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

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!