a period of time followed by cold water for the same time (3-5 minutes). The period of time is flexible as some studies suggest alternating hot and cold at one-minute intervals.
• Wim Hof Method – established by a Dutch athlete who recommends incorporating breathing techniques and meditation with CWI.

Purported Ice Bath Benefits:

• Pain Management – cold water therapy leads to vasoconstriction (narrowing the blood vessels) which can reduce swelling and inflammation associated with pain. Moreover, cold creates an analgesic effect to the skin to aide in pain control.
• Reduces Muscle Soreness – cold water therapy has been found to reduce muscle soreness one hour after intense exercise including delayed-onset muscle soreness (DOMS0, however, strength was compromised following CWI. Moreover, it is important to note that studies showed heat therapy had similar results as CWI.
• Improves Mood and Alertness – Some studies with small sample sizes have demonstrated that CWI improved self-esteem and alertness, reduced muscle tension, anger and nervousness. However, there was no difference soaking in 55 degree water verses 68 degrees for 18 to 20 minutes. Also, the studies were exclusively performed on healthy individuals.

Potential Side Effects of Ice Baths:

Ice baths are not without risk and not everyone reacts the same way to ice immersion. It is recommended that one engages in ice exposure gradually, for short periods and in a controlled setting like a home shower. Furthermore, one must be mindful of age, general health, time of exposure, and water temperature. Remember, body temperature is 98.6 and water temperature of 65-70 degrees will feel very cold so 50-59 degrees can create problems such as:

• Cold-Induced Rash – an itchy, painful skin rash
• Cold Shock – sudden cold immersion can shock your body into rapid breathing, increased heart rate and blood pressure and is often associated with drowning.
• Hypothermia – cold immersion can lead to hypothermia and organ failure.
• Ice Burn – if your skin makes direct contact with the ice you can burn your skin or suffer from frostbite leading to skin and tissue damage.
• Nerve Damage – prolonged exposure to cold can reduce blood flow and lead to nerve and tissue damage.

Potential Risks of Ice Baths:

If you have the following health conditions, ice baths may not be the best therapeutic modality for you. Before you consider trying an ice bath, consult with your physician to avoid potentially serious problems:

• Cold Hives – itchy welts, swollen lips and throat when your skin comes in contact with something too cold.
• Heart or Lung Conditions – when vasoconstriction of the blood vessels occurs from the cold, your heart rate and blood pressure increase dramatically. The excess strain on your heart can be dangerous, especially if you have compromised cardiopulmonary function. It can also lead to an irregular electrical rhythm (arrhythmia), which can be serious.
• Raynaud’s Syndrome – lack of blood flow to the fingers and toes cause a hypersensitivity and cause them to turn white or blue. It can lead to tissue damage.

In Conclusion:

What the Science Says –

While some studies have shown that subjects report less muscle soreness following CWI when compared to rest, most studies suggest that the reported effects are placebo. Also, reports of improved circulation, reduced inflammation and improved recovery or performance has not been scientifically validated. In view of this, it is recommended that those considering the use of CWI for pain and inflammation management, reduced muscle soreness, and mood elevation, should consult their physician to determine if the potential risks are worth the purported benefits.

SOURCES: nih; health.com; health.clevelandclinic.org; prevention.com

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

October is National Breast Cancer Awareness Month and there is good news to report!

A recent study in the Journal of the American Medical Association from Harvard has found that regular exercise can improve the survival of patients with breast cancer. I have discussed these findings with local physician, Dr. Christopher Peters of Northeast Radiation Oncology Center and he says that he regularly councils his patients about the value of exercise in the recovery from breast cancer. As found in the study, he recommends aerobic exercise such as walking and/or biking and mild resistance exercise. He also encourages patients to enroll in a formal rehabilitation program, especially to prevent a frozen shoulder if invasive surgery was performed.

Previous studies have shown many benefits of exercise for breast cancer patients including improving immune functioning and controlling depression. However, new research recently presented at the American Association for Cancer Research annual meeting was the first report to conclude that physical exercise may improve survival in breast cancer patients. Additional studies have shown other benefits of exercise. For example, a study conducted at Vanderbilt University found that women who had high activity levels throughout life were less likely to develop endometrial cancer. At the Hutchinson Cancer Research Center in Seattle, researchers found that exercise with moderate intensity can reduce serum markers of inflammation (C-reactive protein), which, when elevated, are associated with chronic disease and poor cancer survival.

In the current study, conducted at Harvard University, researchers compared survival rates in women with breast cancer with exercise levels in terms of metabolic equivalent (MET) hours per week. While women with high activity levels of exercise had the best outcomes, even women with moderate exercise benefited.

Benefits of exercise in women with breast cancer:

• May increase breast cancer survival
• Lessen risk of endometrial cancer
• Improved C-reactive protein levels
• Improve autoimmune function
• Control Depression
• Psycho-Social Value
  • builds confidence, fosters control, develops new skills
  • promotes health mind, body, & spirit

In conclusion, current research supports the fact that exercise may improve breast cancer survival.  The following guidelines are proposed:

• Medical Clearance
  • Talk to your physician to get clearance for exercise
  • Remember, each patient must be individually evaluated by their physician to determine the extent of their problem and the appropriateness for exercise. Once medically cleared, seek the advice of a physical therapist to assess your needs and specifically design a program for you.
• Aerobic Exercise
  • 3-5 days per week
  • Moderate intensity
  • 20 to 60 minutes
• Strength Training
  • 2-3 days per weekLight to moderate weight

FLEXIBILITY EXERCISES:

Flexibility Exercises involve moving the arms, legs and trunk through comfortable range of motion to give you more mobility in order to improve your ability to perform daily activities such as tucking in a shirt, tying shoes or fastening a bra. Best if performed after strength exercises because the muscles and joints will be warm and limber. Always perform slowly with slight stretch sensation and no pain. No bouncing or overstretching!

Examples of Flexibility Exercises for the Upper Body:

These exercises are to be performed while sitting in a chair with a backrest, slowly, 5 repetitions, 3-5 times per week.

• To Be Performed While Sitting In A Chair With A Backrest:
  • Shoulder Raise – clasp hands together, raise arms up to forehead, then above head, as high as comfortably possible
  • Hands Behind Head – raise arms behind head by first touching ears, then back of head
  • Hands Behind Back – bring arms behind back by first touching the side pocket, then back pocket and toward small of back as comfortably possible

Examples of Flexibility Exercises for the Lower Body:

• To Be Performed While Lying On Back In Bed:
  • Knees to Chest – bring knee toward chest using hands
  • Right Leg 5 Times – Left Leg 5 Times -  Both Legs 5 Times
  • Leg Spread – Spread legs apart by sliding heels on bed
  • Leg Cross – Bring legs together touch by sliding heels on bed
  • Gas Pedals – pump ankles up and down like gas pedal

BALANCE EXERCISES:

Balance Exercises involve strengthening muscles that keep the body upright and stable in standing in order to improve your ability to perform daily activities without falling. According to the NIH, 300,000 US hospital admissions for broken hips occur each year due to falls. Check with your physician if you have a history of dizziness before performing these exercises on your own. Best if performed with someone at home or some assistance. Always use a countertop or back of chair to hold onto for support.

Examples of Balance Exercises:

• Sitting Squat – Squat up and down in a chair
  • First use both arms to assist, then one arm.
• Standing March – March legs up and down while holding onto countertop
• Standing Scissors – Bring leg out and cross over like a scissors one leg at a time
• Standing Squat – Squat down by bending at hips and knees 20-30 degrees while holding onto countertop
• Dance – Slow dancing with a partner is great fun and a very helpful exercise to improve balance.

ENDURANCE EXERCISES:

Endurance Exercises involve any activity such as walking, swimming, biking or raking leaves that elevates your heart rate and breathing for an extended period of time. Check with your physician if you have a history of heart problems or dizziness before performing these exercises on your own. Best if performed with someone at home or some assistance. Start off slowly for only 5 minutes and add 1-2 minutes each week or 2. Wear good and comfortable shoes – no heels!

Examples of Endurance Exercises:

While not all of these endurance exercises may be appropriate for you, one or two of these may offer a good starting point.

• Walk Around the House – Start walking around the house for 1-2 minutes nonstop               
  • Every 1-2 hours. Then, add 1-2 minutes every week.
• Static Marching – hold onto the countertop or back of chair and march in place for 30 seconds.
  • Rest 1-2 minutes and repeat. Do 5 cycles. Add 5-10 seconds every week.
• Climb the Steps – If you can do so safely, use the steps for exercise 1-2 times per day. Then, add 1-2 times per day.
• Walk the Mall/Treadmill – If you are able to get out of the house and can tolerate more extensive endurance exercises, get out and walk the malls or use a treadmill.
• Recumbent Bike – If balance is a problem, but you can tolerate more extensive endurance exercise, use a recumbent bike (a bike with a backrest)

Visit your doctor regularly and listen to your body. Keep moving, eat healthy foods, exercise regularly, and live long and well!   

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

October is National Physical Therapy Month! The American Physical Therapy Association (APTA) would like to recognize the thousands of physical therapists as dedicated health care providers. Moreover, physical therapists would like to thank the public for allowing us to participate in your health and wellness. While PT’s may not save lives…we do save LIFESYLES!

This column will address a question that is frequently asked by people of all ages and activity levels…stretching. First, it is important to keep in mind that stretching should NEVER be performed without warming up your body and muscles first. This can be done by running slowly in place or around the block for 5-10 minutes. Second, stretching should NEVER be painful. Third, a good stretch should be performed slowly and feel like slight tension in the muscle. NEVER bounce or jerk. First, perform the stretches by actively moving your muscles slowly and deliberately 5-10 times. Then, hold the stretch for 5-10 seconds, repeat 5-10 times, 2-4 times per week. 

Remember, flexibility is only one aspect of complete health and wellness. Strength training, cardiovascular fitness, meditation and stress management and proper nutrition are also necessary for a healthy lifestyle. Also, be careful not to overstretch before competition as it may weaken the muscle.

10 MOST COMMON STRETCHES:

• CALF STRETCH
  • Stand with your feet facing a wall shoulder width apart.
  • Step your right foot back keeping it facing forward.
  • Bend your left knee and keep the right knee straight
  • Lean forward and push against a wall for the best stretch, keeping heels on the floor.
  • Feel the stretch at the back of your right leg below the knee
  • Repeat on the left
• QUAD STRETCH
  • Stand with your left arm holding on to a stable object for balance.
  • Bend your right knee and bring the heel up toward your butt by pulling up/back with your right hand.
  • Feel the stretch at the front of your right thigh.
  • Repeat on the left

• HAMSTRING STRETCH
  • Lying on your back, clasp the back of your right knee
  • Straighten out your right knee slowly up toward the sky
  • Feel the stretch at the back of your right thigh.
  • Repeat with your left leg straight.

• GROIN STRETCH
  • Sit with your legs bent with heels together. (Indian Sit)
  • Hold your ankles or feet with both hands.
  • Keep your back straight and stomach in.
  • Push your knees toward the floor.
  • Feel the stretch on the inside of your thighs.
• LOW BACK FLEXION STRETCH
  • Lie on your back and raise your knees to your chest.
  • Hold the knees with both your hands.
  • Feel the stretch at the bottom of your back.

• LOW BACK EXTENSION STRETCH –
  • Lie on your belly and prop up on your forearms
  • Hold this position and inhale and exhale
  • Feel the stretch in the small of your back

• TRUNK SIDE STRETCH
  • Stand with your left hand on your left hip and your right arm above your head.
  • Bend to the left by sliding your left hand toward your left knee without leaning forward or back.
  • Feel the stretch on your right side.
  • Repeat with your left arm.
• TRUNK ROTATION STRETCH
  • Stand upright with feet shoulder width apart
  • Cross arms over chest and turn to the right with your upper trunk
  • Keep lower body facing straight
  • Feel the stretch on the left lower back and trunk
  • Repeat turning to the left
• SHOULDER STRETCH
  • Take your right arm across your chest.
  • Use your left hand to pull your right elbow across your chest.
  • Keep your body facing forward.
  • Feel the stretch on the back of your right shoulder.
  • Repeat with your left arm.

• CHEST STRETCH
  • Stand facing a corner with feet 12 inches away and put both arms up in a “T” position
  • Lean into wall with chest and keep feet away from wall
  • Feel the stretch in your biceps and chest.

MODEL: Sarah Singer, PTA, Mackarey Physical Therapy

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Congratulations to more than 1,000 courageous runners who finished the 28^th Annual Steamtown Marathon today. Most, if not all of you, will wake up tomorrow morning with a little less jump in your step than you had yesterday to begin your recovery.

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

GREAT EXAMPLE OF REST AND RECOVERY:

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

RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body: (RunNow.com - Jim Peskett)

Muscle-Skeletal System:

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

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

Cellular Damage:

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

Immune System:

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

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

1. If I don’t have pain, then I did not damage my body and I can run again soon after the marathon.
   • FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
2. Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
   • FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
3. If I don’t run, I will lose all of my conditioning in one week.
   • FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi! 

Expedite Your Recovery:

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

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Provisional Bag/First Aide Kit

It is one week away from the 28^th Steamtown Marathon. This column is dedicated to all the runners preparing for the big day. One small piece of advice; start slowly, avoid the first mile adrenaline sprint downhill, and enjoy the journey! Remember, only one Olympic marathon winner (Juan Zabala, Argentina, 1932) was in the lead at the 5 mile mark. Lesson: The last miles matter more than the first!

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

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

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

Dress:

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

Clothing:

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

Accessories:

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

FANNY PACK – Especially for those running without a support team

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

SUPPLY BAG – For those with support team

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

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

Don’t Forget:

• Map and directions to the bus or starting line, course map, race number, and get your timing chip.
• Enjoy! Enjoy! Smell the roses, take in the fall foliage and chat with a fellow racer. Savor the moment enjoy the day…you are doing something very special!

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

PREVENT STRESS FRACTURES

It is two weeks away from the 28^th Steamtown Marathon. After training all spring and summer for the first seven Steamtown Marathons, not a Columbus Day Weekend goes by without my thoughts of this great event.

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. The victory kept the intruders 26 miles away from Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to run to the capital city 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!

Each year at this time, dozens of runners preparing for the Steamtown Marathon come to my office with severe shin pain known as shin splints. Unfortunately, in many of these athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture.

What is a stress fracture?

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 but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk?

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.

Causes of Stress Fractures:

• Overuse, Overload, Over training – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
• Inadequate Fitness Level – or activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program to quickly for cross-country in August/September.
• Poor Biomechanics – when your feet hit the ground the forces are absorbed and transferred to the rest of the body. If the biomechanics of feet are not perfect, then the forces are not absorbed, and another body part bears too much force. For example, flat or pronated feet poorly absorb the shock and pull the tendons of the foot and shin.
• Recent Change in Training Schedule – sudden increased intensity or speed
• Recent Change in Running Surface – sudden change to a hard or soft surface
• Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
• Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
• Underweight – the underweight female athlete is at high risk for stress fractures. If underweight and have a history of menstral irregularities or and eating disorder, the risk of stress fracture increases significantly
• History of Stress Fractures – makes the athlete two times as likely to have another

Treatment & Management:

• Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
• Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
• Correct Biomechanics - Orthotics, Running shoes, see a Podiatrist
• Gradual Change in Training Schedule
• Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
• Gradual Change in Footwear – walk in new shoes first, then run 1-2 miles
• If Overweight – gradual exercise with diet, not too much too quickly
  • Mix run & walk every 10 minutes
• If Underweight – improve diet maintain healthy body fat%
• Consult Family Physician – early management often involves immobilization, rest, pain medicine 4-6 weeks for healing.
  • non weight bearing cross training such as the recumbent bike, swimming, elliptical
  • physical therapy modalities such as ultrasound, cold with electrical stimulation, biomechanical taping or orthotic supports, and exercises for foot, ankle muscles.

Visit your doctor regularly and listen to your body.     

Read Health & Fitness Forum Next Monday/Sunday: Preparing Your First Aid Kit For the Steamtown Marathon

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

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!