Science:

A miniscule piece of single-stranded RNA virus has caused over 22 million cases and 776,000 deaths worldwide and is estimated to cost about 10% of the world’s total economic output ($8.8 trillion). The United States remains the most affected country alone with over 5 million confirmed cases. As millions remain jobless and no end in sight, we are all left to ask “What is the coronavirus and why is it so different?” The key aspect of the coronavirus (which is similar to other pandemics) is its novelty and easy human-to-human transfer. Being considered a “novel” virus refers to the fact of its original transfer from animal to humans who have never been in contact with this type of virus. As a result, our bodies have not developed immunity to this particular strain of virus and this allows for the rapid world-wide distribution of the infection that we are currently experiencing. Further, the ease of transmissibility of the coronavirus via the respiratory route (meaning that the virus can remain in mucous membranes of the nose and the mouth and can spread via droplets) from person-to-person further propagates the problem. Even simply talking in close distance can spread the virus. Additionally, the virus is enveloped (“corona meaning “crown” or “wreath” in Greek), which allows the virus to be adherent to surfaces for a couple of hours even after the original host has left.

Personal Impact:

I saw firsthand the extent of the medical problems this virus can cause as my mother, who works in an in-patient nursing unit, became positive for COVID-19. 10 weeks ago, she woke up feeling fatigued in the morning which she attributed to inadequate sleep. Approximately 3 hours into her shift, she was feeling unwell and feverish. Fortunately, she was able to get same-day testing at an urgent care and was told to quarantine for the next 2 weeks with over-the-counter medication of Advil, Tylenol, or Aspirin. After 4 days of stable symptoms and vitals, things took a turn for the worse as she started to experience severe headaches, increased fever, nausea, and vertigo, and weakness which prompted us to visit the emergency room. A week later, respiratory symptoms became much worse as she started experiencing sharp intermittent chest pain, productive cough, and her oxygen levels were 89% (normal is 99%). These symptoms occurred multiple times in the next couple weeks and led to more emergency room visits. Ultimately, she ended up developing pneumonia. From the initial onset to resolving of most, but not all of her symptoms, took a total time of 6 weeks. Her age, health care occupation, and underlying Type II diabetes played a role in the complicated and long course of her recovery and is still not 100%. 

Further complicating our problem was the fact that we did not have immediate confirmation COVID test. Further, our health care services refused to test other family members and did not recommend us being guaranteed until we showed symptoms, even though we had been in contact with my mom. However, we still self-guaranteed and got tested from MedExpress. It is important to remember that COVID does have an asymptomatic infectious period and it was important to us that we do not spread it to other people. 

Unfortunately, I have had other relatives who have also been positive for COVID and have not been as lucky as my mother. They have passed away. As a result of these personal experiences and my status as a medical student, I took the opportunity to research this problem in greater detail which has enlightened me about the proper management of this disease. I would like to share this information and recommend the following to the general public if you need to quarantine an exposed family member returning from college, travel or work:

Prevent Transmission

1. Isolate: Find a room to isolate the infected person as well as a dedicated bathroom for the person
2. Control Air Flow: Turn off outflow vents in the isolation room. Duct tape the vents shut to prevent any air circulation to the rest of the house
3. Medications: Tylenol, Advil, Aspirin, anti nausa
4. Medical Equipment: Volumetric Exerciser for breathing exercises (simple balloon can be substituted), pulse oximeter (to check oxygen levels), gloves, alcohol and thermometer.  
5. Disinfectants: disinfectant sprays, towels, and bleach-based products, to clean door knobs, etc.
6. Wedges/Pillows: to elevate the trunk and head if one develops difficulty breathing or pulse oximeter readings are low (below 95). Use 4/5 pillows when sleeping as oxygen levels can drop very low during nights as laying down flat makes it hard to breath.   
7. Emergency Contact Numbers: If the need to go to emergency room, call ahead so they can get ready for your arrival to decrease any spread.
8. Family Support: is essential. One of the best ways that family members can assist is to cook healthy foods, high in protein. My mom attributes most of her recovery to eating high protein foods such as boiled eggs and milk. She also felt that cooked vegetables and drinking warm water frequently was valuable.
9. Clean Up: after infectious period is over, local disinfection services to disinfect the house may be helpful.

10.) Prevention – without a doubt, the single best treatment for COVID-19 is PREVENTION! Wear a mask, wash your hands, and maintain at least 6 feet distance!

It is important to know that frontline workers who are placing themselves at risk in this pandemic such as nurses, physicians, and health care workers such as my mom are the backbone of our health systems. Keeping yourself healthy, keeps them healthy too!

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

Vaibhav Sharma, MD3  is currently a third-year medical student at Geisinger Commonwealth School of Medicine. He completed his undergraduate studies at the University of Pittsburgh in the field of Neuroscience."

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

Read all of Dr. Mackarey's articles at our website: https://mackareyphysicaltherapy.com/forum/

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

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.

TAKE THE TEST!

Northeastern Pennsylvania is home to a large elderly population and many of the medical problems we expect to see are age related. Dedicated medical practitioners are in constant search for new knowledge and information to prevent or delay many age-related problems. One of the most devastating problems associated with aging is falling.

Loss of balance causes falls. Falls are a leading cause of injury and death. Thirty percent of women and thirteen percent of men over the age of sixty-five will fall. Twenty to thirty percent of these individuals suffer moderate to severe injuries. Preventing falls is not an easy task. A good understanding of the causes of loss of balance and knowledge of a few fall prevention suggestions can enhance your balance and reduce your risk of a fall.

The Falls Risk Self-Assessment below allows an individual to determine their risk of falling AND take the appropriate steps for prevention and treatment. The next three weeks will be dedicated to this topic to educate and inform readers and their families to make good decisions.

The Falls Risk Assessment is from the Centers for Disease Control (CDC).

WHAT IS YOUR RISK OF FALLING?

1. I HAVE FALLEN IN THE PAST YEAR.  YES (2) NO (0) People who have fallen once are likely to fall again.

2. I USE OR HAVE BEEN ADVISED TO USE A CANE OR WALKER TO GET AROUND SAFELY.  YES (2) NO (0) People who have been advised to use a cane or a walker may already be more likely to fall.

3. SOMETIMES I FEEL UNSTEADY WHEN I AM WALKING. YES (1) NO (0) Unsteadiness or needing support while walking are signs of poor balance.

4. I STEADY MYSELF BY HOLDING ONTO FURNITURE WHEN WALKING AT HOME.                YES (1) NO (0) This is also a sign of poor balance.

5. I AM WORRIED ABOUT FALLING.   YES (1) NO (0) People who are worried about falling are more likely to fall.

6. I NEED TO PUSH WITH MY HANDS TO STAND UP FROM A CHAIR.  YES (1) NO (0) This is a sign of weak leg muscles, a major reason for falling.

7. I HAVE SOME TROUBLE STEPPING UP ONTO A CURB.   YES (1) NO (0) This is also a sign of weak leg muscles.

8. I OFTEN HAVE TO RUSH TO THE TOILET.  YES (1) NO (0) Rushing to the bathroom, especially at night, increases your chance of falling.

9. I HAVE LOST SOME FEELING IN MY FEET.  YES (1) NO (0) Numbness in your feet can cause stumbles and lead to falls.

10. I TAKE MEDICINE THAT SOMETIMES MAKES ME FEEL LIGHT-HEADED OR MORE TIRED THAN USUAL. YES (1) NO (0) Side effects from medicines can sometimes increase your chance of falling.                       

11. I TAKE MEDICINE TO HELP ME SLEEP OR IMPROVE MY MOOD. YES (1) NO (0) These medicines can sometimes increase your chance of falling.

12. I OFTEN FEEL SAD OR DEPRESSED. YES (1) NO (0) Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.

SCORE YOUR RISK.

Add up the number of points for each YES answer. If you have scored 4 or more points you may be at risk for falling. Accordingly, 0-1 = Low Risk; 1-2 = Moderate Risk; 3-4 =  At Risk; 4-5 = High Risk; 5-6 = Urgent; > 6 = Severe

Low    Moderate     At Risk     High Risk   Urgent   Severe

0          1          2          3          4          5          6          7          8         

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   Next Monday Part I of III on Balance Disorders and Falls Prevention

Read all of Dr. Mackarey's articles at https://mackareyphysicaltherapy.com/forum/

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

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 clinical professor of medicine at GCSOM.

3^rd of 3 Columns on Balance Disorders and Falls Prevention

Preventing a fall can not only save your independence but also your life! Preventing injuries from falls reduces the need for nursing home placement. Injuries from falls are the seventh leading cause of death in people over the age of sixty-five.

The following suggestions will assist you in minimizing your risk of a fall:

• Diet & Hydration: Proper nutrition and hydration provides adequate amounts of vitamins and minerals to maintain energy levels and prevent drowsiness. Adequate hydration is also important. Treat dehydration from fever, diarrhea and vomiting by drinking plenty of fluids. You may need IV fluids administered in hospital.
• Exercise: Exercise and activity improves strength, flexibility and balance.
• Medication: Consult a pharmacist or physician regarding medications that can cause: drowsiness, dizziness, lightheadedness, faintness, fatigue, tiredness, unsteadiness, blurred vision, double vision, confusion, or otherwise affect alertness, balance or coordination.
• Positional Changes: Avoid sudden drops in blood pressure by avoid sudden changes in posture and position, standing up slowly, sitting for a few minutes and tapping your toes before getting out of bed and raise head of bed with a wedge pillow.
• Alcohol: Be cautious with alcohol since it interferes with alertness, balance, coordination and reflexes.
• Illness: Treat respiratory infections such as ear infections, colds, flu, sinus congestion to prevent labyrinthitis and Meniere’s disease.
• Frequent Urination: Be cautious with urgency, especially at night.  Consider bedside commode and a grab bar by toilet. Turn lights on and put on eyeglasses to supplement vision. Night lights are recommended. A pendant alarm may be beneficial.
• Vision: Check eyesight and hearing regularly. Poor eyesight makes it difficult to see potential hazards. Update old eyeglasses. Inner ear problems can affect balance. Adequate lighting is paramount. Light switches should be within reach without getting out of bed and on both ends of hallway. Nightlights in bedroom, bathroom and hallway are recommended. Keep a flashlight handy. Turn lights on when entering house and at night.  Use light paint and wallpaper to reflect more light. Use 100 watt bulbs for an adequate amount of light.
• Assistance Devices: Use assistive devices when negotiating uneven terrain or when you feel weak or tired. To avoid falls in the bathroom install grab bars in the shower, tub, and toilet areas. Use bathmats with suction cups or nonslip adhesive strips in tub/shower. Consider a shower stool or bench and an elevated toilet seat.
• Good Footing: Proper footwear with a flat sole, wide base and nonslip grips are important. Footwear should be tied securely and fit snugly. Do not walk in stocking feet
• Remove Hazards: Inspect your floors for hazards! Remove rugs and runners that slip or attach nonslip backing. Tack loose rugs. Glue vinyl flooring. Keep pathways free of electrical/telephone cords. Remove wax from floors. Mops up spills promptly.
• Safety on Stairs: Install secure handrails on both sides. Improve lighting. Ensure carpeting on stairs is firmly attached. Highlight with tape or paint edges of steps especially if narrow or higher/lower than the rest. Paint outdoor steps with a mixture of paint and sand for better traction. If carrying item up or down steps, use handrail.
• Walkways: Sidewalks and walkways should be clear, well lit and free of snow and ice. Salt or sand if slippery. Repair uneven paving.
• Eliminate clutter: Do not store items on steps. Rearrange furniture to move around easier. Watch out for pets. Avoid stepping over pets.
• Store Items Within Reach: Limit reaching by storing frequently used items where they can be reached easily. If reaching is required, use a stepstool with high, sturdy handrails. Repair or discard wobbly stools. Do not use a chair to reach for items.

Following these helpful hints will keep you safe by preventing a loss of balance and a potential fall!

Medical Reviewers: Mark Frattali, MD, ENT at Delta Medix, Division Chairman Otolaryngology – Head Neck Surgery at Commonwealth Health Regional Hospital

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

Read all of Dr. Mackarey's articles at https://mackareyphysicaltherapy.com/forum/

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

2^nd of 3 Columns on Balance Disorders and Falls Prevention

Last week we discussed the causes of balance loss. Today, we will discuss treatment for this problem. Two primary treatments are medication and vestibular rehabilitation.

Medication for dizziness and loss of balance requires a visit to your family doctor. In a more involved case, your family physician may refer you to a specialist such as an ear, nose and throat physician or neurologist. There are many medications available for loss of balance. While this can be complicated, the specialist will determine the most appropriate one for your balance disorder.

Vestibular rehabilitation for dizziness and loss of balance is a great adjunct to medication to manage your balance disorder. It is a comprehensive program that addresses a wide range of problems that may cause imbalance such as: addressing the inability to tolerate motion, visual changes, providing balance rehabilitation, instruction in repositioning techniques for BPPV (benign paroxysmal positional vertigo), correcting postural dysfunctions, muscle weakness, joint stiffness, offering education for prevention, maintenance and self care after discharge. Through experience and motion, vestibular rehabilitation allows: formation of internal models (one learns what to expect from ones actions), learning of limits (learning what is safe and what is not) and sensory weighting (one sense, either vision, vestibular or somatosensory is selected in favor of another in maintaining balance).

In some minor cases, vestibular rehabilitation may be performed at home. However, more serious cases may require an evaluation by a physician specializing in the dizzy patient such as an ear, nose and throat physician or neurologist. These specialists will determine the nature of your problem and may enroll you in a more structured program under the direction of a physical therapist. ­Vestibular rehabilitation addresses not only vertigo (i.e. dizziness) but also balance problems.   

Benign paroxysmal positional vertigo (BPPV) and vestibular hypofunction (e.g. unilateral and bilateral vestibular loss) are two causes of vertigo that can be addressed by a vestibular rehabilitation. Your physical therapist will tailor a program designed to address your specific vestibular disorder (i.e. BPPV or hypofunction).

If you have been diagnosed with BPPV, your therapist may take you through an Epley maneuver. In BPPV, particles in the inner ear become displaced and get lodged in an area that produces vertigo. Vertigo is experienced with tilting head, looking up/down and rolling over in bed. The causes include: infection, head trauma and degeneration. During the Epley maneuver the patient is guided through positional changes which clear these particles from the symptomatic part of the ear.

If you have been diagnosed with either unilateral or bilateral vestibular hypofunction, your therapist will most likely design a program to “retrain” your vestibular system with special exercises, including:

• Gaze Stability Exercises for unilateral hypofunction involve staring with eyes fixated on a stationary object held at eye level. The head is rotated from left to right or up and down while gaze is maintained. Once mastered, your therapist will increase the challenge by either changing your position (e.g. from sitting to standing).

• Habituation Exercises are designed to “desensitize” your brain to the sensation of vertigo. Our sensory system is designed to protect our bodies from harmful stimuli. Many harmful stimuli produce painful sensations. However, vertigo (i.e. dizziness) is not painful. Therefore, if we expose ourselves to movements that produce dizziness, our bodies will eventually “get used to the sensation” and start tuning it out until the movement no longer produces “dizziness”.  

If you have a vestibular problem that primarily manifests as loss of balance, exercises to stimulate your balance responses, strengthen your legs, and enhance your joint position sense may be helpful. These exercises encourage reliance on vestibular and/or visual input. The exercises are performed on unstable surfaces (i.e. tilt boards, balance beams, and foam) and include a variety of tasks from simple standing to more complex arm and leg movements requiring coordination.

In addition to the above mentioned treatments, Posturography and Virtual Reality Training are computerized programs that may be used by your therapist to address your vestibular and/or balance problem. Also, Recreational Activities that involve using your eyes while head and body is in motion (i.e. dancing, golfing, tennis, walking while looking from side to side) are shown to be helpful in stimulating balance and vestibular responses. Furthermore, you may consider Alternative Balance Activities (i.e. Yoga, Tai Chi, Pilates) which incorporate slow gentle movements to improve strength, balance and posture as well as relaxation techniques for the anxiety that accompanies dizziness/off-balance.

Whatever you do, just DO NOT give into your dizziness. People that just “give up” become sedentary. A sedentary lifestyle further denies your body the necessary stimuli to challenge your vestibular system and make it stronger. Eventually, these people end up in a vicious cycle because the more they sit the dizzier and more off balance they get which only makes them sit more! 

Remember, one fall increases your risk of another fall. It is imperative to determine what caused your fall and take action! Ask your physician or physical therapist to assess your fall risk.                                                                                         

Medical Reviewer: Mark Frattali, MD, ENT at Delta Medix, Division Chairman Otolaryngology – Head Neck Surgery at Commonwealth Health Regional Hospital

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   Next Monday Part III on Balance Disorders and Falls Prevention

Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum/

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

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 clinical professor of medicine at GCSOM.

1^st of 3 Columns on Balance Disorders and Falls Prevention

Northeastern Pennsylvania is home to a large elderly population and many of the medical problems we expect to see are age related. Dedicated medical practitioners are in constant search for new knowledge and information to prevent or delay many age related problems. One of the most devastating problems associated with aging is falling. It will be the purpose of this series of three columns to educate readers about the risks and causes of falling and the prevention and treatment of balance disorders.

Loss of balance causes falls. Falls are a leading cause of injury and death. Thirty percent of women and thirteen percent of men over the age of sixty-five will fall. Twenty to thirty percent of these individuals suffer moderate to severe injuries. Preventing falls is not an easy task. A good understanding of the causes of loss of balance and knowledge of a few fall prevention suggestions can enhance your balance and reduce your risk of a fall.

The causes of loss of balance which may lead to a fall are divided into three categories: age related changes, medical conditions and medications.

Age Related Changes affecting the sensory system, the musculoskeletal system as well as psychological behavior can negatively impact balance causing a fall:

• Sensory factors that impact balance are maintained through combined sensory input from the eyes, the joints and the inner ear. Sensory deprivation decreases balance and increases fall risk. Visual changes with aging include a decrease in visual acuity, visual field and depth perception. Decreased joint position sense, (joint proprioception) especially in the legs, leads to increased sway and reliance on vision, which is already impaired. Decreased input from the inner ear (vestibular system) negatively impacts eye stability and head orientation.
• Musculoskeletal factors with aging can cause unsteadiness during walking: deceased leg muscle strength especially quadriceps, arthritis in low back/hips/knees resulting in leg pain, stooped posture and leg length discrepancies.
• Psychological factors can also interfere with balance. Fear of falling increases with age. Denial of frailty leads to poor judgment when performing certain tasks. Anxiety and depression not only decreases attention and awareness of environment but may also cause poor sleep leading to drowsiness during the day.

Medical Conditions can also cause loss of balance increasing the risk of a fall:

• Cardiovascular conditions may cause loss of balance due to dizziness or lightheadedness caused by a sudden change in blood pressure. These include: abnormal heart rhythm, heart attack and heart failure. Orthostatic hypotension is an excessive fall in blood pressure on assuming the upright position (quickly standing up after lying down). Syncope (fainting) is a sudden brief loss of consciousness due to decreased blood flow to the brain. Vertebral artery insufficiency occurs from leaning head back too far compromising arterial blood flow to the brain causing dizziness.
• Neurologic conditions  can negatively affect sensory input (visual, vestibular and joint proprioception) and motor (muscular) responses and result in loss of balance. These include: multiple sclerosis, epilepsy (seizures), brain tumor, stroke, Parkinson’s disease, peripheral neuropathy, cerebellar degeneration and head trauma.
• Cognitive conditions contribute to loss of balance because of poor judgment and behavioral problems (e.g. dementia and Alzheimer’s disease).
• Vestibular conditions cause vertigo (sensation that the room is spinning or moving) resulting in loss of balance. Benign Paroxysmal Positional Vertigo (BPPV) is caused by a change in the position of the head when debris is lodged in a symptomatic part of the inner ear. Labyrinthitis is a viral infection of the inner ear following a cold or flu. Meniere’s disease is a common inner ear problem resulting in vertigo and ringing in the ears.
• Genitourinary conditions can contribute to loss of balance. For example, individuals with bladder control problems (incontinence) use poor judgment by moving quickly, especially at night, to prevent an “accident”.
• Endocrine conditions can produce dizziness causing loss of balance.  Hypoglycemia (low blood sugar associated with diabetes) causes dizziness.

• Gastrointestinal conditions may lead to loss of balance. During defecation syncope, fainting is caused by a decrease in arterial pressure when bearing down to assist a bowel movement. Any condition resulting in dehydration (diarrhea/vomiting), decreases blood volume which may cause lightheadedness and loss of balance

Medications can also negatively effect balance and increase the risk of falls. Interactions between medications as well as the side effects of certain medications can cause dizziness or drowsiness resulting in loss of balance. Theses medications include: tranquilizers, sedatives, anti-depressants, alcohol, diuretics, blood pressure medications, cardiac medications, laxatives and pain killers.

In conclusion, determining who is at risk for a fall is a complex task since many factors including age, disease and medication can affect the outcome. Early intervention to prevent a fall can avoid many costly consequences.

Medical Reviewer: Mark Frattali, MD, ENT at Delta Medix, Division Chairman Otolaryngology – Head Neck Surgery at Commonwealth Health Regional Hospital

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   Next Monday Part II on Balance Disorders and Falls Prevention

Read all of Dr. Mackarey's Articles at: https://mackareyphysicaltherapy.com/forum/

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

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 clinical professor of medicine at GCSOM.

According to the New York Times, there is a shortage and backorder of bicycles this summer due to COVID-19, especially in the cities where public transportation is discouraged. Fortunately, in NEPA, the problem is not so extreme. For those who have a bike, now might be a good time to dust them off and enjoy the many beautiful and well-maintained trails are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority.

However, whether you head out for 5 or 50 miles, ensuring a proper bike fit should be on your checklist. Riding a bicycle that is properly fit to your style and body will not only help to prevent injury, but allow for a more comfortable riding experience.  There are many things to take into consideration when checking your bike fit. First and foremost you must choose a bike that fits your style of riding.

BIKE STYLES:

For the sake of simplicity 3 basic styles of bikes include Road bikes, Hybrid bikes and Mountain bikes. Road bikes are designed for long distance riders, hybrid bicycles can be used for longer distance riders, but usually accommodates a recreational cyclist, and mountain bikes are designed for dirt or gravel and technical trails. The next component of ensuring a proper bike fit is making sure that you have a good foundation by choosing the right sized frame. To find the right sized frame you can use the following guidelines as a way to start or simply ask the local bike shop or bike fit consultant of your choice for help.

Road bikes: When straddling the bike you should have about 1” of clearance between your body and the top tube if the bike has a straight top tube (which runs parallel to the ground). When lifting the bike you should have 1” clearance between the tires and the ground. If the bike has a sloping top tube (semi-compact design) you should have a clearance of 2” or more.

Mountain bikes: When straddling the bike lift the bike off the ground and you should have a minimum of 2” clearance between the ground and the tires. With full suspension bikes you will want 1”-2” standover clearance because when you sit on the bike the frame will become lower from compressing the suspension. More aggressive riders will likely have 3”-5” of clearance.

Comfort bikes: Standing over a comfort bike to chose the right sized frame is not necessary. They are commonly designed with a steep sloping top tube and allow the rider to put feet firmly on the ground when the rider comes to a stop.

PROPER FIT:

Now that you have right size for your bike you should adjust the components of the bike to allow for a more comfortable riding experience. Please use the diagram as a point of reference for the following tips. Also be sure to reexamine your bike fit after any bad falls. Keep in mind these measurements are meant to be used as a simple guideline and if you have any pre existing injuries or concerns please be sure to consult your local Physical Therapist or bike fit consultant.

Seat/Saddle

1. Your Seat or saddle should be level (See “A” on diagram). If it is tilted too far forward there will be too much weight on hands, arms and lower back. If it is too far backward, there may be strain on LB and may lead to saddle related pain.
2. Your knee should be measured at the most extended position to adjust saddle height. (see “Knee to Pedal”)
3. The saddle should be a comfortable distance from handlebars. If it is too close it will place too much weight on your mid-back and arms. If it is too far it will put extra strain on your low back and neck. Also make sure seat is the proper width to ensure a more comfortable ride.

Handlebars (HB)

1. Your handlebar placement will affect your hands, shoulder, neck and back. The higher the handlebars are the more weight is placed on the saddle. Taller riders should have lower handlebars in relation to height of saddle
2. For road cyclists there should be a 90° angle between your arm (near the shoulder) and your trunk with a slight bend at your elbows of about 15° (See “B” on diagram).
3. Your trunk angle should be 25-35° if you are a road bike cyclist and 35-90° comfort/recreation cyclist

Knee to Pedal

1. The knee to pedal measurement should be taken with the knee in the most extended position. There should be about a 25-35° angle at the knee (See “C” on diagram)

Foot to Pedal

• The ball of your foot should be over the pedal spindle (See “D” on diagram). This will allow for the best leverage, comfort and efficiency. Using a stiff soled shoe is recommended.

If you are a recreational cyclist it’s a good idea to take all the proper steps in preventing injury. This article can be used as a reference point to help to prevent common cycling injuries, enhance your comfort and improve your riding efficiency. If you have any further questions about enhancing your bike fit please contact your local physical therapist or bike fit consultant.

Sources: REI.com APTA.org

CoAuthor: Sarah Singer, PTA is a physical therapist assistant at Mackarey Physical Therapy, specializing in orthopedic and sports rehab.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” at https://mackareyphysicaltherapy.com/forum/

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com. Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at GCSOM. 

According to the New York Times, there is a shortage and backorder of bicycles this summer due to COVID-19, especially in the cities where public transportation is discouraged. Fortunately, in NEPA, the problem is not so extreme. For those who have a bike, now might be a good time to dust them off and enjoy the many beautiful and well-maintained trails are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority.

WHY BIKE?

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

BENEFITS OF BIKING

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

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be in good working order such as tires, chain, brakes and pedals. Next, be sure to maintain a fairly good fitness level in order to bike safely. If you are a beginner, start slowly. Warm up and slowly bike for 10 to 15 minutes and build up over time. Practice the coordination of stopping, starting, shifting and braking. Work on good strength and flexibility of the hamstrings, quadriceps, calves and gluteal muscles. All of these muscles are necessary to generate pedal force. Balance is also important to safety and can be practiced on and off the bike. Be aware that adaptive equipment can modify your bike for added comfort and safety such as soft handlebar tape, seat post and front fork shock absorbers, padded biking shorts, c-out and gel pad saddle seats, and wider tires.

Be careful not to progress too quickly because inactivity to over activity in a short period of time can create problems. Overuse injuries such as tendonitis, can be avoided by cross training. Bike every other day and walk, run or swim on off days. Make sure to take time off to recover after a long ride. Use ice and massage to sore muscles and joints after riding.

Remember, cycling should be fun! Pain from improperly fitted and poorly maintained equipment is preventable. Excessive workouts and training rides should be kept to a minimum and consider cross-training in between.  

SAFETY

EQUIPMENT: Helmets are a must! Also, keep your bike in good condition. Road bikes should have mirrors and reflectors. Use hand signals and obey traffic rules. Dress for weather and visibility. Have a first aid and tire patch kit, tire pump and tools. Seat comfort can be improved with gel cushion or split seat.

BE ALERT: for traffic, parked cars, pedestrians loose gravel and cracks in the road. 

SOURCES: American Physical Therapy Association

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” at https://mackareyphysicaltherapy.com/forum/ or visit our website at https://mackareyphysicaltherapy.com/

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 in downtown Scranton and is an associate professor of clinical medicine at GCSOM. 

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what type of exercise is best for those suffering from osteoarthritis (OA). Osteoarthritis is also known as degenerative arthritis. It is the most common form of arthritis in the knee. It is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity and weakness with loss of function due to disuse.

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

Benefits of Exercise for Those with OA

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

Pain Control

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

Weight Control

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

Prevention of Joint Stiffness

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

Prevention of Muscle Weakness

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

Maintain Lifestyle

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

Tips How To Exercise With Osteoarthritis

Start Slowly

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

Lose Weight

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

Low Impact Workouts

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

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

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

Warm-Up

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

Balance & Relaxation Techniques

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

Proper Clothing

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

Pre/Post Exercise First Aid

If you are sore for longer than 12 to 24 hours after exercise, then you overdid it and must make adjustments next time. Otherwise, use hot packs, bath or shower before you

EVERY MONDAY – Read Dr. Paul J. Mackarey NEW Article in“Health & Exercise Forum!”

For all of Dr. Mackarey articles visit https://mackareyphysicaltherapy.com/forum/

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

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.

Protect your Skin for it Health

Skin Cancer

Despite the fact that we have limited exposure to sunny days in NEPA (50%), skin cancer still exists in large numbers. Skin cancer is the most common cause of cancer in the United States. While there are several types of skin cancer and not necessarily all are deadly, procedures to remove these skin cancers are both costly and frequently result in unsightly scars. The most dangerous type of skin cancer, called melanoma, results in an estimated 10,000 deaths per year. The good news? Nearly all skin cancers are preventable!

UV rays

The majority of skin cancers are caused by harmful ultraviolet (UV) rays from the sun. Two major types are UVA and UVB:

• UVA rays account for the majority of UV rays in sunlight (about 95%) and penetrate deep into the skin causing continual damage throughout our lives – a process called ‘photo-aging’ that results in wrinkles, sunspots, and uneven texture. UVA can also damage skin at a microscopic level, which may contribute to the development of skin cancers.
• UVB rays, while they do not penetrate as deeply, are what cause sunburns when we spend too much time under the sun. UVB rays are primarily responsible for the development of skin cancers.

Protect your Skin for its Looks

Aging

In the field of anti-aging, advertisers make lofty promises for many products that claim to contain or boost collagen. Whether or not these work is a whole other discussion, but what is collagen and what does it have to do with wrinkles?

Collagen is the most abundant protein in the human body. It is found in nearly all tissues and organs, and plays a crucial role in maintaining structural integrity. Unfortunately, collagen production naturally decreases with age. This causes many of the findings we associate with older age, such as sagging skin and wrinkles, as well as joint pain. Collagen also works together with another important protein called elastin, which helps to maintain elasticity – a feature commonly associated with youthful skin.

When exposed to UV rays, these proteins can become damaged. For instance, studies have shown that skin exposed to UV rays increases the expression of proteins called matrix metalloproteinases, or MMPs. You can think of these MMPs as collagen’s enemy, as they cause their degradation. This results in a decrease in collagen’s structural function leading to loose and wrinkled skin. UV rays can also stimulate the production of reactive oxygen species. These are substances such as hydrogen peroxide and bleach, which further cause destruction of skin’s microscopic structure.

Sunscreen Tips & Tricks

So, you’re convinced and have decided to keep your skin healthy and youthful – what next? With so many different products on the market, choosing a daily sunscreen can become a difficult task. Here are a few pointers:

• Look for the words “broad spectrum” or “UVA/UVB” on the label – this will ensure you are protecting yourself from all of the sun’s damaging effects
• Chose a product that is water-resistant if you anticipate sweating or swimming.
• Don’t stress over SPF. SPF stands for “sun protection” factor. An SPF 15 sunscreen blocks over 90% of UV rays. What’s more important is re-applying periodically throughout the day.
• Don’t let the cold weather fool you – while they may not feel warm, the suns rays are still penetrating the layers of your skin.
• Wear sunscreen even when it’s cloudy – harmful UV rays are invisible and are able to pass through.
• Don’t forget your ears and lips! Some skin cancers are especially common in these areas.

Another consideration when choosing a sunscreen is chemical versus physical blockers:

• Chemical sunscreens typically contain a combination of the following ingredients: oxybenzone, avobenzone, octisalate, octpcrylene, homosalate, and octinoxate. These work by absorbing the UV rays and preventing their damaging effects. Make sure to apply at least 30 minutes before heading outside, as these take some time before they begin working effectively.
• Physical, or mineral, sunscreens contain zinc oxide and/or titanium dioxide. These works by creating a layer over the skin that deflects or blocks the UV rays from penetrating. These are a great choice especially if you have sensitive skin.

If preventing skin cancer isn’t incentive enough to wear sunscreen daily and avoid excessive sun exposure (and indoor tanning booths!), then consider the rapid effects on aging the sun’s rays can have. While a tan may look good for a week, avoiding exposure to UV rays will both delay and prevent aging for years.

For more information on skin cancer and prevention, please visit the Center for Disease Control’s website (https://www.cdc.gov/cancer/skin/) and contact your physician for specific concerns regarding spots on your skin.

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

This week’s article was written by Eduardo Ortiz, a fourth year medical student at Geisinger Commonwealth School of Medicine (GCSOM). Eduardo majored in Biology and minored in Art History at Florida International University in Miami, Florida. As president of the Dermatology Interest group, he helped organize a free skin cancer screening with local dermatologists earlier this year.

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 in his "Health and Exercise Forum" at https://mackareyphysicaltherapy.com/forum/

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Due to social distances and other appropriate precautions during the COVID-19 pandemic, many people are filling the void in their lives with outdoor endurance exercises such as running, cycling, hiking etc. However, as summer is in full swing, with temperature and humidity rising, remembering to properly hydrate is essential.

Next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours); the consequences can be life threatening and the symptoms can be alarmingly swift.

In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.

The risk of dehydration is not limited to endurance athletes and outdoor enthusiasts. Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years.

Is water adequate to prevent dehydration? Will a sports drink improve my performance? While some answers to these questions apply generally to all, others vary according to the temperature, humidity, length of time and intensity of the activity and condition of the athlete. 

Proper hydration is essential for the comfort and safety of the recreational and serious athlete. Hydration is critical to maintain cardiovascular function, body temperature and muscle performance. As temperature, humidity, intensity, and duration of exercise increase, so too does the importance of proper hydration. Excessive sweating can lead to a loss of blood volume which requires the heart to work much harder to circulate you blood through your body.

Dehydration is a major cause of fatigue, loss of coordination, and muscle cramping leading to poor performance. Prehydration, (drinking before exercise) is the first step in preventing dehydration. Marathon runners, other long-distance runners, and cyclists often prehydrate1-2 days before a big event. Rehydration, (drinking during or after exercise) is the second step in preventing dehydration. While athletes may be more vulnerable to dehydration, all persons engaging in exercise would benefit from increased performance, delayed muscle fatigue and pain by maintaining adequate hydration. Proper prehydration would include drinking 12-16 ounces of water 1-2 hours before exercise.  Athletes with other health issues should consult their family physician before engaging in long distance endurance sports.

American College of Sports Medicine Hydration Recommendations:

• Eat foods high in carbohydrates and low in fat. Drink plenty of fluids between exercise sessions. The best fluids are plain water or fluids without sugar, caffeine or alcohol.
• Drink 17 oz or 2+ cups of fluid 2 hours before exercise
• Drink every 15 minutes during exercise.
• Keep drinks cooler than the air temperature. Drinks should be readily available.
• If you exercise more than 60 minutes, you may benefit from a sports drink containing a carbohydrate. The carbohydrate drink should not exceed 8% solution
• If you exercise more than 60 minutes, take 30-60 grams of carbohydrate per hour to delay fatigue and fuel muscle contractions.
• If you exercise more than 60 minutes, include (.5-.7 g per gallon) sodium in your drink of choice. This will also encourage additional drinking.
• Drink 24 ounces of water for every 2 pounds you lose after your workout. This is based on pre and post exercise weight.
• If you exercise more than 90 minutes, sports drinks may be helpful. 60 to 100 calories per 8 ounces of drink will help supply the needed calories for performance.
• Avoid caffeine. While the energy is good, it acts as a diuretic to rid the body of fluid. This is counterproductive for the high-level athlete.

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

For all of Dr. Mackarey articles visit https://mackareyphysicaltherapy.com/forum/

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

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.