January is the time of year that many people set goals and resolve to be their very best. Not surprisingly, weight loss and fitness are the most common resolutions. It is also a time when many residents of NEPA will plan vacations and travel to warmer climates. Well, it may be that you can do both…this year consider visiting a “Fitness Resort!” According to “FitStays,” fitness resorts are rapidly gaining popularity for people of all sizes and shapes.
A fitness resort is a vacation destination where travelers go to exercise and lose weight. Sometimes called a “weight loss resort”, “fitness retreat”, “wellness resort”, “weight loss boot camp”, or “adult fat camp”, fitness resorts around the United States cater to people of all shapes and sizes.
Most fitness resorts consist of pre-determined, calorie-limited menus to help travelers in their weight loss journey. Some resorts promote menus of 1,000 to 1,500 calories-per-day, which is fewer than most people burn naturally via their resting metabolic rate (RMR).
In addition to net-negative calories through nutrition, fitness resorts and fitness retreats typically have an extensive workout plan as part of their standard program. Many resorts and retreats offer daily hiking, in addition to cardio and strength classes and assorted sports and other physical activities.
The combination of healthy nutrition and active exercise means that most visitors can expect to lose weight at a fitness resort. Specific weight loss goals will be determined by which fitness resort you pick, how long you stay, and how strenuously you want to stick to the program.
Fitness resorts (fitness retreats) are not your average “Reality TV Fat Camp.” In fact, you do not have to be excessively overweight to attend as people of all shapes and sizes benefit and enjoy the experience. Thousands of people chose to visit fitness resorts and fitness retreats every year because they are looking for a healthy alternative to a typical vacation. Instead, many want to “kick-start” a healthy lifestyle in a controlled environment.
Fitness resorts have been found to be effective for most attendees. The basic concept of combining a limited-calorie diet with daily exercise, most people will have net-negative calories every day, lose weight, and gain strength and endurance at a fitness resort—provided they stick to the program.
While some people report losing 1-3 pounds-per-week at a fitness resort, others experience much more success. Exactly how much you will lose will be dependent on a wide variety of factors, including the duration and intensity of your exercise and activities and the calories you consume. Inherently, men tend to lose weight more easily than women, and younger people typically have an easier time shedding pounds than older people.
Ideally, for long term success, a fitness resort program should be a part of a healthy lifestyle, rather than an absolute weight loss goal. Be aware that many “spas and wellness centers” entice people with lavish facilities in a beautiful environment but mostly offer passive modalities such as massage, meditation, acupuncture, manicures, pedicures and facials. While these modalities have value, if your goal is jump start on weight loss and physical fitness, a fitness resort may be a better option.
Most fitness resorts are not “diet retreats” or painful “boot camps.” With a little effort, you can easily find the right fit for you. You will not starve! While you need to limit caloric intake, you also need enough energy for the 3-6 hours of exercise and activities (swimming, biking, hiking, Zumba, Yoga) offered. There is no need to be intimidated as most attendees are like-minded people with the same goals and needs. A good resort will not only provide the right amount of calories and exercise for your goals but also educate you how to prepare meals and engage in proper exercise once you return home.
According to FitStays, most fitness resorts offer a set schedule and a camp-like experience for adults with three meals every day, usually prepared by expert nutrition staff and/or dietitians, designed around healthy foods. A typical morning begins with extended cardio exercises, such as a run, bike or hike. The afternoon may have more intense exercise classes such as strength training classes as well as more fun activities such as sports and games. Educational classes are offered throughout the day, so you can carryover the lessons from your fitness resort experience when you return home. Evenings are usually lighter to allow for leisure, rest, or spa services, which are also offered at many resorts.
NEXT WEEK: FITNESS RESORTS - PART II – A typical day at a fitness resort, recommended length stay, cost and top 20 recommended resorts.
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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, please check out our exercise forum!
New Year’s Resolutions are very predictable. While most New Year Resolutions are health oriented, I purport that a healthy mind, body and spirit requires a healthy lifestyle. Interestingly, the ten most popular resolutions listed below, all have an impact on a healthy life.
SOURCE: A. Powell, About.com Guide
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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!
According to the American Diabetes Association (ADA) and the Centers for Disease Control (CDC), 11.3% of the population in the United States or almost 37.3 million adults and children has diabetes. Unfortunately, the number keeps rising and one-third of these people are not aware that they have the disease. It will be the purpose of this column to raise the level of consciousness through education and offer recommendations for lowering blood sugar levels naturally.
Perhaps no goal is more important to a person with diabetes than maintaining a healthy blood sugar level. When managed over time, healthy blood sugar levels can slow the onset of complications associated with the disease. According to the ADA, pre-diabetes, or impaired glucose tolerance, occurs when blood glucose levels are higher than normal (110 to 125mg/dl) but below type 2 diabetes levels (126mg/dl). 54 million Americans have pre-diabetes in addition to the 20.8 million with diabetes.
While medications are effective in maintaining blood sugar levels, for those who are borderline, there are effective ways to lower your blood sugar naturally. Your physician will determine which treatment is most appropriate for your problem. Also, maintaining your ideal body weight is always important.
SOURCES: The American Diabetes Association (ADA), CDC, NIH, and Lifescript
Visit your doctor reguLlarly and listen to your body.
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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!
November is National Diabetes Awareness Month. This column will present information regarding type 1 and type 2 diabetes and the diagnosis and symptoms of the disease. Next week, Part II will present the role of exercise in the management of the disease.
What is it?
Diabetes is a disease where the hormone insulin is not adequately produced or used by the body. Insulin is needed for cells to take up glucose after it is broken down from sugars, starches and other food that we eat. When working properly, this provides the fuel necessary for activities of daily living. While the exact cause is not completely understood, genetics is known to play a big role. However, environmental factors such as obesity and inactivity have also been found to play a large role.
According to the American Diabetes Association (ADA) and the Centers for Disease Control (CDC), 11.3% of the population in the United States or almost 37.3 million adults and children has diabetes. Unfortunately, the number keeps rising and one-third of these people are not aware that they have the disease.
A Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT) can be used to screen a person for diabetes or pre-diabetes. Due to the fact that it is easier, quicker and cheaper, the FPG is the recommended test by the ADA. A FPG test results between 110 and 125 mg/dl indicates pre-diabetes. A FPG of 126 mg/dl or higher indicates diabetes.
Type 1 diabetes occurs when the islet cells of the pancreas are destroyed and unable to produce insulin. Without insulin, the cells of the body are unable to allow glucose (sugar) to enter the cells of the body and fuel them. Without the hormone insulin, the body is unable to convert glucose into energy needed for activities of daily living. According to the ADA, 5-10% of Americans diagnosed with diabetes has type 1. It is usually diagnosed in children and young adults.
While type 1 diabetes is serious, each year more and more people are living long, healthy and happy lives. Some conditions associated with type 1 diabetes are: hyperglycemia, ketoacidosis and celiac disease. Some things you will have to know: information about different types of insulin, different types of blood glucose meters, different types of diagnostic tests, managing your blood glucose, regular eye examinations, and tests to monitor your kidney function, regular vascular and foot exams.
While symptoms may vary for each patient, people with type 1diabetes often have increased thirst and urination, constant hunger, weight loss and extreme tiredness.
Type 1 diabetes increases your risk for other serious problems. Some examples are: heart disease, blindness, nerve damage, amputations and kidney damage. The best way to minimize your risk of complications from type 1diabetes is to take good care of your body. Get regular checkups from your eye doctor for early vision problems, dentist, for early dental problems, podiatrist to prevent foot wounds and ulcers. Exercise regularly, keep your weight down. Do not smoke or drink excessively.
Type 2 is the most common type of diabetes as most Americans are diagnosed with type 2 diabetes. It occurs when the body fails to use insulin properly and eventually it fails to produce an adequate amount of insulin. When sugar, the primary source of energy in the body, is not able to be broken down and transported in the cells for energy, it builds up in the blood. There it can immediately starve cells of energy and cause weakness.
Also, over time it can damage eyes, kidneys, nerves or heart from abnormalities in cholesterol, blood pressure and an increase in clotting of blood vessels. Like type 1, even though the problems with type 2 are scary, most people with type 2 diabetes live long, healthy, and happy lives. While people of all ages and races can get diabetes, some groups are at higher risk for type 2. For example, African Americans, Latinos, Native Americans and Asian Americans/Pacific Islanders and the aged are at greater risk. Conditions and complications are the same as those for type 1 diabetes.
People with type 2 diabetes experience symptoms that are more vague and gradual in onset than with type 1 diabetes. Type 2 symptoms include feeling tired or ill, increased thirst and urination, weight loss, poor vision, frequent infections and slow wound healing.
Sources: NIH; American Diabetes Association; Harvard Health Publications
Visit your doctor regularly and listen to your body.
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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!
Studies have shown a recent escalation of joint replacements in a much younger and more active group than previously noted…the baby boomer! While the end result is mostly physical, the cause is often psychological. We all know the personality type: type A, hyperactive, goal-oriented, driven, possessed and highly organized – almost at all costs! Many of you have seen fitness enthusiasts running through the streets at 5:30 AM for 5-10-15 miles each day. Moreover, many of these runners have more activities planned later in the day: golf, tennis, ski, swim, play sports with their kids. Well, after 20 years of this behavior, many of these enthusiasts are now suffering the effects of long term multiple micro traumas. They are suffering from what orthopedic surgeons at the University of Pennsylvania call “Boomeritis! Boomeritis is inflammation of the baby boomer from overuse. Lower back pain, hip, groin, and knee pain is almost a daily event.
As baby boomers continue to enjoy sports with the same vigor and intensity as when they were younger, they are finding that their older bodies just can’t keep up. While these individuals often succeed in finding the balance of fitness and craziness, they have had times when they took it too far. Furthermore, nearly all compulsive exercisers suffer from over training syndrome. When take too far compulsive behavior is rationalized by insisting that if they didn’t work to extreme then their performance would suffer.
*Each sign is worth 1 point:
If you have two or more of the warning sings, consult your family physician to rule out potentially serious problems.
Avoid weight bearing exercises two days in a row. Run one day, walk, swim or bike the next.
Use the elliptical instead of the treadmill.
Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.
Visit your family 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 orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
For all of Dr. Mackarey's articles, visit our exercise forum!
Ankle swelling is a common symptom that occurs when your body retains fluid in the lower legs, ankles and feet. Most people have experienced it at some point in their lives and it often resolves on its own with elevation and muscle movement. While it is usually benign and occurs on both sides of the body, in some instances immediate medical attention is required. The most common causes of ankle swelling are:
Prolonged Positions – you have probably noticed swelling in your ankles and feet after a long trip by plane or car. Some may also experience symptoms after a long day at work sitting or standing in one position for an extended period of time. It may be the most common cause of lower leg swelling and easiest to resolve.
Diet- excessive salt in your diet is associated with swelling in the lower legs, especially when associated with other risk factors for swelling such as organ function or obesity.
Varicose Veins – when the valves in the blood vessels which carry blood from the legs back to the heart are damaged, blood and fluid can collect in the lower legs. Prolonged standing or sitting without intermittent movement with worsen the condition.
Pregnancy – during pregnancy, the body retains more fluids than usual and most women experience some form of swelling in the lower legs, ankles and feet.
Medications – certain drugs can cause fluid retention in the lower legs such as: anti-inflammatory medications, steroids, diabetes medications, antidepressants and cardiac medications.
Blood Clots – blockages in the blood vessels of the lower leg can limit the movement of fluid from the legs back to the heart. It is often present in only one leg and associated with warmth, pain, and cramping. It is a serious condition and requires immediate medical attention.
Trauma/Infection – after a trauma or injury such as an ankle sprain, bruise or fracture, the damaged tissue leaks fluid surrounding the affected area. Also, when specific area of the lower leg can becomes infected, as in the case of a cut or splinter in the ankle or foot that has not healed properly, swelling occurs in the surrounding tissues. These situations are often associated with warmth, pain and limited to the side of the injury. Treatment to injured tissues and the infection is required.
Lymphedema – swelling in the lower leg can occur when there is a blockage in the lymphatic system is blocked or when lymph nodes are removed in surgery for cancer. Medications, massage, compression garments, and elevation, can address the symptoms.
Obesity – due to the excessive weight placed on the tissues of the legs, ankle and feet and adipose tissue in the abdomen compressing blood vessels, obesity is one of the most common causes of lower leg swelling. It also complicates all of the above conditions associated with swelling in the legs.
Diseases – such as those of the kidney, heart, and liver are associated with swelling in the lower legs.
Change Positions – on a long plane ride or sitting all day at school or work – get up and walk around every 30-45 minutes. Set a timer on your phone to remind you.
Exercise – regular exercises keeps the muscles and blood vessels in you lower extremities healthier. Also, intermittent movement of the leg muscles throughout the day, even when sitting, serve to prevent swelling. Try ankle pumps and toe curls.
Elevation – when sitting or lying down, try elevating your ankles and feet on a pillow to allow gravity to assist fluid movement in your legs.
Low-Sodium Diet – read the labels on your food and you will be shocked by how much sodium is in most foods, especially canned soups and vegetables. But, there are low-sodium options and don’t add more salt to your food.
Weight Loss – maintaining a healthy BMI is the single best thing you can do, not only for lower leg swelling, but for your overall health and wellness.
Compression Socks – for most people, over-the-counter compression socks will adequately prevent fluid retention in the lower legs. For comfort, begin with the lightest compression possible. 12-15 or 15-20 mm of mercury is a good start and put them on as soon as you get up in the morning, before swelling begins.
Visit your doctor regularly and listen to your body.
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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Paul's articles, check out our exercise forum!
There is little doubt that the workplace has been redefined since the pandemic as many employees continue to work from home. Sitting for many hours at a workstation that may not be optimal has also changed the way we define workplace health and safety. It may be more important than ever to pay close attention to designing an ergonomic workstation, changing position, and stretching regularly to prevent injury.
Since 1894 Labor Day has been designated as the national holiday that pays tribute to the contributions and achievements of American workers. Research supports the notion that healthier employees are happier and more productive. When employers encourage healthy behavior and safety at work, they benefit in many ways. For example, in addition to improving job satisfaction and productivity, healthy employees save money by using less sick time, worker’s compensation benefits and health benefits. For example, according to the Centers for Disease Control and Prevention, approximately 75 percent of employers” health care costs are related to chronic medical problems such as obesity, diabetes, high blood pressure, and high cholesterol. De-conditioned, overweight employees are more likely to suffer from these preventable conditions and are at greater risk for injury. Employers, please consider using this holiday as an opportunity to start a health promotion program at your workplace…have a health fair, offer healthy snacks, encourage walking, smoking cessation, exercising at lunch, and offer fitness club stipends.
Lower back pain, one of the costliest illnesses to employers, is one example of a problem which can be prevented with a good health and safety program. It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics are essential in the prevention of LBP. At our clinic, significant time and effort is spent emphasizing the importance of these concepts to our patients, employees, and the businesses we work with through industrial medicine programs. A comprehensive approach can produce significant reductions in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonomics.
As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.
Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back. Also, consider sitting on a physio ball, which promotes proper posture for part of the day.
Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
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.
Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the surface resistance of the floor. Does it require two people to lift? Can I safely lift that high or bend that low?
When bending to lift an object think about safety:
Proper Lifting Technique:
Visit your doctor regularly and listen to your body.
Model: Lexi DiGregorio, PTA
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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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Paul's articles, check out our exercise forum!
It is time to celebrate the 4TH of July with 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 this holiday weekend 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!
The majority of skin cancers are caused by harmful ultraviolet (UV) rays from the sun. Two major types are UVA and UVB:
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.
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:
Another consideration when choosing a sunscreen is chemical versus physical blockers:
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
NEXT WEEK! Read Dr. Mackarey’s Health & Exercise Forum – every Monday. 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. 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. check out our exercise forum!
What medical problem does 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.
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 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 pre-fabricated splints or can fabricate a custom splint. The above mentioned treatments all focus on decreasing inflammation and compression on the median nerve.
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.
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, referred to as a carpal tunnel release, may be indicated if symptoms are significant and impair functional activity performance.
To reduce your chances of getting CTS:
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.
NEXT WEEK! Read Dr. Mackarey’s "Health & Exercise Forum" – every Monday
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. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For of Dr. Paul's article, check out our exercise forum!
A local high school teacher came to my office with weakness and numbness on one side of her face. This well-groomed, attractive middle-aged woman was unable to smile, frown, pout, speak, or eat with facial symmetry. She suffered from a cold, on and off, for about two months. It was not a bad cold, but it would not go away. One day in early summer, while engaged in bird watching, one of her favorite pastimes, she noticed that she could not look through her binoculars. She noticed that her eye would not open and close at will. The next day she woke with ear pain, flaccid muscles on one side of her face, and an inability to close her eye. She had difficulty speaking with clarity due to weak mouth muscles and feared she had a stroke.
She immediately saw her family physician who determined that she had shingles in her ear and developed Bell’s palsy. She was prescribed a steroid anti-inflammatory (Prednisone), antiviral medicine (Acyclovir), and a topical cream (Zovirax). Once she got over the initial fear and shock, she was grateful that her problem of facial weakness was not due to a more serious problem, such as a stroke or brain tumor. She began physical therapy and improved slowly. Her story, along with many other patients, reminded me of the need to raise awareness about cause, diagnosis, symptoms, complications and treatment of Bell’s palsy.
Bell’s palsy, a facial nerve paralysis, occurs when the nerve that is responsible for the movement and sensation of the muscle and skin of the face becomes damaged. The end result of this damage is paralysis of the muscles and numbness of the skin on one side of the face. Typically, the first sign of this disorder is the inability to close one eye or smile on one side of the face. While this problem can occur in any age group, it is rarely seen in people less than 15 or more than 60 years of age. The good news is that most people show signs of improvement within 3-4 weeks and have complete recovery in 4-6 months. The bad news is that reoccurrence can occur on the other side of the face in approximately 10 percent of those affected.
Bell’s palsy is caused by a viral infection. The most common virus is the herpes simplex virus, the same virus that causes cold sores and genital herpes. Other viruses that can cause Bell’s palsy are herpes zoster virus that causes chicken pox and shingles and Epstein-Barr virus, which causes mononucleosis, and cytomegalovirus. When one of these viruses causes inflammation to the facial nerve, it becomes swollen and irritated in the narrow tunnel of bone by the ear. As pressure on the facial nerve increases, damage progresses to the point that the muscles and skin of the face are unable to receive messages from the nerve, leading to paralysis, numbness and other symptoms.
The hallmark symptom of Bell’s palsy is sudden onset of facial muscle weakness and numbness on one side of the face. As a result, it is difficult to close the eye and smile on the weak side. Other symptoms on the affected side can include: the inability to make facial expressions, speak clearly (especially vowel sounds), diminished sense of taste, pain in the area of the jaw or ear, sensitivity of sound, headaches, and changes in production of tears and saliva.
While Bell’s palsy can occur in anyone, it is more common among those who are: pregnant, (especially during the third trimester or first week after birth), diabetic, or suffering from a cold or flu. Also, some research suggests that there may be a genetic predisposition to this problem.
In mild cases of Bell’s palsy, symptoms are completely resolved within 4-6 weeks. As mentioned before, most cases resolve in 4-6 months. However, recovery for those with complete paralysis may vary. For example, permanent facial weakness, facial muscle twitching, and visual problems due to the inability to close the eye, can occur.
Contact you primary care physician immediately, because these symptoms may be associated with a more serious medical condition such as a stroke. Remember, most people with Bell’s palsy make a complete recovery, but early intervention can expedite the process. In severe cases, a neurologist may be consulted. Two commonly used medications are corticosteroids and antiviral drugs. Corticosteroids such as prednisone are strong anti-inflammatory drugs used to reduce the swelling and inflammation on the facial nerve. Antiviral drugs such as acyclovir are used to stop the viral infection that may have caused the inflammation. Studies show that these drugs, when used in combination, are most effective when administered in the first 3 days of the appearance of symptoms.
Physical therapy can also assist in the restoration of facial muscle recovery. Ultrasound with anti-inflammatory drugs, electric stimulation, massage and exercise are commonly performed. While the use of electric stimulation has limited support in the literature, a home exercise program that concentrates on facial muscles, is an essential part of the therapy program. Some simple exercises performed in front of a mirror are: raise eyebrows, bring eyebrows together, open/close eye, fill cheeks with air, suck in cheeks, smile, frown, whistle, say vowels.
Surgery, to relieve pressure on the nerve by removing bone, is rarely performed. Plastic surgery, to improve the appearance of the face, may be an option in cases with permanent paralysis.
Sources: Mayo Clinic; WebMD
NEXT WEEK! Read “Health & Exercise Forum” – Every Monday. 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. Dr. Mackarey is an Associate Professor of Clinical Medicine at GCSOM.
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