PREVENT STRESS FRACTURES

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

I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon. The victory kept the intruders 26 miles away from Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to run to the capital city to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!

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

What is a stress fracture?

A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk?

10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.                                                              

The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).

Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.

Causes of Stress Fractures:

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

Treatment & Management:

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

Visit your doctor regularly and listen to your body.     

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

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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!

What medical problems do a carpenter, typist, truck driver, jackhammer operator, violinist, pianist and court stenographer have in common? Carpal tunnel syndrome! Over the past 10-15 years, carpal tunnel syndrome has moved to the forefront in medicine and has become water cooler conversation. So, what is carpal tunnel syndrome and how is it treated?

Carpal tunnel syndrome (CTS) is a nerve disorder caused by compression of the median nerve at the wrist. The median nerve is one of three main nerves that provide sensation to the hand. This nerve specifically supplies sensation to the thumb, index, middle, and half of the ring finger. In CTS, compression on the median nerve occurs as it travels through a narrow passage in the wrist called the carpal tunnel. The carpal tunnel is formed by eight bones in the wrist (the floor of the tunnel) and the transverse carpal ligament, a strong ligament traveling across the roof of the tunnel. Within the tunnel there are nine tendons, which are a bit smaller than a pencil. These tendons share this space with the median nerve. In the case where there is swelling on the structures in the carpal tunnel, a person can experience pins and needles, numbness, and aching in the hand.

Common causes of CTS include:

• Repetitive motion of the fingers/wrist
• Vibration from machinery/equipment
• Wrist trauma such as fractures and crush injuries
• Naturally narrow carpal tunnel
• Hormone related conditions including pregnancy and menopause
• Arthritis
• Diabetes
• Medications (i.e. birth control pills and some high blood pressure drugs)

Risk factors for CTS include:

• Gender (more common in females)
• Aging
• Obesity
• Smoking
• Repetitive motion type jobs and activities (i.e. sewing, playing instruments)

Some common symptoms include:

• Tingling, numbness, or burning in the thumb, index, and middle fingers
• Pain or numbness that worsens with use or activity or becomes worse at night
• Cramping/hand stiffness that is relieved after shaking or upon waking
• Dropping objects
• Decreased grip strength

Diagnosis:

To be properly diagnosed, a physician will discuss your symptoms and medical history and examine strength and sensation. A nerve conduction study, electromyography (EMG), and x-ray may be ordered to provide information regarding sensation in the median nerve distribution and confirm compression at the carpal tunnel.

Treatment:

Treatment focuses on the causes. Therefore, treatment suggestions may include activity modification and postural changes during activities. Other suggestions may include frequent rest periods, elevation, and exercises or stretching. Wrist splints are effective in relieving compression at the carpal tunnel and are typically recommended for night wear. Appropriate fit of the splint is vital. Occupational and physical therapists or certified hand therapists can check the fit of prefabricated splints or can fabricate a custom splint. The above-mentioned treatments all focus on decreasing inflammation and compression on the median nerve.

Medication:

Your physician may order pain relievers or anti-inflammatory medication. A cortisone injection into the carpal tunnel may also be recommended to assist with decreasing inflammation near the carpal tunnel.

Occupational or Physical Therapy:

A referral to an occupational or physical therapist or certified hand therapist may be made. A therapist can provide information regarding the diagnosis, appropriate treatment, and symptom reduction. They can make recommendations to introduce into daily activities to allow appropriate positioning of the upper extremities. A therapist will also instruct individuals on helpful stretching exercises or fabricate a wrist splint. Other treatments include ultrasound, iontophoresis, and massage. The focus of therapy is to introduce changes and interventions that reduce inflammation at the carpal tunnel to assist with symptom relief.
 

Surgery:

Surgery, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.

Prevention:

To reduce your chances of getting CTS:

• Minimize repetitive hand/wrist motion
• Alternate activities
• Avoid prolonged hand use or prolonged positioning
• Keep wrists straight during use when possible
• When working on a computer or at a desk, adjust environment for optimal positioning (back straight, feet flat, knees level with or slightly lower than hips, shoulders straight, elbows at a 90 degrees angle, forearms parallel to floor, and wrists straight)
• Take frequent rests and massage hands
• Exercise regularly
• Reduce smoking and caffeine intake

Guest Contributor: Nancy Naughton, OTD, CHT, is a Doctor of Occupational Therapy and certified hand therapist, specializing in the rehabilitation of the hand and upper extremity at Hand Surgery Associates, Olyphant, PA.

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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!

PIAA fall sport teams will begin their official practices a soon – including double sessions for high school football. While a warm August may be a wonderful time of year to swim and kayak, it may not offer the best temperature and humidity for athletes playing football, soccer and other sports. One common problem these athletes suffer from is severe muscle cramping. Every year multiple players limp off the practice field in pain and many concerned players, parents and grandparents repeatedly ask me about the problem. What exactly is a muscle cramp? Why does it happen? How can it be prevented?

What is a muscle cramp?

A muscle cramp is defined as an involuntary contraction or spasm of a muscle that will not relax. The tight muscle spasm is painful and debilitating. It can involve all or part of the muscle and groups of muscles. The most common muscles affected by muscle cramps are gastrocnemius (back of lower leg/calf), hamstring (back of thigh), and quadriceps (front of thigh). Cramps can also occur in the abdomen, rib cage, feet, hands, and arms. They can last a few seconds or 15+ minutes. They can occur once or multiple times. It can cause very tight spasms or small little twitches.

Theory:

Although the exact cause may be unknown at this time, there are several theories why muscle cramps occur. According to the American Academy of Orthopaedic Surgeons, when a muscle is flexible and conditioned, the muscle fibers are capable of changing length rapidly and repeatedly without stress on the tissue. Also, overall poor conditioning or overexertion of a specific muscle leads to poor oxygen/carbon dioxide exchange and build up of lactic acid and cause a muscle spasm. Also, this process can alter muscle spindle reflex activity and stimulate the spinal cord to send a message to the muscle to contract. If uncontrolled this leads to cramps and spasm.

Muscle cramps are more common in hot weather due to loss of body fluids, salts, minerals, potassium, magnesium and calcium. This leads to an electrolyte imbalance which can cause a muscle to spasm.

Common Causes of Muscle Cramps:

• Tight muscles
• Imbalance in strength/length between two cooperative muscles
• General Fatigue
• Overexertion in extreme heat
• Dehydration – electrolyte imbalance
• Medications/Supplements– some medications and supplements can increase risk of muscle cramps

High Risk Factors For Muscle Cramps:

• Infants & young children
• 65+ years old
• Obesity
• Deconditioned Athletes in mid-40’s
• Smoking
• Medication/Supplements
• Endurance Athletes

Treatment and Prevention:

First Aid:

• Cramps usually do not require a physician visit
• Stop the activity
• Stretch or elongate the muscle
• Deeply massage the muscle while on stretch
• Heat the muscle if tightness continues
• Cold to muscle if sore later in day or next day

Prevention:

• Exercise regularly and stay conditioned for your sport
• Reduce caffeine intake
  • Hydrate regularly – especially in warm conditions - Use sports drinks, drink all day BEFORE the activity as well as during/after
• Stretch – AFTER you warm up – concentrate on the vulnerable muscles – stretch slowly, hold for 10 seconds, slowly release, and repeat
  • Hamstring – feel pull in back of thigh
    • - lying on the floor in doorway, extend one knee and rest heel on wall
    • -standing – lock knees and touch shins/toes
  • Calf – feel pull in back of knee and lower leg
    • - stand and lean into wall with one leg back while keeping your heel     down
  • Quad – feel pull in front of thigh
    • -stand grab onto foot, bring heel to buttocks while extending hip
    • - repeat while sitting on ground
• Consider:

1. Diet, vitamins, tonic water, sports drinks
2. Heel lifts for calf cramps when unable to adequately stretch calf
3. Compression shorts for hamstring or quad cramps
4. See your family physician if cramps persist or worsen
   • There are other medical reasons for persistent cramps and spasms

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!

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!

Despite recent challenges for air travel due to increased volume, severe weather and a nationwide shortage of air traffic controllers, Americans report high levels of enthusiasm for air travel this summer, including travel abroad.  

Confession; I recently was on a long trip that required sitting on an airplane for more than six hours…and I wore compression stockings … guess I’m getting older (and wiser)!

Have you noticed that being in a car or on an airplane for more than three hours leads to neck and back pain? Soreness, stiffness and swelling in your legs? With a little planning, preventing or limiting these problems on long trips is possible. Also, as people age and/or develop other health problems, they are more vulnerable to developing a more serious problem associated with long trips; deep vein thrombosis (DVT) or blood clots. But problems with long-distance travel can be avoided. The following tips, based on research and personal experience, can prevent neck, back and leg pain and stiffness and DVT.

Deep Vein Thrombosis  (DVT)

A DVT is a blood clot that forms in a deep vein. The deep veins pass through the muscles and cannot be seen like the veins just under your skin. While it may occur in your arms, it is much more common in the legs, especially the calf muscle when traveling. When a blood clot forms in a leg vein it usually sticks to the vein wall. Often, pain and swelling lead you to the doctor and treatment is rendered before serious complications develop. However, there are two possible complications. One, a pulmonary embolus, occurs when a part of the clot logged in your deep vein of the calf breaks off and gets lodged in the lung. This is a very serious problem that can be fatal. Two, post-thrombotic syndrome, occurs when you have pain and swelling in your calf after a DVT.

Risk Factors for Travel Related DVT?

The following risk factors for DVT significantly increase the potential for problems when traveling on long trips by air, more than 5 hours. Trains, cars and buses also create a risk, but air travel creates a greater risk for the following reasons: reduced cabin pressure, reduced cabin oxygen levels, dehydration and alcoholic drinks, which may increase dehydration and immobility.

• Immobility - such as sitting on a plane slows down blood flow, especially in the legs.
• Blood Clotting Problems  - are inherited problems and rare
• Contraceptive Pill – leads to increased blood clotting
• Hormone Replacement Therapy - leads to increased blood clotting
• Previous Vein Damage – such as a trauma, surgery or previous DVT
• Over 40 Years Old – DVT risk increases with age, especially associated with poor
• health
• Recent Surgery or Trauma– such as total joint replacement or hip fracture
• Pregnancy – 1 in 1000 pregnant women will get a DVT
• Obesity – health and mobility risk
• Family History – increases risk
• Heart Failure – increases risk

Risk Factors For Travel Related Neck and Back Pain

• History – of neck, back, and leg pain or previous injuries
• Arthritis – osteoarthritis and other forms of arthritis
• Over 40 Years Old – makes you more prone to back pain and stiff joints
• Obesity/Deconditioning – makes you more prone to back pain and stiff joints
• Poor Posture – slouching, slumping, falling asleep in airplane seats
• Poor Ergonomics – working on laptop or reading with head down and slouched for prolonged periods when traveling
• Sleep Deprivation – lack of sleep for long periods

Prevention of Travel Related DVT and Leg Pain/Stiffness

• Exercise - Keep your calf and foot muscles moving every 30 minutes and can be performed in your seat;
  • 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
• Compression Stockings – Wear elastic compression stockings when you travel on   
• long trips by air (or car, bus, train etc) and have risk factors
• Anticoagulant Medication – If you are at high risk of DVT your physician may        
• discuss the use of medication to prevent clots. Sometimes, a simple aspirin may do the trick.             
• Walk – keep moving every 30-45 minutes…walk around the cabin
• Hydrate – Drink plenty of water, stay hydrated, and avoid alcohol

Prevention of Travel Related Neck and Back Pain

Airplane seats are “C” shaped and force you to round your neck and back forwards. These exercises are designed to stretch and extend your back in the opposite direction. Please perform slowly, hold for 3-5 seconds and repeat 10 times each hour.

• Chin Tuck: Tuck your chin back to bring your head over shoulders.
• Shoulder Blade Pinch: Pinch your shoulder blades together.
• Standing Extension: While standing, put your hands behind back and extend lower back 10-20 degrees.
• Bend Your Knees Up Toward Your Chest – one at a time
• Arch Lower Back Slightly

Sitting:

When sitting in an airplane seat, take the neck pillow in the overhead compartment and place it in the small of your lower back. While sitting or standing up, perform postural exercises every 30-45 minutes.

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

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!