Have Fun and Get in Shape!

Happy 4^th of July! As our country celebrates 250 years and the summer heat is kicking into gear, it is time to think about getting to the pool to cool off. It may also be time to think of your pleasure puddle in different light…a health spa! It may very well be the exercise of choice for many people. Many have discovered the benefits of moving their limbs in the warm water of a home pool following knee or shoulder surgery. Also, long distance runners who often look for cross training methods without joint compression and arthritis sufferers who are often limited in exercise choices by joint pain from compressive forces when bearing weight, can enjoy the buoyancy effects of water. These are good examples of the benefits or water exercise…aerobic and resistive exercise without joint compression.  

Exercise and Arthritis:

Most doctors recommend some form of exercise with arthritis. Pain and fatigue are the most limiting factors for a person with arthritis. Pool exercise may be the answer. With proper technique, adequate rest periods, appropriate resistance and repetitions, water exercise can be very effective.

Pool Exercise Benefits:

The following are some of the benefits of water exercise:

• Decreased Risk of Cardiovascular Disease
• Improved Endurance
• Improved Strength – with resistance of water to exercise muscles
• Improved Flexibility and Range of Motion – with less pain
• Improved Function in Daily Activities
• Maintain Mobility
• Improved Balance
• Slow Down Osteoporosis
• Weight Control – which leads to less stress on joints
• Improved Mood and Attitude – release of endorphins and serotonin
• Improved Circulation – especially in warm water
• Decreased Muscle Spasm and Tension – especially in warm water
• Decreased Stress on Joints – Buoyancy effect of water

Getting Started:

• Medical Clearance – see your family physician for clearance especially if you have a cardiac history or joint replacements. Do not use pool if you have surgical sutures or an open wound.
• Warm Pool -  83-88 degrees Fahrenheit
• Water Walking Exercise– begin in shallow end
• Water Running Exercise– with buoyancy vest in deep end
• Water Aerobics Exercise– using arms and legs as in regular aerobic exercise but in the water
• Strength & Flexibility Exercise – just as on land but in water

• Start Slowly – Don’t Overdo it
  • 5-10 minutes and repetitions first time and add 2-3 minutes/repetitions each week
  • Long Term Goal: 20 – 40 minutes per session
    • 3-4 times per week          
• Submerge The Body Part
  • That you want to exercise into the water and move it slowly
• Complete The Range of Motion
  • Initially 5 times, then 10-15-20-30 times
• Assess
  • Determine if you have pain 3-4 hours after you exercise or into the next day. If so, you overdid it and adjust next time by decreasing repetitions, speed, amount and intensity of exercise.
• Warm-Up
  • Make sure you warm up slowly before exercise with slow and easy movements
• Advance Slowly
  • By adding webbed gloves, weighted boots, and buoyant barbells to increase the resistance.
• Exercises – standing in shallow end of pool
  • Heel Raises – push toes down and heel up
  • Toe Raises – lift toes up and heel down
  • Leg Kicks – extend leg up and down
  • Hip Hike – raise knee up 4-6 inches and down
  • Leg Squeeze – squeeze knees together and apart
  • Leg Curl – bend knee
  • Torso Twist – slowly turn arms/torso to right, then to left
  • Shoulder Forward and Backward – like paddling a boat
  • Shoulder Out and In – like a bird flying
  • Bend Elbow Up and Down

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!

According to the United States Environmental Protection Agency, NEPA and all of Pennsylvania is experiencing a change in climate as indicated by a half a degree (F) in temperature, more frequent and heavy rainstorms and the tidal portion of the Delaware River is rising one inch every eight years. Last summer was one of our hottest on record and this summer more is expected. For those without air conditioning or access to a lake or pool, it will also be remembered as record setting warm temperatures. A local reader who cares for her elderly mother wrote to express her concern about dehydration in the elderly. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year-round.

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

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

Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.

Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. Older adults often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly people may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration.      

Elders may suffer headaches, fainting, disorientation, nausea, seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated.

Those who care for the elderly whether at home or in a health care facility need to be alert to the following symptoms:

• CHANGE IN MENTAL STATUS (CONFUSION)
• WARM,MOIST SKIN WITH POOR SKIN ELASTICITY: gently pull the skin on the forehead and over the breastbone by pinching and releasing a skin fold; if the skin remains elevated for 3 seconds or more, dehydration is suspected
• DRY, STICKY MOUTH WITH CRACKED LIPS AND DRY FURROWED TONGUE
• DRYNESS IN NOSE
• DECREASED BLOOD PRESSURE
• INCREASED PULSE RATE (RACING HEART; HEART BEATING TOO QUICKLY)
• CONSTIPATION
• CONCENTRATED URINE WITH SCANTY OUTPUT: as the urine becomes more concentrated, it irritates the bladder and may increase the urge to void resulting in frequent, small voidings.
• WEIGHT LOSS
• SUNKEN, TEARLESS EYES
• FAINTING WHEN STANDING UP (FEELING LIGHT-HEADED AND DIZZY WHEN STANDING AFTER SITTING OR LYING DOWN)

By the way, plain old tap water is a good way to replenish fluid loss. Keep in mind that some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed from the stomach. Consuming alcoholic and caffeinated beverages actually have an opposite, diuretic effect!

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 has finally arrived in NEPA as we get outdoors to enjoy sunshine and blue skies. It is also time to dust off your hiking shoes and hit the trails to enjoy fresh air and exercise…but don’t forget the trekking poles. I have been recommending walking or trekking poles to my patients for many years. These poles are an essential part of hiking or distance walking gear, for the novice and expert alike.

Specifically, for those over 50 who have degenerative arthritis and pain in their lower back, hips, knees, ankles or feet, these simple devices have been shown to improve the efficiency of the exercise and lessen the impact on the spine and lower extremities. Additionally, using poles reduces the likelihood of ankle sprains and falls during walking. Trekking poles are also a safe option for those with compromised balance. If you want to walk distances for exercise and need a little stability but don’t want the stigma of a cane, trekking poles are for you.

History of the Hiking Stick

Early explorers, Europeans and Native Americans have been using walking sticks for centuries. More recently, in the 1968 classic hiker’s bible, “The Complete Walker,” Colin Fletcher praised his “walking staff” for its multipurpose use: for balance and assistance with walking and climbing, protection from rattlesnakes, and for use as a fishing rod. Today, these sticks are now versatile poles made from light-weight materials.

Trekking Pole Features

Trekking poles are made of light-weight aluminum and vary in cost and quality. But, like most things, “you get what you pay for!” These hollow tubes can telescope to fit any person and collapse to pack in luggage for travel. Better poles offer multiple removable tips for various uses, conditions and terrains. For example, a basket to prevent sinking too deeply in snow, mud or sand; a blunt rubber tip for hard surfaces like asphalt or concrete, or the pointed metal tip to grip ice or hard dirt/gravel. Better quality poles offer an ergonomic hand grip and strap and a spring system to absorb shock through your hands, wrists and arms upon impact.

The poles should be properly adjusted to fit each individual. When your hand is griping the handle the elbow should be at a 90 degree angle. Proper use is simple; just walk with a normal gait pattern of opposite arm and leg swing. For example, left leg and right arm/pole swings forward to plant while the left arm/pole remain behind with the right leg (PHOTO 1).  This pattern is reciprocated with as normal=ait advances (opposite arm and leg). I have been very pleased with my moderately priced poles (Cascade Mountain Tech from Dick’s Sporting Goods ($34.99 per pole). Prices range from $19.99 to 79.95 per pole. dickssportinggoods.com; montem.com; leki.com; rei.com. However, if you travel frequently to hike the State and National Parks, you may want to purchase more expensive poles that collapse and retighten more efficiently. (montem.com; leki.com;) 

Research

There are numerous studies to support the use of trekking poles, especially research that supports their use for health and safety. One study compared hikers in 3 different conditions; no backpack, a pack with 15% body weight and a pack with 30% body weight. Biomechanical analysis was performed blindly on the three groups and a significant reduction in forces on lower extremity joints (hip, knee, and ankle) was noted for all three groups when using poles compared to those not using poles.

Another study confirmed that trekking poles reduced the incidence of ankle fractures through improved balance and stability. Additional studies support the theory that trekking poles reduce exercise induced muscle soreness from hiking or walking steep terrain and another study found that while less energy is expended in the lower body muscles using poles, increase energy is used in the upper body; therefore, the net caloric expenditure is equal as it is simply transferred from the legs to the arms.

Reasons to Use Trekking Poles

• Reduced Stress on Lower Back, Hips, Knees, Ankles and Feet –
  • Biomechanical studies confirm that using trekking poles creates less stress on the lower back and joints of the lower body. Those with a history of degenerative arthritis and pain in these areas are wise to consider this when planning to hike or walk distances for exercise.
• Improved Stability and Balance/Less Injury –
  • Studies have found that those using trekking poles were less likely to suffer sprains, strains and even fractures of the lower body, especially the ankle, due in great part to the improved balance and stability. This benefit is found not only on uneven terrain, but also for those walking distances and may have age-related balance issues.
• Upper Body Workout –
  • One comment I have heard from those questioning the value of trekking poles is that they do not want to make their walking/hiking exercise too easy because they desire a “good workout.” Studies show that the caloric expenditure is equal to exercise without using poles as the energy is simply transferred from the legs to the arms.
• Improve Walking Posture and Stride
  • It is common when walking distances, especially if carrying a backpack, to lean your trunk forward. Using poles has been found to promote a more upright posture while walking.

• Less Perception of Cardiovascular Exertion
  • While cardiovascular demands increased with pole walking, subjects reported less exertion when using poles. 
• Reduced Exercise Induced Muscle Soreness
  • Studies testing the blood for chemicals associated with muscle damage found less exercise induced muscle soreness/tissue damage and delayed onset muscle soreness among pole users. This was reported to be critical in walkers and hikers who participated in their activities several days in a row to complete the task such as hiking in and out of a canyon. In conclusion, it is important to remember that trekking poles for hiking or distance walking are much more than a style statement. They are proven to be an invaluable tool for health, safety and wellness by reducing lower extremity joint stress, improving stability and balance, and enhancing efficiency for muscle recovery.    

Sources: Medicine and Science in Sports and Exercise. The Complete Walker, by Colin Fletcher

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 sufferers 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 may 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.
  • Guidelines for Athletes with Allergies from the National Athletic Trainers Association:
• 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!

Part II of II

May is National Bike Month! For those who have a bike, now might be a good time to dust it off and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority. For those who don’t have a bike, it might be a good time to get one!

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

BIKE STYLES:

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

• Road bikes: When straddling the bike, you should have about 1” of clearance between your body and the top tube if the bike has a straight top tube (which runs parallel to the ground). When lifting the bike, you should have 1” clearance between the tires and the ground. If the bike has a sloping top tube (semi-compact design) you should have a clearance of 2” or more.
• Mountain bikes: When straddling the bike lift the bike off the ground and you should have a minimum of 2” clearance between the ground and the tires. With full suspension bikes you will want 1”-2” standover clearance because when you sit on the bike the frame will become lower from compressing the suspension. More aggressive riders will likely have 3”-5” of clearance.
• Comfort bikes: Standing over a comfort bike to choosing the right sized frame is not necessary. They are commonly designed with a steep sloping top tube and allow the rider to put feet firmly on the ground when the rider comes to a stop.

PROPER FIT:

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

Seat/Saddle:

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

Handlebars (HB):

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

Knee to Pedal:

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

Foot to Pedal:

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

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

Sources: REI.com, APTA.org

Contributions & Illustrations: Sarah Singer, BFA, PTA

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

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

May is National Bike Month!

HAPPY MOTHER’S DAY!

Consider a Giving Mom a Healthy Gift…a Bike!

May is National Bike Month! It is time to dust it off your bike and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, Lackawanna Heritage Valley Authority and other locations in the Greater Scranton Area. For those who don’t have a bike, it might be a good time to get one!

WHY BIKE?

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

BENEFITS OF BIKING:

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

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be in good working order, such as tires, chain, brakes and pedals. Next, be sure to maintain a reasonable fitness level in order to bike safely. If you are a beginner, start slowly. Warm up and slowly bike for 10 to 15 minutes and build up over time.

Practice the coordination of stopping, starting, shifting and braking. Work on good strength and flexibility of the hamstrings, quadriceps, calves and gluteal muscles. All of these muscles are necessary to generate pedal force. Balance is also important to safety and can be practiced on and off the bike. Be aware that adaptive equipment can modify your bike for added comfort and safety such as soft handlebar tape, seat post and front fork shock absorbers, padded biking shorts, c-out and gel pad saddle seats, and wider tires.

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

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

SAFETY:

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

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

SOURCES: American Physical Therapy Association

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

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

“The woods are lovely, dark, and deep,

But I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.”  Robert Frost

On March 30, 2026, NEPA lost one of its most dedicated conservationists, Dorrance Reynolds Belin…our version of John Muir, Theodore Roosevelt, and Rachel Carson. While Dorrance served on numerous boards, in my view, he will be most fondly remembered for his environmental stewardship as founder of the Eastern Pennsylvania Chapter of the Nature Conservancy and Countryside Conservancy. I am not sure if Dorrance ever had the pleasure of meeting Robert Frost, Pulitzer Prize winning American Poet, but it is not hard to imagine that he had Dorrance in mind when writing the above poem. Thank you Dorrance, and those who worked with you, for the vision and foresight to preserve these special places for our children, grandchildren and great grandchildren to enjoy!

According to their mission statement, The Countryside Conservancy manages 1,190 acres of lands and waters to protect their conservations value. Most of these acres are open to the public for visitation and many have trails. Collectively, the conservancy contributes to 10 miles of singletrack hiking and biking trials to the 30-mile Lackawanna State Park/Countryside Conservancy Trail System …for more information visit: countrysideconservancy.org.

Please get outdoors and enjoy the trails…walking, running, biking, snowshoeing, cross-country skiing or horse back riding. But if you want to try something new this spring that will allow you to exercise on more interesting and less stressful surfaces in the beautiful woods of Northeast Pennsylvania…try trail running!

Trail running forces one to run 25% slower due to the uneven terrain (rocks, tree roots, stumps), incorporate “light running” techniques by running with short strides on the balls of my feet. You will feel much more refreshed by avoiding the direct sunlight under the cover of the trees. Furthermore, you can enjoy the up-close view of nature as I ran by cool streams and wet mossy rocks, beautiful flowers, rhododendron, and mountain laurel. Observe deer, chipmunks and birds. In my quest to avoid the hot sun, I discovered the beautiful underworld of “trail running” - it is beautiful, peaceful, natural and unique. It is fun to get in touch with your inner child as you run in the woods and get muddy. Trail running makes running fun…and it’s good for your joints!

The trail running community purports that trail running is popular because it satisfies a primal need for man to move through nature, derived from hunter/gatherer days. Others who promote trail running feel the popularity is due to the many advantages it offers. One, trail running prevents impact injuries due to soft surfaces. Two, the training style of running with shorter strides on the ball of the foot, lessens impact. Three, this type of running will develop stronger ankles and trunk core muscles while improving balance, coordination and proprioception from running on uneven surfaces. Lastly, the ability to release copious amounts of endorphins while breathing fresh air instead of roadside fumes is invaluable.

Trail Running Gear:

• Clothing - Trail running clothes can be the same as those worn for road running except be sure you don’t mind if they get dirty and a little torn.
• Shoes – While you can begin trail running in the same shoes you road run in, you will find that a different pair is necessary due to excess dirt and water. Also, if you decide to get into trail running, it is worth purchasing trail shoes which are stronger, more waterproof and offer better traction.
• Water – a handheld water bottle or a water bottle belt is essential. The belt offers little pouches for money, keys, ID, and power bars for longer runs.
• Insect Repellent - a must for mosquitoes and ticks! 
• Headlamp – necessary for evening runs because it gets very dark in the woods. Also, it gets dark earlier in the woods than on the roads and you need to see the terrain clearly.
• Change of Clothes – it is a good idea to have a first-aid kit, towel and change of clothes in your car to change into before you drive home.
• Cell Phone – just in case of an emergency.

Tips to Begin Trail Running:

Find a Trail – Start by asking around. Hikers, mountain bikers, and horseback riders are a good start. The American Trail Running Association has a website with a free directory of trails in the United States. PA State Parks such as Lackawanna State Park in Dalton, offer many options www.visitPAparks.com, countrysideconservancy.org. or download the app AllTrails. Learn the difference between “nontechnical trails” which are wider with a paved, dirt or gravel base and much easier than “technical trails” which are narrow, rocky, hilly and challenging.

• Run Slowly – To be safe, run 25% slower when running a trail in the woods. Use a short stride and land on the ball of your foot. Forget about the pace, feel the dirt under your feet, work on balance and stability. It is a different type of running.
• Walk – Don’t hesitate to walk when necessary, especially up rocky and slippery hills.
• Keep Your Eye on the Trail – Pay careful attention to the terrain by looking 5 to 10 feet ahead.
• Anticipate Slippery Rocks and Stumps - Pick your feet up higher and bend your hips and knees more when necessary to avoid tripping over a log. Walk over obstacles if necessary.
• Keep a Distance – Don’t crowd the trail. You may have to share it with other runners, bikers and hikers. Pass with care.
• Be Safe/Be Prepared– Remember the first-aid kit, cell phone, extra clothes and food in the car and make sure someone knows where you plan to run. Run with a friend.

Sources: American Trail Running Association, Trailspace.com, countrysideconservancy.org.

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!

New study recommends a 15 minute walk after a meal reduces blood sugar!

Spring has sprung in NEPA and summer is just around the corner... great news for outdoor enthusiasts! It is also good news for those who need walk for health reasons. However, for many who have not maintained an active lifestyle or have health issues, it is challenging to know where to begin. Moreover, beginning without a good plan can lead to injury and leave you discouraged. For example, those overweight and de-conditioned should not start a walking program too aggressively. Walking at a fast pace and long distance without gradually weaning into it will most likely lead to problems.

WALKING FOR HEALTH:

There is probably nothing more natural to human beings than walking. Ever since Australopithecus, an early hominin (human ancestor) who evolved in Southern and Eastern Africa between 4 and 2 million years ago, that our ancestors took their first steps as committed bipeds. With free hands, humans advanced in hunting, gathering, making tools etc. while modern man uses walking as, not only a form of locomotion, but also as a form of exercise and fitness. It is natural, easy and free...no equipment or fitness club membership required!

BENEFITS OF WALKING:

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.” A recent study demonstrated that a 15 minute walk after a meal is very effective in reducing blood sugar levels.

According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

• Improve blood pressure and blood sugar levels
• Help maintain a healthy body weight and lower the risk of obesity
• Enhance mental well-being
• Reduce the risk of osteoporosis
• Improve muscle and joint health
• Improve circulation
• Improve sleep

PLAN AHEAD:

• Gear Up – but don’t go overboard. Good running shoes with proper arch support and shock absorption are also recommended for walking. Wear weather appropriate dry tech clothing with bright, reflective visible colors. Bring a cell phone in case of emergency…but try not to use it to talk or text because it will ruin the vibe!
• Select the Best Path – begin on level surfaces like a “rails to trails.” In inclement weather consider walking in a shopping mall.
• Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.
• Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.
• Stretch. After you cool down, gently stretch your muscles. If you want to stretch before you walk, remember to warm up first.
• Trekking Poles. Consider using trekking poles, especially if you have a balance issue or lower back, hip, knee or ankle/foot problems.
• Hydrate. If you build up to more than 45 to 60 minutes or if the temperatures soar, bring a water bottle and be sure to hydrate.

SET REALISTIC GOALS:

Anything is better than nothing! However, for most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity. The guidelines suggest that you spread out this exercise during the course of a week. Also aim to do strength training exercises of all major muscle groups at least two times a week.

As a general goal, aim for at least 30 minutes of physical activity a day. If you can't set aside that much time, try several short sessions of activity throughout the day (3 ten or 2 fifteen minute sessions). Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefit.

Remember it's OK to start slowly — especially if you haven't been exercising regularly. You might start with five minutes a day the first week, and then increase your time by five minutes each week until you reach at least 30 minutes.

For even more health benefits, aim for at least 60 minutes of physical activity most days of the week. Once you are ready for a challenge, add hills, increase speed and distance.

TRACK YOUR PROGRESS:

Keeping a record of how many steps you take, the distance you walk and how long it takes can help you see where you started from and serve as a source of inspiration. Record these numbers in a walking journal or log them in a spreadsheet or a physical activity app. Another option is to use an electronic device such as a smart watch, pedometer or fitness tracker to calculate steps and distance.

MARK YOUR CALENDAR:

Make walking part of your daily routine. Pick a time that works best for you. Some prefer early morning, others lunchtime or after work. Enter it in your smart phone with a reminder and get to it!

FIND A WALKING PARTNER:

Studies show that compliance with an exercise program is significantly improved when an exercise buddy is part of the equation. It is hard to let someone down or break plans when you commit to someone. Keep in mind that your exercise buddy can also include your dog!

USE EFFICIENT WALKING TECHNIQUE:

Like everything, there is a right way of doing something, even walking. For efficiency and safety, walking with proper stride is important. A fitness stride requires good posture and purposeful movements. Ideally, here's how you'll look when you're walking:

• Head up, look forward – glance at the ground but don’t stare down.
• Relax your neck, shoulders and back – avoid a rigid upright posture.
• Swing your arms freely with a slight bend in your elbows.
• Keep your stomach muscles slightly tightened (work the core) with a straight back.
• Walking smoothly - rolling your foot from heel to toe.

Sources : Sapiens.org; WebMD; Mayo Clinic

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!

Have you ever noticed high level athletes warming up before a game or competition walking or running backwards? You may also see fitness enthusiasts in gyms emulating these athletes to improve their fitness or performance. I found the concept of backward walking (also called retro walking) interesting and decided to research the topic for more information and validation. Walking backward does have many therapeutic benefits, however, before you attempt this activity on a treadmill or elliptical, please consult your physician and physical therapist and have a spotter nearby.

Strength Improved in Leg Muscles:

At a recent meeting of The American College of Sports Medicine, several studies were presented on the topic of backward waking. Most of the research was conducted while moving backward on a treadmill and an elliptical machine. When comparing two groups recovering from knee injuries, the backward motion group showed significant improvement in strength in the quadriceps (front thigh) and hamstring (back thigh) muscles when compared to the traditional forward walking group. Furthermore, the muscles of the front (tibialis anterior) and back (gastro/achilles) of the shin/ankle also demonstrated an increase in strength and endurance with backward walking. One explanation is that forward motion is routine in daily living that it has become very efficient and does not tax or stress the muscles the body. While this efficiency prevents fatigue in daily activities, it may not stress the muscles enough to gain strength as quickly as an unfamiliar exercise.

Cardiovascular Benefit/Calorie Expenditure:

Due in great part to the increased strain of performing unfamiliar exercise, backward walking on a treadmill or backward pedaling on an elliptical, offered a greater cardiovascular benefit and caloric expenditure than forward motion at all levels. Specifically, walking backward on a treadmill at 2.5 mph at grades of 5% - 10% has been found to significantly increase cardiovascular endurance than walking forward under the same conditions. This knowledge is useful for healthy individuals in need of greater cardio exercise. However, it may also serve as a precaution for those with cardio problems and should consult their physician prior to engaging in this activity.

Weight Loss:

A recent study in the International Journal of Obesity, found that those who performed new activities or increased the intensity of an activity, even if for a short duration (interval training) expended more energy and burned more calories than those who worked out at the same pace consistently for a longer duration. Moreover, when engaging in a new activity such as backward walking, even more calories were burned. This phenomenon may be due to the fact that routine activities such as forward walking are performed more efficiently and easily.

We challenge our body when we inefficiently perform a new motor skill such as backward walking and burn more calories. In other words, if you want to burn more calories without exercising for longer periods of time, then try a new activity and engage in higher intensity, intermittently, for part of the time. For example, walk backward on the treadmill for 30 minutes at 2.5 mph, but do so at a 5 – 10% incline for 1-2 minutes every 5 minutes.

Protection for Your Muscles, Tendons and Joints:

Some studies show that using other muscle groups by performing different exercises not only prevents boredom but also protects your muscles and tendons from overuse and joints from wear and tear. Specifically, the knee joint and the patella joint (the joint where the knee cap glides on the knee), benefit from backward walking due to less stress and compression forces on the joint. The thigh and ankle/foot muscles benefit from using a different form of contraction while lengthening the muscle. Some authors propose that this may also prevent strains and pulls and may be valuable to strengthen those with a history of shin splints and flat feet (pronation).   

Prevents Boredom:

Mixing up your program prevents boredom. As a rule, those willing to change their exercise routine are more compliant and continue to exercise longer than those stuck in the same routine. A new challenge to improve distance, speed, and resistance while exercising in a different direction will be refreshing to your program.

Improved Balance and Coordination:

Prevention of falls by improvement in balance and coordination has received a great deal of attention in the past few years. This is not only valuable to the athlete but may be even more important to those over 50. With age, balance centers are slow to react to changes in inclination, elevation, rotation and lateral movements. This slow reaction time leads to falls that may cause fractures, head injuries and more. Working on this problem by challenging the vestibular and balance centers before it is seriously compromised is important and backward walking is one way for this to be effectively accomplished.

Treadmill Backward Walking MODEL: Lexi DiGregorio, PTA

• NOTE: When walking backward, hold on to the grab bars on the treadmill and make sure to have a spotter to supervise the new activity until you become accomplished.
• NOTE: Reduce the treadmill speed and elliptical resistance until you become more familiar with this new technique.

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!

Spring sports and outdoor activities are here…tennis, pickleball, baseball, soccer, running, walking, hiking, golfing, etc. One of the most common injuries associated with physical activity, especially after a sedentary winter or change in temperature is a “pulled hamstring.” This painful injury is not only for the weekend warrior. Well-trained, healthy and fit professional athletes often have their season interrupted for weeks and months due to a hamstring injury. What is the hamstring?  How is it injured? What is the best treatment?

Hamstring Strain:

A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating. This injury, like others muscle strains, varies in intensity.

Severe hamstring strain occurs when many muscle fibers are torn. The athlete may experience a sudden onset of severe pain in the back of the thigh and occasionally report a popping sensation. Pain, swelling and black and blue skin from tissue damage and bleeding is often reported. Also, pain is reproduced when attempting to bend the knee. In very severe cases, the boney attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.

The Most Common Causes of a Hamstring Strain:

• Overuse – every time the knee is bent the hamstring muscles must contract. If there is not adequate time allowed for rest between workouts or competition, then the muscles may be fatigued and become vulnerable to injury. Also, overuse of the same muscles without rest may make them irritated and inflamed.
• Inadequate Warm-up – a warm muscle stretches like a piece of gum warmed up in your mouth. When you pull the warm gum, it stretches. However, if you drink an ice cold drink with gum in your mouth and then stretch the gum, it will tear instead of stretch. A good warm-up will prevent tearing and prepare the nervous system for sudden movements and changes in direction.
• Sudden Movement – quick sprint, sudden change in direction, quick turn with an unexpected force or slip.
• Poor Body Mechanics – especially when moving or lifting a heavy load away from your center of gravity.
• Forceful Contact or Loss of Traction – when a leg is forced away from the body by an outside force (tackle in football) or slip on grass or ice.

Diagnosis:

Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from your lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.

Treatment:

There are many conservative options. Your family physician or orthopedic surgeon will help you decide which choices are best.

• Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling. 
• Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, massage, range of motion exercises, strengthening exercises, and supportive compression strapping. Once pain free, a preventative training program is essential to prevent reinjury.
• Activity Modifications: if it is not the week of the district tournament, rest, avoid running or stretching/stressing of the thigh muscles.
• Supportive Devices: such as thigh wraps or sleeves, compression shorts (like those worn under basketball shorts) can provide compression and relief.

Prevention:

Recent studies have determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:

• High Intensity Training- regardless of the speed of your sport, high intensity, interval anaerobic training is critical. Interval sprints are the best example.
• Simulate the Demands of the Sport – when training, simulate the specific demands of your sport… “train the way you play.” For example, in football, the average play lasts 7-10 seconds. Therefore, sprint on a count from the line of scrimmage for 7-10 seconds. First, sprint in a straight line. Then, sprint and cut at 3-5-10 yards. Then, sprint, cut and spin. Then, sprint figure 8’s.
• Weight Train for Power and Strength/Weight Train for Speed and Endurance- traditionally, weight training is performed with high weights and low repetitions to increase power and strength and both arms or both legs are used at the same time. However, to prevent hamstring injuries, add a few sets of speed/coordination training by performing lifting with low weights and high reps. Also, alternate right and left legs to simulate normal walking speed.
• Weight Training Using Negatives/Eccentrics – weight training with a concentration on lowering the weight against gravity, not raising it.
• Exercise All Muscle Groups – of the lower body, not just the quads and hams. Include: Hip flexion, extension, abduction, adduction, internal & external rotation
  • Knee: flexion, extension
  • Ankle: flexion, extension, inversion, eversion
• Warm -Up: a pregame slow jog or exercise bike and/or massage to the area to warm up the muscles prior to activity.
• Stretching: Indian sit stretch, Hurdler stretch, Lying hamstring wall stretch 
• Strengthening Exercises: weight training for legs, including inside and back leg muscles, use weights or resistance tubing for leg curls and hip extensions.
• Agility Drills: figure 8, cross-over, tire or disc running
• Compression Shorts: like those worn under basketball shorts
• Cool Down: use ice to the effected area after exercise or sport

SOURCES: Journal of Physical Medicine & Rehabilitation and 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!