It is the middle of summer in NEPA with plenty of time to have some fun in the sun…but don’t forget to protect your skin! A little awareness and some precautions can go a long way to make golfing, swimming, kayaking, biking, hiking, water skiing and other outdoor activities safer!

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 and Skin Cancer:

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.

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.
• Clothing: There are plenty of great Ultraviolet Protection Factor (UPF) clothing options available such as hats, shirts (long or short sleeve, hooded or not), shorts, long pants, etc. These products are light weight, breathable, and effective. However, using UPF clothing is even more effective when combined with sunscreen blocks. Also, remember to protect your hands and feet!

Sunscreen – Chemical vs. Physical Blockers:

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.

Guest Contributor: Eduardo Ortiz, MD, Geisinger Commonwealth School of Medicine 2018

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

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

Be Alert of These Health Issues – Prevention is the Cure!

I wish I could tell you that after turning 50, there are health issues associated with age I plan to be mindful of and address proactively. Unfortunately, that ship has sailed for me well more than a decade ago. So, I share this medical information, not only as a health professional but also as an experienced senior.

Entering the fifth decade is not all dome and gloom. Often, this decade is associated with an established family, gratifying career, good health and acquired self-confidence…realizing that life does not have to be perfect to be wonderful! 

However, research tells us that as the body ages, even small changes at the cellular level can be manifested into big changes and problems over time. Nine of ten older adults have some type of chronic disease and eight of ten have more than one. But the good news is that, with a modicum of effort, most of these illnesses can be controlled or prevented, including regular doctor visits, health screening and testing, and lifestyle changes.

Obesity

While it is normal to experience some weight gain is expected with age. However, uncontrolled, the average person will gain 1-2 pounds per year, leading to 11 pounds per decade, according to the National Institutes of Health. Consequently, almost 45% of Americans between 40 to 60 are obese. Obesity is associated with at least 20 chronic illnesses such as high blood pressure, heart disease, diabetes, cancer, and arthritis.

SCREEN: Body Mass Index (BMI)       

TREATMENT: Diet, Exercise, Lifestyle, Medications, Surgery

High Blood Pressure

With age, the flexibility of blood vessels loses elasticity and, unchecked, two out of three adults over 60 have high blood pressure. While genetics is a factor, there are a few things that you can control such as diet (salt, calories), exercise, weight, stress, and smoking.

SCREEN: Blood Pressure Test, Lab Tests, Electrocardiogram (ECG/EKG)       

TREATMENT: Diet, Exercise, Lifestyle, Medications

Heart Disease

Plaque buildup in the arteries of the heart begins in childhood and advances rapidly with age. 6-7 percent of US adults between the ages of 40 and 60. 20% of men and almost 10% of women between the ages of 60 and 80 have heart disease.

SCREEN: Blood Pressure, Cholesterol testing, Blood Sugar Testing, Imaging (ECG/MRI)

TREATMENT: Diet, Exercise, Lifestyle, Medications, Surgery

Diabetes

10 % of Americans have diabetes and the percent only increases with age. Diabetes is associated with many serious chronic illnesses such as heart disease, blindness, kidney disease and others.

SCREEN: Blood Test for blood sugar levels such as A1C, fasting plasma glucose test and random plasma glucose test

TREATMENT: Diet, Exercise, Lifestyle, Medications

Osteoarthritis

In many cases osteoarthritis (wear and tear of joints) is often associated with age. However, lifestyle, joint injuries, inactivity, obesity and diabetes play a significant role.

SCREEN: Physical Exam, Functional Scores, Xrays, MRI, CT, US

TREATMENT: Diet, Exercise, Physical Therapy, Lifestyle, Medications (NSAID’s, Steroids, Viscosupplementation), Bracing, Surgery

Osteoporosis

Loss of bone density and strength is associated with age and certain metabolic conditions such as early menopause, thyroid disease, prolonged use of blood thinners and steroids. However, a diet rich in vitamin D, regular weight bearing exercises such as walking, jogging, dancing etc can go a long way.

SCREEN: Fracture Risk Assessment Tool (FRAX), Dual-Energy X-Ray Absorptiometry (DEXA) TREATMENT: Diet, Exercise, Physical Therapy, Lifestyle, Medications (Oral and Injection)

Balance/Falls

Losing balance with age is a common problem due to changes in the vestibular system (balance system in the brain), loss of muscle strength and joint flexibility, and compromised vision and hearing. This can often lead to falls, head injuries and fractures.

SCREEN: Timed Up and Go (TUG) Test, Morse Fall Scale

TREATMENT: Physical Therapy – Falls Prevention Program/Balance Training , Diet, Exercise, Lifestyle, Environmental Modification, Vision/Hearing Testing

Hearing Loss/Vision Loss

Almost 10% of adults between the ages of 55 and 65 have some form of vision and/or hearing loss. This can lead to many problems such as balance and falls as well as isolation and depression.

SCREEN: Regular Hearing Tests/Vision Testing          

TREATMENT: Corrective Devices

Bladder Issues

Both men and women suffer from bladder problems with age... especially frequency and control. It can impact lifestyles in many ways. Often adults fail to hydrate properly, especially when traveling, to control urgency. This can lead to other health problems.

SCREEN: Urine Analysis, PSA, Imaging, CT Urogram, Urine Cystoscopy, Ultrasound,           

TREATMENT: Diet, Exercise, Lifestyle, Avoid Caffeine and heavy lifting, Medications, Surgery

Cancer

As the body ages, so too do the cells that make it up. Often these cells change into cancer different parts of the body. Skin, colon, breast, prostate, lung, throat, etc. Today, however, much progress has been made for early detection and treatment.

SCREEN: Physical Exam (Skin Exams), Lab Tests (blood work, PSA), Imaging (CT, Mammography, MRI), Genetic Testing, Pap Smears, HPV Tests, Colonoscopies/Stool Tests, Multi-Cancer Early Detection (MCED)           

TREATMENT: Diet, Exercise, Physical Therapy, Lifestyle, Medications, Chemotherapy, Radiation, Immunotherapy and Targeted Therapy Surgery specific to the cancer type.

Dementia/Depression/Loneliness

Age related mental health issues are vastly unreported and diagnosed. Medical problems can contribute to mental health such as high blood sugar levels and some infections. Overall, lifestyle, environmental factors and family structure and support are particularly important.

SCREEN: No Single Test – Combination of Tools including - Neurological and Cognitive Tests, Brain Scans (CT/MRI), Blood tests, Genetic Testing

TREATMENT: Diet, Exercise, Physical Therapy, Lifestyle, (avoid excessive toxins like alcohol and nicotine), Medications, Environmental Modifications.

SOURCES: WebMD, NIH, Mayo Clinic, Alzheimer’s Association, American Cancer Society, American Heart Association, American Diabetes Association

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

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

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

Part II of II

Happy Father’s Day! It is my hope that this information will be helpful to all the fathers who enjoy working in the yard! It is not too late to buy dad a new cart or kneeling pads for the yard. Last week, Health & Fitness Forum presented tips for gardeners for preventing hand and arm injuries such as carpal tunnel syndrome. This week’s column is dedicated to prevention of lower back and lower body injuries when working in the yard and for gardeners with disabilities.

A relaxing and enjoyable activity for many, gardening can turn dangerous without proper precaution as repetitive stress injuries, back pain, muscle pulls, can stem from raking, weeding, digging and pruning, can turn into serious problems if not treated appropriately.  Since prevention is the best approach, the US Dept of Agriculture promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

People with various disabilities enjoy gardening at different levels. For example, those suffering from neurological diseases with muscle weakness, paralysis and poor balance as well as those with musculoskeletal problems such as neck and LBP or hip and knee arthritis can safely enjoy gardening at some level. This outdoor labor of love is very therapeutic.

Warm up and stretching is important. Don’t garden first thing in the morning before you have a chance to warm up. Get up, go for a short walk, have breakfast and maybe warm up with a hot shower before working in the garden. Some stretches include;

• Corner Stretch: Stand facing a corner wall with arms and shoulders at 90 degrees. Lean into corner and stretch shoulders and back.
• Knees to Chest Back Stretch: While lying on your back, bring both knees up towards your chest.

Note:  These exercises should never be painful when completing them.  You should only feel a gentle stretch. Hold the stretch10 seconds and repeat 5 times before you garden and every 2-3 hours while working. Should you experience pain, please consult your family physician or physical therapist.

The following guidelines to prevent injury and foster healthy gardening for those with and without disability:

• Listen To Your Body – Aches and pains are signals from your body that you may be doing something wrong or overdoing it. Just like a baseball player in spring training, you must ease into a new activity slowly and stop before you get pain. Do not try to do it all in one day.
• Take Frequent Breaks – Perform work in short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue and pain.
• Change Positions Often – Alternate positions from standing, sitting, bending, and kneeling every 15 to 20 minutes.
• Use Large Muscles- When possible use the large muscles of the body to do the work. For example, use your legs to push a shovel blade into the ground instead of your arms. Also, lift with your legs and not your back.
• Avoid Awkward Motions – Do not squat, twist and bend at the waist for prolonged periods or with repetition. 
• Use Supportive Devices and Braces – Remember to wear wrist and knee supports if you have a problem. A lower back brace or corset is also advisable when working in the garden to protect the spine and add support.
• Use Well Designed Tools.  Use the right tools for the job. Padded, ergonomic handles with extensions to add reach are helpful.   
• Use Sun Block, Sun Glasses and bug spray – to protect your skin and eyes from the sun and ward off ticks and other bugs.
• Plan ahead.  Use a container with wheels to carry supplies to the garden.  When necessary it should be carried/pulled with hands, distributing the workload equally and decreasing stress in the joints of your body.
• Eat Well and Stay Hydrated – When working outdoors eat and drink properly for the climate and temperature.
• Use Adaptive Devices -  Special gardening carts, wheel barrels, motorized carts, and a garden tractor with a cart can make a job easier, especially for those with disabilities.
  • “Easy-Grip” tools are available for those unable to grip strongly. For example, hand shovels and weed cultivators that attach to the wrist/forearm with Velcro straps and tools with telescoping extensions are available. (www.wrightstuff.biz)
  • Mobile Adjustable Stools – with arm rests and 2-3 steps that allow you to go from sitting upright to a position closer to the ground.
  • Elevated and Raised Beds – allows gardening from a standing, sitting or wheelchair height for improved safety and enjoyment.
  • Pipe Planter or Seeder – a PVC pipe 5-6 feet long allows planting and seeding without bending or kneeling. For example, a 6 or 8 inch pipe allows plants to slide down and be tampered into a hole and a 1-2 inch pip allows seeds to slide down to the ground for cover or planting.
  • Kneeling Pads, Mats, Carts – are healthier for your knees and back.

Source: Karen Funkenbusch, MA; Willard Downs, PhD.: U. S. Department of Agriculture - Agricultural Engineering Extension

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

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

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

Part I of II

Farmers and gardeners in NEPA always say that Memorial Day, the “kick off” day for planting without the fear of frost, however, this year we have had an unusually cold and wet spring… but it is not too late to start…not only for the beds but your body! While gardeners are anxious to work in their gardens and enjoy the fruits of their labor, a relaxing and enjoyable activity can turn dangerous quickly. Precautions are necessary as repetitive stress injuries such as shoulder and elbow tendonitis and carpal tunnel syndrome can stem from raking, weeding, digging and pruning. Additionally, simple scrapes, blisters, and bites can turn into serious problems if not treated appropriately.  Since prevention is the best approach, the American Society of Hand Therapists (ASHT) promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

ASHT recommends following these upper extremity warm-up exercises prior to gardening:

Note:  These exercises should never be painful when completing them.  You should only feel a gentle stretch. Hold 10 seconds and repeat 5 times. Should you experience pain, please consult a physician or hand therapist.

1. Forward Arm Stretch: Fold your hands together and turn your palms away from your body as you extend your arms forward.  You should feel a stretch all the way from your shoulders to your fingers.
2. Overhead Arm Stretch: Fold your hands together and turn your palms away from your body, but this time extend your arms overhead.  You should feel the stretch in your upper torso and shoulders to hand. 
3. Crossover Arm Stretch: Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder.  This stretch for the upper back and shoulder and should be performed on both sides.

ASHT recommends the following guidelines to prevent injury and foster healthy gardening practices:

• Wear gloves at all times.   Bacteria and fungus live in the soil and a small irritation or cut can develop into a major hand infection.  Glove choice should be specific to the specific task.  Thick, leather or suede gloves may protect your hands from thorns, cuts and scrapes while pruning roses.  Rubber or latex coated gloves may be appropriate to aid in grip when working in the soil.
• Keep your hands and arms covered.  Be especially careful if you live in an area where you may disturb a snake, spider or rodent living in your garden.  You will be better protected from poison ivy, insect bites, ticks and other common skin irritants that may inhabit a garden.
• Take a break every hour or switch to another activity.  Overuse of repetitive motions, such as digging, and sustained/constant gripping can cause tendonitis of the wrist, elbow or lead to carpal tunnel syndrome.  Break up large tasks into short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue.
• Use a tool when digging into unfamiliar or new areas.  Buried sharp objects can cause tendon lacerations or punctures.  Use the correct tool for the task at hand in order to avoid accidental injury. 
• Store your tools to prevent accidents.  Learn how to use and store your tools correctly to prevent accidents, and keep sharp tools out of the reach of children at all times.  Also make sure to put all tools away after use to prevent future injuries.
• Regular/periodic tool maintenance.  Keep garden tools in top working order to reduce the physical effort required for yard and garden work.
• Use well designed tools.  Use tools with non-slip rubber or padded hands to protect the smaller joints in your hands.  Make a circle with your index finger and thumb—that is how the grip of the tools should be.  The shape of the handle should provide equal pressure along the palm. 
• Avoid awkward motions.  Using better body positioning minimizes muscle pain.  Work with the wrists in a neutral position by avoiding the extremes of motion (up, down and sideways).  Hold objects with a light grasps or pinch. To avoid a tight sustained grip.  Use both hands for heavy activities like lifting a bag of potting soil and alternate hands on more repetitive tasks like scooping dirt out of the bag into a pot.
• Plan ahead.  Use a basket or large handled container to carry supplies to the garden.  The basket should be carried with both hands, distributing the workload equally and decreasing stress in the joints of your upper body.

Professional Contributor: Nancy Naughton, OTD, CHT, is an occupational therapist and certified hand therapist practicing in NEPA.

Next Week: “Prevention of Gardening Injuries” Part II of II.  

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

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

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

Part II of II

Introduction:

As most sports enthusiasts know, in 2021 Tiger Woods acquired an Achilles tendon rupture while training at home and in 2023 Aaron Rodgers, a former Green Bay Packer quarterback, did the same in the first game of the 2023/24 NFL season with the New York Jets. As with many sports injuries, it is painful and devastating and best managed by PREVENTION!

Spring is here! Many overjealous fitness enthusiasts will rush to pound the pavement and barely “fit in” a warm-up before participating. But, no matter how limited time is, skipping the warm-up is risky. This time of year, one can expect to feel a little cold and stiff, especially if you are over 40, and therefore a little caution and preparation are in order to avoid muscle/tendon strain, or worse yet, muscle/tendon tears. The Achilles tendon is one of the more common tendons torn. Prevention of muscle tears, including the Achilles tendon includes; gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions.

This is the second of two columns on Achilles tendon rupture. Last week, I discussed the definition, sign and symptoms of the problem. This week will present examination, treatment and outcomes.

Exams and Tests:

A thorough history and physical exam is the first and best method to assess the extent of the Achilles tendon rupture and/or injury and determine accurate diagnosis. While a complete tear is relatively easy to determine, a partial or incomplete tear is less clear. Ultrasound and MRI are valuable tests in these cases. X-rays are not usually used and will not show tendon damage.

Treatment:

Initial First Aide Treatment:

• Remember RICE!
  • Rest the involved tendon/ankle/heel. Pain is telling you NOT to move the tendon.
    Use crutches and limit weight bearing on the involved foot until you are seen by a
    medical professional.
  • Ice the tendon/ankle/heel. Control the swelling and spasm.
  • Compress the ankle/foot and control the swelling but do not wrap it too tightly.   
  • Elevate the ankle/foot to allow gravity to help control swelling.
• Medication: Depending on your tolerance and previous experience, choose an over-the-counter nonsteroidal anti-inflammatory drug for pain and inflammation such as ibuprofen. Discuss with your primary care physician and pharmacist.
• Note: If symptoms persist, see your primary care physician, podiatrist or orthopedic specialist to determine the extent of your injury. Do not delay too long to seek medical attention because early intervention will produce the best outcomes.

Early Treatment - Conservative:

• Protection – the torn tendon must be protected from further damage or stretching by using a heel lift to put the tendon on slack. In more involved cases, a removable walking cast/boot may be used for additional protection.
• Physical Therapy -  
  • Controlled Motion – gentle controlled motion to the ankle, foot and toes to control swelling and prevent stiffness is usually encouraged.
  • Modalities – such as ice, compression, ultrasound, massage, electrical stimulation may also be employed for pain and swelling.
  • Gradual Resistance Exercises – in the case of a partial tear, once healing begins, resistance exercises may be introduced gradually. These exercises will require the supervision of a physical therapist to emphasize resistance in a lengthening position (to be described under “prevention” later in this column).

Surgery:

Consultation with an orthopedic or podiatric surgeon will determine the best treatment option for you. When conservative measures fail and for complete Achilles tendon ruptures, surgical intervention is usually considered to be the best option with a lower incidence of re-rupture. Surgery involves reattaching the two torn ends. In some instances, a graft using another tendon is required. A cast or walking boot is used post-operatively for 6-8 weeks followed by physical therapy. 

Outcome:

Most people return close to normal activity with proper management. In the competitive athlete or very active individual, surgery offers the best outcome for those with significant or complete tears, to withstand the rigors of sports. Also, an aggressive rehabilitation program will expedite the process and improve the outcome. Walking with full weight on the leg after surgery usually begins at 6 -8 weeks and often requires a heel lift to protect the tendon. Advanced exercises often begin at 12 weeks and running and jumping 5-6 months. While a small bump remains on the tendon at the site of surgery, the tendon is well healed at 6 months and re-injury does not usually occur.

Prevention:

Prevention of muscle and tendon tears is critical for healthy longevity in sports and activities. In addition to the Achilles tendon, the tendons of the quadriceps (knee) and rotator cuff (shoulder) are also vulnerable. A comprehensive prevention program includes; gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions. Also, utilizing interval training, eccentric exercise (lowering body weight slowly against gravity and proprioceptive and agility drills are essential.

Eccentric Lowering and Lengthening: for the Achillies tendon during exercise. Beginning on the ball of both feet (1a), bend the strong knee to shift the weight onto the weak leg (1b). Slowly lowering the ankle/heel to the ground over 5-6 seconds. Repeat.

Proprioceptive Training: for the Achillies tendon. Standing on a Bosu Ball while exercising the upper body (for example, biceps curls, shrugs, rows, lats) while maintaining balance on the ball.

Agility Drills: for the Achilles tendon involves stepping through a “gait ladder” in various patterns and at various speeds. 

Sources: MayoClinic.com;Christopher C Nannini, MD, Northwest Medical Center;Scott H Plantz, MD, Mount Sinai School of Medicine

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

Introduction:

As most sports enthusiasts know, in 2021 Tiger Woods ruptured his Achilles tendon while training at home and in 2023 Aaron Rodgers, a former Green Bay Packer quarterback, did the same in the first game of the 2023/24 NFL season with the New York Jets. As with many sports injuries, it is painful and devastating and best managed by PREVENTION!

Spring is here and as the days continue to get longer and temperatures begin a slow steady rise, athletes and weekend warriors are eager to get outdoors to play and exercise. However, be mindful of the weather (damp and rainy), temperature (cool mornings and evenings) and winter “dust” on your muscles and tendons. Many overjealous fitness enthusiasts will rush to pound the pavement and barely “fit in” a warm-up before participating. But, no matter how limited time is, skipping the warm-up is risky.

This time of year, one can expect to feel a little cold and stiff, especially if you are over 40, and therefore a little caution and preparation are in order to avoid muscle/tendon strain, or worse yet, muscle/tendon tears. The Achilles tendon is one of the more common tendons torn. Prevention of muscle tears, including the Achilles tendon includes; gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions.

A muscle contracts to move bones and joints in the body.  The tendon is the fibrous tissue that attaches muscle to bone. Great force is transmitted across a tendon which, in the lower body, can be more than 5 times your body weight. Often, a tendon can become inflamed, irritated, strained or partially torn from improper mechanics or overuse. Although infrequent, occasionally tendons can also snap or rupture. A tendon is more vulnerable to a rupture for several reasons such as a history of repeated injections of steroids into a tendon and use of medications such as corticosteroids and some antibiotics. Certain diseases such as gout, arthritis, diabetes or hyperparathyroidism can contribute to tendon tears. Also, age, obesity and gender are significant risk factors as middle-aged, overweight males are more susceptible to tendon tears. Poor conditioning, improper warm-up and cold temperatures may also contribute to the problem.  

Tendon rupture is very painful and debilitating and must not be left untreated. While conservative management is preferred, surgical management is usually required for complete tears. The purpose of this column is to present the signs, symptoms and management of Achilles tendon ruptures.

Achilles Tendon:

The Achilles tendon (also called the calcaneal tendon), is a large, strong cordlike band of fibrous tissue in the back of the ankle. The tendon (also called the heel cord) connects the powerful calf muscle to the heel bone (also called the calcaneus). When the calf muscle contracts, (as when you walk on the ball of your foot), the Achilles tendon is tightened, tension is created at the heel and the foot points down like pushing a gas pedal or walking on tip of your toes. This motion is essential for activities such as walking, running, and jumping. A partial tear of the tendon would make these activities weak and painful, while a full tear through the tendon would render these activities impossible.     

With age, the Achilles tendon (and other tendons) gets weak, thin, and dehydrated, thus making it prone to inflammation, degeneration, partial tear or rupture. The middle-aged weekend warrior is at greatest risk. A full or complete tear (Achilles tendon rupture) usually occurs about 2 inches above the heel bone and is associated with a sudden burst of activity followed by a quick stop or a quick start or change in direction, as in tennis, racquet ball, and basketball.

In some instances, the tendon can be injured by a violent contraction of calf when you push off forcefully at the same time the knee is locked straight as in a sudden sprint. Other times, the tendon is injured when a sudden and unexpected force occurs as in a trip off a curb or sudden step into a hole or a quick attempt to break a fall.

Achilles Tendon Rupture Symptoms:

• Pain – sudden and severe pain in the back of the ankle or calf that feels like being hit by a rock or gun shot.
• Pop – sometimes it is reported that a loud pop or snap is heard when the tendon tears.
• Divot Deformity – sometimes a depression or indentation in the tendon is seen or felt with a bulbous area above or below the tear.
• Black and Blue – it is common to have bleeding after tearing the muscle or tendon with black and blue color and bruising the night or day after the injury.
• Swelling – in addition to swelling in the tendon area of the tear, sometimes swelling will be prominent in the ankle and foot.
• Stiffness – loss of movement due to swelling and weakness.
• Weakness – inability to “push off” on the injured foot when walking or climbing steps.
• Loss of Function – difficulty with daily activities that require walking, ascending inclines, climbing stairs, or jumping.

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

Next Week: Achilles tendon Part II of II

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!

EXERCISE IS A CRITICAL COMPONENT IN THE CURE!

The World Health Organization has classified obesity as a chronic disease and determined that it is reaching epidemic proportions, not only in the United States, but globally. Moreover, closer to home, the Pennsylvania Department of Health has determined that PA ranks 17^th among all states in the country for percentage of obese residents. Childhood obesity is defined as having a body mass index (BMI) at or above the 95^th percentile for age and sex in children aged 2 and older.

People have theorized for many years that obesity must be genetic. Scientific research has validated this theory and more importantly, a recent study has shown that while there is an obesity gene that may predispose one to obesity, one can control the outcome with exercise. The fat mass and obesity gene (FTO) is linked to a high body mass index according to a new study in the Archives of Internal Medicine. More importantly, this study found that exercise can offset a genetic predisposition for obesity. Aerobic exercise 30-45 minutes 3-5 times per week coupled with mild weight training and other physical activities can overcome the FTO. With new knowledge, it becomes apparent that it is critical to promote a healthy lifestyle with exercise and physical activity at an early age to prevent childhood obesity.

Childhood Obesity as a Medical Problem:

Obesity increases with age and its prevalence among obese children will continue to be obese with age. Childhood obesity is the leading cause or is associated with: hypertension, Type II diabetes mellitus, coronary heart disease, lower extremity joint stress and pain, lower self-esteem and other psychological problems. 

Causes of Childhood Obesity:

As with adult obesity, childhood obesity is most often caused by multiple problems including: nutritional, psychological, familial, and physiological.

1. The Family
   • The risk of becoming obese is very high for those children with two obese parents. Strong genetic factors as well as parenting habits of eating and exercise may play a role.
2. Low-Energy Expenditure
   • The average child in this country spends several hours watching TV or playing video games. Childhood obesity is greater among those who exceed this average not only because of low-energy expenditure, but also due to the consumption of high-calorie snacks and drinks while watching TV. Previous generations spent this time engaging in physical activity. Only one-third of grade-school children have daily physical education in school.
3. Heredity
   • Not all children who eat badly and lack physical activity are obese. As shown in the Archives of Physical Medicine study the FTO gene has shown that there are other causes for obesity, such as heredity. 

Treatment of Childhood Obesity:

Weight loss is not the primary role of a good childhood obesity program. The goal is to limit or stop weight gain so the child will eventually grow into their body weight over a period of many months or years. One study suggests that it requires 1 ½ years of body weight maintenance for every 20 percent excess in ideal body weight for a child to ultimately attain ideal body weight.

1. Physical Activity
   • Increasing physical activity or engaging in a formal exercise program is essential to burn fat, increase caloric expenditure to lose and/or maintain weight. However, studies show that exercise alone is not nearly as effective as when it is combined with proper nutrition/diet and behavior modification. Physical activity is also critical for the health of the child. Blood pressure and lipid profiles improved in children/adolescents who engaged in 50 minutes of aerobic exercise, 3 times per week, even when weight loss was only minimal. In view of this, I recommend 45-60 minutes of exercise and physical activity as a minimum of 5 days per week and preferably 7… walk, run, bike, swim, play tennis, pickleball, soccer, and walk when you golf.
   • Use technology to promote fitness with physically active video games such as the “GET STRONG” Kids Workout and “Kids Daily Exercise” that children expended significant energy when they play video games that require physical activity. Many studies have found that kids expended three times more energy than traditional video games played while sitting or when compared to watching TV while walking on a treadmill. There may be hope for our kids!
   • Also, some personal trainers and fitness clubs specialize in programs exclusively for children such as “My Gym Scranton” on Birney Avenue, Scranton.  
2. Diet Management
   • Extreme dieting and fasting is not appropriate for children. It is emotionally stressful and physically harmful to the growth and development of a child/adolescent. A balanced diet with moderate caloric and portion restrictions coupled with exercise and counseling is the proper combination.
3. Behavior Modification
   • Behavioral strategies are found to be very successful in children/adolescence. Self-monitoring and keeping a record in a journal of food intake, activity and exercise are helpful. Also, rewards and incentives can be effective. Parent/child counseling programs are most effective.

In conclusion, childhood obesity is a serious epidemic. It is physically and emotionally stressful for the child/adolescent and family. This problem requires a comprehensive team approach including: family, physician, educator, dietitian, psychologist, physical therapist and other health and exercise specialists. Lastly, to be successful, it must involve the entire family and be a lifetime lifestyle change 7 days a week regarding diet and exercise, not a 3-to-6-month fad. It must be a long-term program with a long-term goal!

Sources: World Health Organization (WHO), Archives of Physical Medicine, 2008, Vol 168, 1791 – 1797

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

April is National Stress and Anxiety Awareness Month! According to the National Institutes of Health, an estimated 19.1% of U.S. adults 18 and older had an anxiety disorder in the past year. Anxiety disorders were higher for females (23.4%) than for males (14.3%). An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives.

There are a wide variety of anxiety disorders and will vary by the objects or situations that induce them. However, the features of excessive anxiety and related behavioral disturbances are similar. Anxiety disorders can interfere with daily activities such as job performance, schoolwork, and relationships. Symptoms include: distress, nausea, shortness of breath, bowel pattern changes, excessive perspiration, frequent laughing or crying, restlessness, and is often associated with depression. While there are many types and degrees of anxiety and there is no substitute for medical and psychological care, there are some simple and basic tools to help manage the problem…daily exercise is one easy, affordable and accessible suggestion for most. Multiple studies have discussed the incidence of unhealthy self management of anxiety, including the use of alcohol and recreational drugs.

Last week, I presented coping tips for the management of anxiety. In this column, I will discuss one of the most understated benefits of exercise – mental health! Specifically, aerobic exercise (exercise that increases your heart rate for 30 minutes or more) such as walking, biking, running, swimming, hiking, elliptical & stepper machines to name a few, is the secret to “runner’s high.” This exercise euphoria is not limited to runners alone, but all who engage in aerobic exercise are more likely to experience high energy, positive attitude and mental wellness.

Physical activity, specifically aerobic exercise, is a scientifically proven useful tool for preventing and easing anxiety and depression symptoms. Studies in the British Journal of Medicine and the Journal of Exercise and Sports Science found that anxiety and depression scores were significantly reduced in groups that engaged in aerobic running, jogging or walking programs, 30-45 minutes 3-5 days per week for 10-12 weeks, when compared to a control group and a psychotherapy counseling group.

HOW EXERCISE REDUCES ANXIEY AND DEPRESSION:

According to research reported in sports medicine journals, exercise reduces anxiety and depression in two ways, psychologically (mentally) and physiological (physically). 

Psychological or Mental Benefits of Exercise on Anxiety and Depression:

• Helps a person gain control over their lives
• Increases self-esteem
• Diverts attention away from worry, concern or guilt
• Improves mood – with visible signs of improvement in physique & body weight
• Increases sense of pleasure and satisfaction
• Anger management – release pent-up frustration, anger and hostility

Physiological or Physical Benefits of Exercise on Anxiety and Depression:

• Increase in brain serotonin (natural mood elevator chemical in brain)
• Increase in beta-endorphins (natural mood, stress & pain control chemical in brain)
• Improvement in natural sleep patterns

HOW TO BEGIN EXERCISE FOR ANXIETY AND DEPRESSION:

• First and most importantly, consult your primary care physician to confirm the diagnosis of depression. Be sure that your symptoms are not related to other health problems. Also, if you are using antidepressant or other medications discuss the impact it may have on your exercise program with your physician.
• Recognize and fight depression symptoms that are contrary to or prohibit physical activity such as: fatigue, lack of energy, slow motor skills. Work hard to recognize and overcome these symptoms to begin an exercise program. An aerobic exercise routine should eventually lessen these symptoms.
• Be realistic. Expect that aerobic exercise will take time to have a noticeable benefit. Do not get overly ambitious and set yourself up for failure.
• Begin with an aerobic exercise program that is practical and destined to succeed. For example: inactive and deconditioned people should begin walking 5 minutes per day, 3-5 days per week for 1 week. Then, add 3-5 minutes each week until you attain 30-45 minutes per walk 3-5 times per week. Younger and fitter people can begin to walk for 15 minutes and continue until they attain 45-60 minutes per walk, 3-5 times per week. Remember, what seems impossible today will be easier and routine in 3-4 weeks so JUST DO IT !
• Find a pleasurable environment: a beautiful park (Nay Aug), a scenic lake (Lake Scranton), quiet countryside (rural farmlands of Dalton or Lackawanna State Park). Use a mall in inclement weather.
• Find a friendly, uplifting group of people to enjoy a good walk and talk. This may be more appropriate for people feeling isolated or withdrawn. Others may enjoy the peace and quiet of exercising and meditating alone.
• Be specific and compliant! Make a serious commitment. Keep a journal or exercise log. Mark a calendar. 30-45 minutes, 3-5 days per week – NO EXCUSES! Get and exercise buddy you can count on and help keep you compliant!
• Make it fun! Mix it up. Walk 3 days, swim or bike 1-2 days, some days alone, some days with a buddy.
• BE RELIGIOUS! Be religious about exercise BUT don’t get too compulsive!

SOURCES: University of Pittsburgh Medical Center (UPMC); National Institutes of Health (NIH); The American Journal of Sports 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!

Part I of II

April is National Stress and Anxiety Awareness Month! According to the National Institutes of Health, an estimated 19.1% of U.S. adults 18 and older had an anxiety disorder in the past year. Anxiety disorders were higher for females (23.4%) than for males (14.3%). An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives.

There are a wide variety of anxiety disorders and will vary by the objects or situations that induce them. However, the features of excessive anxiety and related behavioral disturbances are similar. Anxiety disorders can interfere with daily activities such as job performance, schoolwork, and relationships. Symptoms include: distress, nausea, shortness of breath, bowel pattern changes, excessive perspiration, frequent laughing or crying, restlessness, and is often associated with depression. While there are many types and degrees of anxiety and there is no substitute for medical and psychological care, there are some simple and basic tools to help manage the problem…daily exercise is one easy, affordable and accessible suggestion for most. 

Multiple studies have discussed the incidence of unhealthy self management of anxiety, including the use of alcohol and recreational drugs. The University of Pittsburgh Medical Center (UPMC) recommends the following healthy tips for coping with anxiety:

Healthy Coping Tips:

1. Get Enough Sleep 
   • Adequate sleep is critical for mental health. Unfortunately, anxiety can lead to sleeping problems and, according to the Anxiety and Depression Association of America (ADAA) inadequate sleep can worsen anxiety.
   • Seven to nine hours of sleep each night is recommended for most adults. The National Sleep Foundation recommends maintaining a regular schedule that includes going to bed at the same time each night and waking up at the same time each morning.
2. Practice Mindfulness Meditation 
   • Incorporating meditation into your life can help you cope with anxiety, according to the National Center for Complementary and Integrative Health.
   • Research shows mindfulness meditation programs are effective in reducing anxiety and depression. UPMC offers a Mindfulness-Based Stress Reduction Course and a Beginners Guide to Meditation that have been proven to be very effective. Another option for reduction of anxiety and stress is Progressive Muscle Relaxation. This mind-body technique can be found in 5, 10, 15 or 20 minute videos.
3. Spend Time in Nature 
   • How you deal with anxiety should include a walk in the forest or even a tree-lined park. In NEPA we are very fortunate to have access to beautiful walking and biking trails and state parks. Make time to enjoy them.
   • Research shows that “forest bathing,” long, slow walks in nature for health purposes, can lower blood pressure and relieve anxiety. A review of clinical trials published in the International Journal of Biometeorology found that salivary cortisol levels, biomarkers for stress, were significantly lower in groups who participated in forest bathing versus the control group.
4. Take up Yoga or Tai Chi 
   • Yoga does more than increase your flexibility. It incorporates exercise, deep breathing, and meditation. Yoga is an all-in-one anti-anxiety activity, as shown in a review of body-centered interventions published in Frontiers in Psychology. Tai chi, a mix of meditation and martial arts, works much the same way.
5. Dance Therapy 
   • That same research found that dance therapy, also known as movement therapy, reduces anxiety by engaging the body’s nervous system, which regulates how the body reacts to stress. In addition, dance/movement therapy increases production of serotonin, a chemical produced by the cells that’s responsible for mood.
6. Breathe Through It 
   • When you begin to feel anxiety or a panic attack with symptoms such as: sweating, trembling, dizziness, rapid heartbeat and nausea, start to come on, “take a deep breath.” Research shows that slow deep breaths can calm you down and lower your heart rate while quick, shallow breaths can induce or worsen anxiety.
   • One breathing technique shown to reduce anxiety is diaphragmatic breathing. Using your diaphragm for deep breathing requires you to fill your lungs to capacity.
   • Breathe in slowly through your nose so that your stomach rises. Then, tighten the stomach muscles and exhale slowly through pursed lips. Repeat several times.
7. Limit Caffeine and Alcohol 
   • Too much caffeine restricts blood vessels, which can increase blood pressure and contribute to anxiety. Coping with anxiety also doesn’t mean masking it with alcohol. Studies show that there is a complex relationship between alcohol and anxiety. While some may use alcohol and recreational drugs to mask the symptoms of anxiety (often leading to substance abuse disorder), some studies show that alcohol can interfere with the neurotransmitters that manage anxiety and prevent you from getting a good night’s sleep. Drinking alcohol to cope creates a sort of feedback loop, which makes anxiety worse and can lead to alcohol dependence.
8. Check Your Medicine 
   • Certain medicines, such as corticosteroids, asthma drugs, and others, can cause anxiety. Ask your doctor if any medicines you take may be a contributing factor.
9. Eat Healthy Foods 
   • Keeping the body nourished is essential for all functions of life. New research shows that a healthy diet may affect more than just weight and energy levels. One example is a Mediterranean Diet, with lots of vegetables, fruits, beans, lentils, nuts, whole grains, extra virgin olive oil and a moderate amount of fish (especially those rich in omega-3 fatty acids), with limited use of red meat.
10. Keep a Journal 
    • Keeping a Journal can be a great way to keep track of your progress with anxiety and how your body responds to such situations. Tracing the triggers of anxiety can help you develop the skills to properly respond when put in anxious conditions.
11. Exercise Regularly
    • Exercise promotes the release of endorphins. These brain chemicals reduce the body’s reaction to pain and stress. They also produce a feeling of euphoria, or happiness, that’s comparable to morphine. Just five minutes of aerobic exercise can kick start these anti-anxiety effects, according to some studies.  Next week in “Health & Exercise Forum” specific details about exercise for anxiety will be presented.

Talk to a Mental Health Professional

Chronic anxiety also can point to an underlying mental health issue. When your anxiety causes extreme distress or interrupts your ability to function on a daily basis, or when panic attacks are frequent and debilitating, it’s important to talk to your physician and ask for a referral to a mental health professional. They can provide a treatment plan, which may include specialized anti-anxiety medicine, psychotherapy, or both.

SOURCES: University of Pittsburgh Medical Center (UPMC); National Institutes of Health (NIH)

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!

Allergies affect 30 % of adults and 40% of children in the United States. Avoiding the outdoors is often not an option…especially if you enjoy outdoor activities and sports. Not long ago, it was unthinkable that an athlete with serious allergies could compete at a high level, such as the Olympics. Now, in great part due to advanced research, medications and proper management, an Olympic gold medal for those suffering from allergies is a reality. Recently, the National Institute of Allergy and Infectious Disease at the National Institutes of Health have published research on this topic to provide a better understanding and make recommendations.

The most common allergic reactions which athletes suffer from are sneezing, itchy and watery eyes, runny nose and coughing. Moreover, 67% of those with these symptoms also suffer from asthma. The athlete in NEPA is particularly vulnerable when the pollen count is high during spring and fall for several reasons. One, after being indoors all winter, one might develop a heightened sensitivity to allergens. Also, increased rapid and deep breathing during exercise makes athletes more susceptible to significant symptoms when exposed to allergens such as tree, grass and weed pollens.

Treatment:

Allergy Shots/Drops:

As mentioned last week, allergy skin testing can be performed to determine the allergens to which you are susceptible. Once determined, allergy shots are effective in building up tolerance to these allergens. If appropriate, you may be able to use allergy drops, administered under the tongue and conveniently used at home.  

Pre-Treat:

Asthma suffers should use their inhaler BEFORE symptoms occur. A recent study found that pretreatment using a short-acting bronchodilator inhaler within 15 minutes before exercise is very effective in preventing asthma symptoms for more than four hours. It is important to keep a bronchodilator available. If you fail to benefit from this, see your physician for other methods to control your exercise-induced symptoms.

Warm-up/Cool Down:

Whether you have allergic respiratory problems from rhinitis or asthma, you many benefit from conditioning your airways with a 10 to 15 minute warm-up before and cool-down after the activity. This may serve to gradually prepare your lungs for an increased demand.

Hydrate:

In addition to preventing dehydration on hot and humid days, constant hydration is very important for the athlete with allergies to prevent dry airways in athletes.

Educate Staff:

Know the signs and symptoms of asthma (coughing, wheezing, tightness in chest, shortness of breath).

Plan for the Problem:

Some schools have a file on each student athlete with a allergic or asthmatic problem which requires medication. The file includes information such as medical doctor release and instruction, emergency contacts and medications. Students must have their medications on hand before they can enter the field. The National Athletic Trainers Association recommends using a peak flow meter to monitor at risk players and can determine when a player can return to the field.

Practice in Climate Control:

If possible, find an alternate practice facility with climate control for athletes at risk. Plan practices for these athletes when the pollen count is low. Check the newspaper or internet for pollen counts in your area. Training by the water, (ocean) where there is a breeze and less pollen is helpful.

Additional Suggestions:

Shower and change clothing immediately after being outdoors

During a flare up, do less aerobic exercise to limit stress on respiratory system. Try strength training indoors instead. 

When pollen count is high, keep windows shut at home and in your car….use air-conditioning.

Keep pets out of your bedroom…especially when sleeping

Dry clothing in dryer…do not hang on clothesline outdoors

Sources: American College of Allergy, Asthma, and Immunology. National Athletic Trainers Association.

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!