Human beings were designed to move…walk, run, climb, lift, hunt, and gather. Contemporary man has suffered greatly from a technologically driven inactive and sedentary lifestyle. Inactivity is associated with many health problems; obesity, adult-onset diabetes, high blood pressure to name a few. Other problems associated with lack of movement are;
Constipation
The more you move your body, the more your colon moves! A regular and consistent exercise and activity regime results in a more consistent bowel schedule, especially with age. Healthy muscle tone in your abdominal muscles and diaphragm is also the key to moving waste through your digestive tract.
Stiff Joints
Osteoarthritis, rheumatoid arthritis and many inflammatory or auto-immune diseases can cause achy and stiff joints. However, even healthy joints can also stiffen when you don’t use them enough. Put them to work so they get tight and cause pain.
Shortness of Breath
All muscles get weak from lack of use, including the muscles that help your lungs expand and contract as you breathe if you don’t work them out regularly. The less exercise or activity you do, the more you experience shortness of breath, even during easy daily tasks.
Depression or Moody
Physical problems are not the only complication of inactivity. A lack of movement can also increase feelings of anxiety and depression. Aerobic exercises like walking, biking, swimming, or running, have been proven to stimulate endorphins to boost and steady your mood, and even improve your self-esteem.
Lack of Energy
Many studies have found that regular movement improves energy. Exercise helps deliver oxygen and nutrients to your tissues. When you sit or are inactive, tissues are not getting the same amount of fuel they need to keep you going.
Slow Metabolism
Movement stimulates your metabolism. Hyperactive people burn more calories…just by fidgeting! Even if you are not hyperactive, the more active you are, the more calories you burn each time you move.
Difficulty Sleeping
One of the first recommendations sleep doctors make to their patients suffering from insomnia is exercise. When you keep a regular exercise routine, you fall asleep faster, and you sleep deeper once you drift off.
Brain Fog
Regular exercise tells your body to make more chemicals called growth factors. They boost blood vessel production in your brain. The more blood that gets to your brain, the better you can think, remember, and make decisions.
High Blood Pressure
Spending most of your time sitting raises your risk of heart disease, in great part because you’re more likely to have high blood pressure. This is a big risk factor for heart issues like coronary artery disease and heart attack.
High Blood Glucose
When physical activity is a regular part of your life, your body has an easier time keeping your blood glucose under control. Exercise can stabilize blood sugar levels and keep you out of the type 2 diabetes danger zone.
Lower Back Pain
When your core muscles are weak from lack of use, they can’t support your back the way they should. This makes it much easier to tweak your back muscles during everyday movements like standing or reaching. Pilates, yoga, and other exercises that use stretching are good for building a stronger back. Schedule an appointment with a good orthopedic and sports PT.
Hunger Pains … “Hangry”
Logically, one might think that you’d be hungry more often if you exercised more, but the opposite is usually true. Aerobic exercise like biking, swimming, walking, and running can decrease your appetite because it changes the levels of certain “hunger hormones” in your body.
Sick Often
Studies show the more moderate activity you get, the lower your chance of catching a cold or other germs. When you make exercise a habit, your immune system gets stronger.
Dull and Pasty Skin
If your skin looks duller than usual, a lack of movement may be to blame. Some studies show that moderate exercise boosts your circulation and your immune system, which helps your skin keep that youthful glow.
SOURCE: WebMD
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!
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. Osteoarthritis 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 Osteoarthritis:
When performed correctly, exercise for those with Osteoarthritis 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 increased 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 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 sleep.
Proper Clothing
Stay warm in winter and consider wearing compression shorts. Be cool in the summer months with DrytechR 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 adjust next time. Otherwise, use hot packs, bath or shower before you exercise to loosen up and apply ice to your joints after exercise, especially if they are sore.
Post Exercise Stretch
Gentle, active range of motion stretches after exercise is important to maintain mobility. Do not bounce or cause pain. For example: Low Back – knees to chest; Arms – row –the – boat, arms behind head, arms behind back; Legs – wall lean calf stretch, bend and extend knees, open and close hips.
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons; www.lifescript.com
Visit your doctor regularly and 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!
We are in the middle of another heat wave this summer and ice baths, which people do all year, may sound like a very refreshing thing to do! But, before you take the plunge, know the benefits and risks of a frigid bath.
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.
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!
(and back, shoulders, etc)...
Germaphobes, cleaning zealots, neat freaks, and those with diagnosed or undiagnosed obsessive-compulsive disorder (OCD), this column is for you! If you would rather clean your bathroom floor than go for a walk on a beautiful sunny day, please read on. If you use a toothbrush on tile grout on a regular basis and take pride in the sparkle of your toilet bowl than beware… studies show that performing these tasks with too much vigor and passion might lead to back, neck, and shoulder and wrist pain.
For some, and you know who you are, (I am related to a few) spring cleaning can be a particularly exciting sporting event. It is almost an exorcism to rid a home of all its evil spirits, smudges, dust, dirt, germs, and odors. Every April curtains come off the windows to be washed and carpets rolled up, removed and cleaned. The surfaces under the curtains and carpets are sterilized with cleaning detergents, disinfectants and chemicals that would make sterile techniques in most hospital operating rooms seem inadequate. And that doesn’t include the heavy work: moving furniture, bedding, including mattresses and box springs.
As a physical therapist and survivor of childhood exposure to copious amounts of cleaning chemicals, I have come to learn that there are healthy and safe options for spring cleaning your home. Of course, the most obvious solution is to hire professional help if you can afford it. The other practical solutions are below:
10 Health Tips for Spring Cleaning:
Have a Plan - Take your time
It doesn’t have to be done in one day or one weekend!
Make a list, follow a schedule and do it over the course of 3-4 weeks
Do Not Move Heavy Furniture or Appliances by yourself
Get Help –
Use Sliders – to move heavy items like furniture
Be Cautious on Ladders and Stools
Falls are a leading cause of injury mortality in the US and 43% of fatal falls have involved a ladder, according to the Centers for Disease Control (CDC).
Avoid Reaching or stepping on the top step
Open and lock the ladder properly instead of leaning it against a wall
Use Proper Ergonomics
Lift Properly – back straight, knees bent
Incorrect Correct
Work at Eye Level – don’t work overhead for extended periods of time. Working overhead extends the neck and back and can lead to compression of the spine. This can cause pain, muscle spasms, headaches and pinched nerves which radiate symptoms into the arms and legs. Also, overextending and reaching with the shoulder, such as when cleaning windows, can lead to shoulder pain and stiffness from tendonitis or bursitis.
IncorrectCorrect
Wear a support if needed: knee or back brace, tennis elbow strap, arch supports
Avoid Prolonged Squatting – instead, kneel on a kneeling pad or wear knee pads
Use Caution Walking on Wet Surfaces
Use Caution Working Around Water and Electricity
Use Caution When Working with Household Cleaning Chemicals – provide adequate air circulation
Wear a Mask – when using cleaning chemicals or around dust, mold etc
Limit the Amount of Weight or Items You Carry – especially on the stairs
Take Breaks
Hydrate, Eat, and Rest
Stretch – neck, back, shoulders with a wall stretch
7 Safety Tips for Spring Cleaning:
Replace or Clean Filters for air and heat units
Clean out Medicine Cabinet
Get rid of unused and expired meds properly
Call your local pharmacist for details
Clean Attic, Garage, Cabinets and Basement of Dangerous Chemicals or toxic trash
Old paint cans, paint thinner, soiled rags, brushes etc
Contact your local government agency or recycling center for details
Remove mold and fungus from bathroom and laundry room
Replace Batteries in Smoke, Fire and Carbon Monoxide Detectors
Clean the Chimney – call a professional to protect you from carbon monoxide exposure
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!
Spring, Summer, Winter or Fall…weather changes can cause joint pain!
It is not just a cold weather problem…
“Everybody talks about the weather, but nobody does anything about it,” said Mark Twain. Just ask 93% of the arthritis sufferers who believe that the weather affects their pain level. History tells us that Benjamin Franklin, Leonardo da Vinci, and Christopher Columbus also felt this way about the weather.
Patients at our clinic have been particularly sensitive to joint pain on cold, damp days, especially during the past few weeks. In my clinical practice of orthopedic and sports physical therapy, an informal survey found that 95 out of 100 patients (95%) with arthritis reported increased pain with weather changes. While most people report that the coldness and dampness seem to irritate their joints, they also report more pain with weather changes in the summer. There is a reasonable explanation…
Joints in the body have a lining called synovium that secretes a lubricating fluid called synovial fluid. In joints with arthritis, there is an overproduction of synovial fluid. In theory, when the barometric pressure changes, so to will the pressure inside your joints, especially if it is already overfull with extra fluid from arthritis. This added pressure stimulates the nerve endings in the joint to produce inflammation and pain.
Despite this overwhelming response from patients, scientific studies vary in their support of this claim. According to the Mayo Clinic, in 1961, a famous arthritis doctor (rheumatologist), built a climate chamber and discovered that when high humidity was combined with low barometric pressure, patients reported increased joint pain and stiffness. A recent study found that changes in barometric pressure and cooler temperatures are associated with joint pain. However, other studies have found increased joint pain with high barometric pressure in both warm and cold weather while another study found pain with low pressure.
What does this mean? It means that patients with arthritis consistently report pain with weather changes, but science has not found an accurate method to consistently support these claims. Some of these inconsistencies may be attributed to the fact that there are differences in sensitivity among individuals. For example, some patients have symptoms before the weather changes, while others notice symptoms during or after the weather changes. Still yet, some report more pain in colder conditions while others notice more pain in warmer weather. It appears that changes in the weather, such as a high to a low or warm dry to cold damp and vice versa is the culprit when it comes to irritating arthritis in a joint.
If I have arthritis, should you move to Arizona? Yes and no! Yes, the warm and dry climate of Arizona will probably make you feel better overall. However, it will not cure the degenerative changes in your joints, and you may still have pain when CHANGES in the weather occur. This is proven to be true by the fact that there are many very busy rheumatologists in Arizona!
In conclusion, it is safe to say that there is some evidence to support the claim that most patients with arthritis have increased symptoms of joint pain and stiffness with CHANGES in the weather:
Changes in barometric pressure (most often lower pressure)
Changes in temperature (most often lower temperature)
Changes in humidity (most often high humidity)
Changes in weather overall (most often with precipitation)
Therefore, each patient must be individually evaluated by their physician to determine the extent of their arthritis and its relationship to the changes in the weather. While the cause of their increased symptoms with changes in the weather may not be completely understood, each patient must determine the adjustments in their lifestyle and/or medications according to the particular weather patterns that affect their problem most.
Visit your doctor regularly and listen to your body.
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!
It’s that time of year…after a long winter of nights that come early and last too long there is LIGHT at the end of the tunnel! In the fall and winter, especially this far north, many people start to feel the gloom of their surroundings creep into their psyche and spring cannot arrive too soon...Is this normal, or a sign of something more serious?
Seasonal affective disorder, or SAD, is at the far end of a spectrum of seasonal mood changes. The mildest of these, “seasonality”, is a normal response to cyclical changes in weather and light exposure. However, when symptoms like depressed mood, lack of motivation, or a shift to more vegetative daily habits become severe and debilitating, SAD may be the cause. In fact, one study found that SAD affects up to 10% of primary-care patients, and that those with a previous diagnosis of depression are even more at risk. Fortunately, though, there are well established therapies that can help those afflicted with SAD to get through the dark winter months.
The American Psychiatric Association defines SAD as a subtype of either Major Depressive Disorder or Bipolar Disorder, depending on the symptoms. It can consist of episodes that onset during either fall/winter or spring/summer, or have symptoms characteristic of either “major depressive” or “manic” episodes. The vast majority of those with SAD, however, experience a persistent overall depressed mood during the shorter days of fall and winter.
Symptoms of SAD:
Depressed mood
Lack of interest in previously enjoyable activities
Decreased energy level, impaired concentration
Changes in appetite
In more serious cases:
Excessive feelings of guilt or worthlessness
Slower or racing thoughts or movements
Suicidal impulses.
If enough of these symptoms are present for a long enough time and onset in a seasonal pattern, that can mean Seasonal Affective Disorder. Most people with the disorder find themselves sleeping more and eating more (especially carbs), and report that their symptoms can even resolve with relocation to a sunnier environment. Along the spectrum of disease is a less severe form called “subsyndromal” SAD, which can still be effectively treated. Periods of SAD tend to resolve with the coming of spring, but they can be immensely distressing and always deserve medical intervention.
No one knows exactly why Seasonal Affective Disorder happens, but it appears to be associated with decreased exposure to natural light during the fall and winter months. One possible explanation is the “phase-shift” hypothesis. It states that your body’s circadian rhythms, which are regulated by hormones and the brain, become out-of-step with environmental sleep/wake cues as the days shorten. In other words, the light levels around you and your body’s internal clock are telling you two different things about when to sleep. This disruption of circadian rhythms, or “phase-delay”, likely contributes to the symptoms of SAD, although precisely how it induces changes in mood remains unclear.
Another hypothesis for the mechanism underlying SAD involves abnormalities in the activity of serotonin, a neurotransmitter in the brain. Normally, serotonin regulates mood and attention. However, studies have found that people with SAD clear serotonin out of their brains faster, giving the hormone less of a chance to provide a boost in mood.
Treatment for SAD:
Current medical treatment of SAD targets the changes in both circadian rhythms and serotonin metabolism. This can be accomplished with light therapy, antidepressant medications or a combination of both.
Light Therapy - works by correcting the miscommunication between the body’s internal clock and its surroundings. It is administered as either “bright-light therapy” or “dawn stimulation.” Bright-light therapy involves the patient sitting or going about their activities while exposed to a very bright light for a certain amount of time every day. Dawn stimulation, on the other hand, gradually exposes the patient to more light as they wake up in the morning. In this way, dawn stimulation simulates a pattern of morning light-exposure more akin to what we experience in the summer.
Antidepressant Medications - most of the time, doctors begin with a “selective serotonin reuptake inhibitor” (SSRI), which remedies the dysregulation of serotonin signaling observed in patients with SAD. SSRIs block serotonin from being recycled in the brain, thus giving it more time to work.
Lifestyle Changes - behavioral and lifestyle changes can be instrumental in fending off seasonal depression. Below are some easy changes you can make that are proven to help with seasonal mood changes--whether it be the “winter blues”, subsyndromal SAD, Major depression with seasonal pattern...or just plain “seasonality”:
Maximize your sleep hygiene:
Go to bed and wake up at the same time every day.
Try not to let your bedtime or wake time vary by more than an hour from day to day.
Have a regular, relaxing bedtime routine.
Doing the same thing every night, including taking time to just wind down, will help you sleep and optimize your circadian clock.
Create a comfortable sleeping environment.
Make sure your bedroom is quiet, dark, and not too warm.
Avoid using TV, computers, phones and other electronics before bed. Bright blue light from screens can interfere with circadian rhythms.
If possible, try to minimize exposure to bright light from any source for 2 hours before bed.
Limit caffeine intake later in the day. 4 to 6 hours after you have a cup of coffee, half of the caffeine from it is still in your body--keeping you awake! Be sure to check labels: coffee, soda, iced tea and dark chocolate are not the only things that contain caffeine.
Maximize Outdoor Activities:
Get Outside! Take daily walks outside. Some experts believe that natural light can alleviate the symptoms of seasonal depression in exactly the same way as bright light therapy. Don’t stay in, even if it’s overcast. Even on a cloudy day, the outdoor light intensity is up to half that of prescription bright-light lamps. And on a bright day, the midday sun can be up to ten times their intensity!
Exercise! Engage in aerobic exercise like biking, running, or walking Regular exercise can improve the symptoms of seasonal depression, even in the absence of other lifestyle changes. If you can exercise outside when it’s sunny, you’ll be killing two birds with one stone. Early morning and late afternoon are the best times to exercise. Try to avoid strenuous activity right before bed.
Stay Positive! Always remember that spring sunshine is never all that far away!
Medical Contributor:
Brendan Bormes, MD, GCSM 2019: This column was previously featured in “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.
Visit your doctor regularly and 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!
NEPA has had its share or snow this winter…and the recent storm added plenty of the pretty white stuff for work and play. Much has been written about the dangers of snow shoveling for your heart. However, while not fatal, low back pain is the most common injury sustained while shoveling snow. Heart attacks are also more common following wet and heavy snow.
Snow shoveling can place excessive stress on the structures of the spine. When overloaded and overstressed, these structures fail to support the spine properly. The lower back is at great risk of injury when bending forward, twisting, lifting a load, and lifting a load with a long lever. When all these factors are combined simultaneously, as in snow shoveling, the lower back is destined to fail. Low back pain from muscle strain or a herniated disc is very common following excessive snow shoveling.
Snow Shoveling as a Form of Exercise:
GOOD - For the Young and Healthy – studies show that snow shoveling for 15 minutes is considered moderate physical activity and extreme and vigorous physical activity when performed more than 15 minutes even for young healthy college students.
BAD – For the Older and Unfit – research clearly shows that there is a significant increase in heart attacks among snow shovelers. If you have any risk factors or medical condition and do not exercise regularly consult your physician.
Cold Weather – makes this activity even more difficult and physically stressful. Cold air makes breathing more labored and difficult and cold temps create added strain on the body.
People at High Risk of Illness Due to Snow Shoveling:
History of Heart Attack
History of Heart Disease
History of High Blood Pressure or High Cholesterol
Smokers
Inactive & Sedentary Lifestyle
Overweight
Elderly
10 TIPS FOR SAFE SNOW SHOVELING:
MEDICAL CLEARANCE: If you have any medical condition or risk factors consult your physician.
PAIN: Stop immediately if you experience any pain. Especially in the chest, left arm, jaw, face, neck, or lower back.
ERGONOMICS: Choose a snow shovel that is right for you:
An ergonomic shovel with a curved handle allows you to keep your back straighter or arched when shoveling
An ergonomic shovel with a shorter or adjustable handle length allows you to keep your back straighter and knees bent when shoveling. The right handle length allows you to arch your back 10 degrees with your knees slightly bent when the shovel is on the ground.A plastic shovel blade is lighter than a metal one and will be better for your spine.
A smaller blade is better than a larger blade. It may take longer but will stress your back less.
PUSH: When possible, push the snow. Do not lift it. Lifting is much more stressful on the spine. You can find shovels that are ergonomically designed just for pushing snow.
WARM – UP: Be sure your muscles are warm before you start to shovel. Cold and tight muscles are more likely to strain than warm, relaxed muscles. Layer and consider compression shirts or tights can help prevent cold and tight muscles.
LEVERAGE: When you grip your shovel, spread your hands at least 12 inches apart. This will improve your leverage and reduce strain on your lower back.
TECHNIQUE: Shoveling technique is very important. The American Academy of Orthopaedic Surgeons recommends:
Squat with your legs apart, knees bent and back straight.
Lift with your legs. Do not bend at the waist.
Scoop small amounts of snow into the shovel and walk when you want to dump it.
Do not hold the filled shovel with outstretched arms.
If snow is deep, remove in piecemeal, a few inches at a time.
Rest and repeat as necessary.
Move your feet and do not twist your back as you shovel or dump. Never throw snow over your shoulder
CAUTION: Be cautious shoveling wet snow. One full shovel can weigh 25 pounds.
Shovel wet snow slowly in piecemeal.
PACE YOURSELF: Take frequent breaks and stretch your back in the opposite direction of shoveling. For example: 1. Lean backwards and extend your lower back. 2. Pinch your shoulder blades together.
TECHNOLOGY:
Snow Blower - Use a self-propelled snow blower. It will put much less stress on your lower back than shoveling snow if used correctly. For example, push the blower with your legs and keep your back straight or arched and knees bent.
Ergonomic Shovels:
Rechargable Electric Snow Shovel: Toro, DeWalt, Voltask
2 Handle Shovels: ErgieShovel or Snow Joe ShovelutionPush Shovels: Garant Yukon or Garant Sleigh Shovel
WarmlyYours - HeatTrak® portable snowmelting system for roofs, gutters, driveways, sidewalks, stairs and handicapped ramps uses electric mats or runners for home or office which can be customized.
Sources: The Colorado Comprehensive Spine Institute; American Academy of Orthopaedic Surgeons
Visit your doctor regularly and 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!
Part II of II
Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA 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 joint involved, especially after increased activity. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.
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 make poor lifestyle choices, do the wrong exercise, use poor technique, or are too aggressive, you could flare-up your joints and do more harm than good.
Don’t Burn the Candle at Both Ends
Poor sleep can affect your joints. One study found that people with arthritis felt more pain after restless nights. One theory is that when you don’t sleep well, it triggers inflammation in your body, which may lead toOA over time.
Don’t Slouch and Slump
Posture matters. Sit up straight. When you slump in your chair, it puts more stress on your muscles and joints and tires them out. Two good posture stretches are making a double chin by bringing your head over your shoulders and the second is pinching your shoulder blades together.
Don’t Ignore Pain
The exercise mantra “no pain, no gain” may be appropriate for a young healthy athlete, however, it may prove counterproductive for most of us. It’s true that some muscle soreness is OK, but not if it lasts for days or if your muscles are swollen or too sore to move or to touch. Joint pain isn’t normal, so pay attention to it. If you think you overdid it, ease up on your exercises. If the pain won’t go away, check with your doctor.
Don’t Overdo Computer Time
It can literally be a pain in your neck -- and your elbows, wrists, back, and shoulders. The problem isn’t just bad posture, but that you hold it for too long. That overworks your muscles. It also puts pressure on the discs in your back. Set up an ergonomic workstation. If you’re in a soft chair, prop up your arms with cushions to take the load off your shoulders and your neck. Be sure to get up and move every hour.
Don’t Get Rigid and Repetitive in Your Exercise Routine
If you perform the same exercise, sport or activity every day, you use the same muscles and joints repeatedly. Remember, overtraining problems commonly occur in single sport athletes. Mix in fun sports and activities to break the monotony by adding fun activities such as golf, swimming, biking, skiing, hiking or playing tennis. Avoid weight bearing exercises two days in a row. Run one day, walk, swim or bike the next. Use the elliptical instead of the treadmill on various days. Limit intensity – only work out intensely 2-3 times out of 5 days per week.
Don’t Squat
Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.
Don’t Smoke and Chew Tobacco
Nicotine from cigarettes and chewing tobacco cuts down on blood flow to your bones and to the cushioning discs in your back. It limits how much bone-building calcium your body can take in. It also breaks down estrogen, a hormone you need for bone health. And it slows new growth that thickens bones…which can lead to OA and osteoporosis.
SOURCES: WebMD, University of Pennsylvania
Visit your family doctor regularly and 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!
Part I of II
Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA 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. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.
Your joints, which link your bones together, are sensitive to heavy loads. Every pound on your frame puts 4 pounds of stress on your knees. It also strains your back, hips, and feet.
That causes wear and tear that can lead to damage, aches, and pain. A poor diet, which can lead to being overweight, can also be the source of inflammation. That can make all your joints, including in your hands, stiff, painful, and swollen.
Don’t Text Too Much
“Texting thumb” is a real thing. Your tendons can get irritated and lock your thumb in a curled position. All that looking down at your phone is just as bad for your neck and shoulders, too. Every inch your head drops forward raises the load on your muscles.
Don’t Wear High Heels Too Often
While they might look styl”n, the higher the heel, the more your weight tips forward. Your leg muscles have to work harder to keep your balance and alignment, which can cause pain. When heels go up, so does the twisting force in your knees. If you wear them every day, you increase your odds of developing OA.
Don’t Wear the Wrong Shoes
Old, worn-out shoes will not adequately support your feet and ankles. That’ll throw your knees, hips, and back out of whack. Also, make sure your sneakers are right for your sport. High tops for basketball, for example, can protect your ankles from sprains and flip flops or summer beach shoes are not meant for long distances…especially if you are over 50.
Don’t Crack Your Knuckles
That satisfying pop comes from tiny bubbles bursting in the fluid around your joints, or from the ligaments snapping against the bone. While it might not cause OA directly, one study showed that this habit may cause your hands to swell and weaken your grip.
Don’t Carry a Heavy Bag
Whether it’s a purse, backpack, or messenger bag, packing too much can cause neck, back and shoulder pain. Heavy weight on one shoulder throws off your balance and your walk. If you tend to carry things only on one side, the constant pull overstretches your muscles and tires out your joints.
Don’t Use Wrong Muscles for the Job
When you put too much load on little muscles, your joints pay the price. If you need to open a heavy door, for example, push with your shoulder instead of your fingers. When you lift something off the floor, bend at your knees and push up with your strong leg muscles, instead of your arms.
Don’t Sleep on Your Stomach
While it might help with snoring, it may not be best for the rest of your body. Lying on your belly pushes your head back, which compresses your spine. Your head also will face in one direction for longer stretches than if you sleep on your back.
Don’t Skip Stretching
Gentle, comfortable, active stretching on a regular basis can help strengthen your muscles and tendons. It also can make them more flexible. That allows your joints to move more easily and helps the muscles around them work better.
Don’t Skip Strength Training
Once you turn 40, your bones start to get a little thinner and more likely to break. If you build muscle with strength training, it slows bone loss and triggers new growth. So, you not only get stronger muscles, but denser bones, too. Together, they stabilize your joints so you’re less likely to get hurt. In fact, studies show that the stronger your leg muscles, the less stress on your knees.
SOURCES: WebMD, University of Pennsylvania,
Visit your family doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
Next Week: Part II of II “Save Your Joints”
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.
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!
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