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.
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.
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.


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)
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

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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!

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?
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.
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.
There are many conservative options. Your family physician or orthopedic surgeon will help you decide which choices are best.
Recent studies have determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:
SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.

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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!

Germaphobes, cleaning zealots, neat freaks, and those with diagnosed or undiagnosed obsessive-compulsive disorder (OCD), this column is for you! If you would rather clean your bathroom floor than go for a walk on a beautiful sunny day, please read on. If you use a toothbrush on tile grout on a regular basis and take pride in the sparkle of your toilet bowl than beware… studies show that performing these tasks with too much vigor and passion might lead to back, neck, and shoulder and wrist pain.
For some, and you know who you are, (I am related to a few) spring cleaning can be a particularly exciting sporting event. It is almost an exorcism to rid a home of all its evil spirits, smudges, dust, dirt, germs, and odors. Every April curtains come off the windows to be washed and carpets rolled up, removed and cleaned. The surfaces under the curtains and carpets are sterilized with cleaning detergents, disinfectants and chemicals that would make sterile techniques in most hospital operating rooms seem inadequate. And that doesn’t include the heavy work: moving furniture, bedding, including mattresses and box springs.
As a physical therapist and survivor of childhood exposure to copious amounts of cleaning chemicals, I have come to learn that there are healthy and safe options for spring cleaning your home. Of course, the most obvious solution is to hire professional help if you can afford it. The other practical solutions are below:
Incorrect
Correct
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Correct
Model: Hannah Keane, Physical Therapy Aide, Mackarey PT
Sources: National Center for Injury Prevention and Control at the CDC, www.medicinenet.comwww.household-management-101

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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!

NEPA has had its share or snow this winter…and the recent storm added plenty of the pretty white stuff for work and play. Much has been written about the dangers of snow shoveling for your heart. However, while not fatal, low back pain is the most common injury sustained while shoveling snow. Heart attacks are also more common following wet and heavy snow.
Snow shoveling can place excessive stress on the structures of the spine. When overloaded and overstressed, these structures fail to support the spine properly. The lower back is at great risk of injury when bending forward, twisting, lifting a load, and lifting a load with a long lever. When all these factors are combined simultaneously, as in snow shoveling, the lower back is destined to fail. Low back pain from muscle strain or a herniated disc is very common following excessive snow shoveling.
Sources: The Colorado Comprehensive Spine Institute; American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

More than 65 million people, almost 30% of the population in the United States, are actively involved in providing 20 or more hours of care for a chronically ill, disabled, or aged family member or friend each week. As our population continues to age, this number is expected to grow rapidly.
The role of a caregiver is multifaceted and often involves tasks and skills beyond the education or comfort level of most providers. Some examples include; managing money, paying bills, shopping, cleaning, maintaining and repairing a home, dispensing and injecting medications, cleaning wounds, changing dressings, catheter management, bed baths, assisting in position changes, transferring from the bed to the chair, ambulation, stair climbing, bathroom assistance for toileting and showering and many other responsibilities. Consequently, a caregiver is often at risk for mental, spiritual and physical fatigue or breakdown. It is no surprise that depression, illness and injury often plague a caregiver and eventually, the caregiver is in need of a caregiver. One of the most common injuries suffered by a caregiver is back pain.
Lower back pain (LBP) is one of the most common problems in our society. Over 90% of all Americans will suffer from it at least once in their lives. It is generally agreed that prevention is the best treatment for LBP.


MODELS: Andrea Molitoris Kozlowski, PT, DPT, Associate Mackarey Physical Therapy, Doris Koloski, Scranton

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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!

I think we would all agree, technology is a wonderful thing. However, like all good things, it comes at a price. Students and workers alike are suffering from the many physical effects of sitting for too many hours. Studies show the impact of prolonged sitting, especially with proper posture, are multifaceted: pain, headaches, vision problems, poor concentration, excess fat storage with weight gain. Studies strongly support the use of good posture, ergonomic workstations, posture stretches, frequent changes of positions, including the use of standing desks to prevent pain and injury. In fact, standing desks are not a new invention; they have been used by many to promote health and stimulate thought…Hemingway, Franklin and Jefferson all stood while they worked.
The average head weighs 10 to 12 pounds and when tilted down at a 45 degree angle the forces of gravity are multiplied by 5. While reading, studying or working on the computer with poor posture, one must support 50 or more pounds of pressure on the neck, middle and lower back for hours on end. It is no wonder why this activity is associated with headaches, neck and back pain, numbness and tingling in arms and legs, muscle spasms etc. Some studies report the lifetime prevalence of neck and shoulder pain in office workers as high as 80%.
Recent research has also correlated the amount of time an individual sits to a decrease in their average life expectancy. Seriously, watching television and sitting is literally killing us. The Heart and Diabetes Institute of Australia conducted extensive research on sedentary behavior, including a review of almost one million people. They used actuary science, adjusted for smoking, waist circumference, and diet and exercise habits to assess the specific effects that the hours of sitting in a day impacts a person’s life span. They found that sitting too long results in a decrease in muscle contraction of the big leg muscles and because these unused muscles need less fuel, more unused glucose (fuel) is stored in the muscle. High glucose levels result in high blood sugar, which leads to adult-onset diabetes and other health issues.
The deleterious effects of sitting in children have also come under scrutiny and it may impact the classroom. Due to technology, today’s classroom is more advanced in many ways. However, the traditional hard chair and desk remain unchanged. Not only are these, “one size fits all,” desks uncomfortable, current research suggests that they may also limit learning.
Recent studies show that standing desks promote not only a physically healthier child by expending more calories and lowering obesity but also improves focus and concentration to improve academic outcomes.
Research from Texas A&M Health Science Center found two landmark things about children who worked at standing desks such as Stand2LearnR, when compared to those seated: One, children burned more calories and obese children burned more than normal-weight peers. Two, children were more attentive in the classroom and engaged more with their teacher and their work when allowed to stand. Teachers in the study not only found the results to be favorable for fidgety, high-energy kids, but those who tend to be overweight and tired benefited greatly.
Researchers were quick to point out that there may be many ways to promote movement and limit sitting in the classroom that may also promote learning in a healthy way such as sitting on exercise balls or inflatable discs.
The average office worker sits for more than 10 hours per day between office work, sitting at lunch, checking email and social media at home. Amazingly, studies suggest that even vigorous exercise before and after work cannot overcome the damage from prolonged sitting. New products such as the “TrekDeskR,” allows a worker to work on a computer, phone, or do paperwork, while walking on a treadmill, has great health value. Also, other products such as VariDeskR, allows for frequent positional changes from sitting to standing while working. Even without using a standing desk, changing positions, such as standing during phone calls or meetings has proven to be valuable. Current Wisdom: Alternate standing (30-45 minutes) and sitting (15-30 minutes)
Spine problems can be prevented with good posture and proper body mechanics. Poor posture and improper body mechanics subject the spine to abnormal stresses that, over time, can lead to degeneration and pain. Good posture and proper body mechanics and frequent changes in positions, can minimize current spine pain and prevent recurrent episodes. Posture is the position in which you hold your body upright against gravity. Good posture involves positions that place the least amount of stress on the spine. Good posture maintains the spine in a “neutral” position. In a neutral spine, the three normal curves are preserved (a small hollow at the base of the neck, a small roundness at the midback and a small hollow in the low back). When viewed from the side, the upper back appears straight with a small hollow in the lower back.

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!

Recently, a young woman came to my office with complaints of severe middle and lower back pain. On her first visit, I noticed her beautiful pink purse (big bag) and asked her permission to weigh the bag and discovered that it weighed 8 pounds. While 8 pounds does not seem excessive, the woman weighed 120 pounds and based on the research, would be advised to carry a 2.5-to-3.5-pound bag, (2-3% of her body weight).
A recent study shows that the average weight of a woman’s purse has increased by 38% and now exceeds 6 pounds. Despite technological advances, women have not found a way to simplify their lives, or at least what they think they need in their lives. High tech gadgets have only added weight to a purse already filled to the brim.
On a whim, I decided to ask permission to examine the contents of some of my patient’s purses. A typical purse includes the following: hairbrush, cosmetic bag, mirror, feminine products, keys, and sunglasses, reading glasses, checkbook, wallet, coupons, water bottle, and medications. Additionally, I discovered heavy high-tech products such as cellular phones, tablets, digital Bluetooth earpieces, and rechargers. Lastly, some women add the weight of a book or Kindle to the bag. Studies also show that the larger the bag and stronger the straps, the more items are stuffed in, resulting in a very heavy purse.
It is a pervasive attitude that a woman should never be stranded without her purse full of essentials. So, where is the problem? The problem is that carrying a heavy bag, usually on one side of the body, forces the body to tilt forward and to the opposite direction to compensate. Over time, this change in posture leads to neck, middle and lower back pain.
Consider the following suggestions to promote healthy use of a purse and prevent injury:

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!

While I normally do not address the topic of shoveling snow until January, considering recent weather events, I thought it might be valuable to present it sooner. Much has been written about the dangers of snow shoveling for your heart. However, while not fatal, low back pain is the most common injury sustained while shoveling snow. Heart attacks are also more common following wet and heavy snow.
Snow shoveling can place excessive stress on the structures of the spine. When overloaded and overstressed, these structures fail to support the spine properly. The lower back is at great risk of injury when bending forward, twisting, lifting a load, and lifting a load with a long lever. When all these factors are combined simultaneously, as in snow shoveling, the lower back is destined to fail. Low back pain from muscle strain or a herniated disc is very common following excessive snow shoveling.
Sources: The Colorado Comprehensive Spine Institute; American Academy of Orthopaedic Surgeons
Visit your doctor regularly and listen to your body.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

While many people celebrate the Labor Day holiday by firing up the grill, others will be shopping to get their students ready for the school year. One item on the shopping list should be a good quality and well-fitted backpack…to prevent lower back pain!
In 2018, the government of India announced a ban on homework and recently in Poland; the government ministers did the same. Can you imagine…a ban on homework? In an effort to promote student health and address recent surges in the incidence of back pain in the young, there will be no homework for students in grades one and two.
It was estimated that the majority of students ages 7 – 13 in India were carrying almost half their body weight. Not surprisingly, medical practitioners noticed a dramatic increase in reported cases of back pain among this group and decided to take action. In addition to the homework ban for grades one and two, Indian authorities have also implemented a limit of 10% of the student’s body weight.
Back pain in students seems to be universal. Each year, as students in the United States prepare to return to school from summer vacation, the subject of backpacks arises. The good news: when compared to purses, messenger bags, or shoulder bags, backpacks are the best option to prevent lower back pain. The bad news is, most of the 40 million students in the USA using backpacks, are doing so incorrectly.
Studies have found more than 33% of children had LBP that caused them to miss school, visit a doctor, or abstain from activity. Also, 55% of children surveyed carried backpacks heavier than the 10-15% of their body weight, which is the maximum weight recommended by experts. Additionally, the study noted that early onset of LBP leads to greater likelihood of recurrent or chronic problems. Backpacks that are too heavy are particularly harmful to the development of the musculoskeletal system of growing youngsters. It can lead to poor posture that may lead to chronic problems.
The following information on backpack safely is based, in part, by guidelines from The American Physical Therapy Association. Parents and teachers would be wise to observe the following warning signs of an overloaded and unsafe backpack:
Consider the following suggestions to promote backpack safely and prevent back injury:

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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 orthopaedic 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!

Several years ago, while hiking to the bottom of the Grand Canyon with my family, my wife Esther developed “canyon knee,” also known as “hiker’s knee” or in medical terms, “patellar tendonitis.” Regardless of the term, the end result was that she had severe pain in the tendon below her knee cap and was unable to walk up the trail to get out of the canyon. In addition to ice, rest, bracing, and non-steroidal anti inflammatory medications, the National Park Ranger insisted that she use two trekking poles on her ascent to the rim.
Prior to that experience, I always thought that “walking, hiking sticks or trekking poles” were for show or those in need of a walking aide. Well, I could not have been more incorrect. Needless to say, Esther made it out of the canyon safely and, with the use of our life saving trekking poles; we have lived “happily ever after!” Now, 15 years later, I rarely walk more than 5 miles without my poles.
As a result of this experience, I have been recommending walking or trekking poles to my patients. 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.
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 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, abasket 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 .
This pattern is reciprocated with as normal gait 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;)
Montem Trekking Poles - with close-up of easy adjustable locking clasp.

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.
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
Model: Andrea Molitoris, PT, DPT at Mackarey Physical Therapy

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 orthopaedic 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!