Fall is here, cross-country running season has begun and the 26^th Steamtown Marathon is only a few weeks away! With that in mind, running injuries, some very specific to women, are on the increase…

While driving to or from work have you noticed more local running enthusiasts in the past few years? Moreover, have your noticed that most of the runners are women? Scranton Running Company has contributed to NEPA’s participation in a national trend; more women are engaged in running than men! Female runners account for 9.7 million runners (57%) while 7 million males run on a national level.

With this surge, the female runner has been subjected to a host of related injuries, including shin splints, which often lead to stress fractures. New research has found that stress fractures may be related to the loss of weight and body mass associated with the sport.

A recent study from Ohio State University found that female runners with a Body Mass Index (BMI) below 19 may have a higher risk of developing stress fractures than women with a BMI of 19 or above. Furthermore, the study also found that these women took longer to recover from these injuries.

According to Timothy Miller, MD, “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture,”

The study also found that female runners with a BMI of 19 or higher with severe stress fractures required 13 weeks to recover from their injuries and return to running. Runners with a BMI lower than 19, however, took more than 17 weeks to recover.

They concluded that women should know their BMI and consult with a medical professional to maintain a healthy number. Additionally, women should cross-train and include resistance training to improve the strength and muscle mass of the lower extremities to prevent injury.

The current BMI wisdom, according to the National Institutes of Health, is 19.8 for men and 24 for women, however, strong and competitive women tend to have a BMI of 26. A BMI of 18 is considered malnourished.

What is BMI?

Body mass index (BMI) is a measure of body fat based on height and weight of adult men and women over 20 years of age, according to the National Institutes of Health.

BMI = (weight in pounds / height in inches squared) X 703)

Example 1: a person who weighs150 pounds and is 68 inches (5 feet 8 inches) tall has a BMI of 22.8

Example 2: a person who weighs 110 pounds and is 66 inches (5 feet 5 inches) tall has a BMI of 17.7

Underweight      < 18.5%

Normal weight      18.5 to 24.9%

Overweight      25 to 29.9%

Obesity            30 and over

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 (shin bone) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk for stress fractures?

FEMALE RUNNERS WITH BMI LOWER THAN 19 – is a primary risk factor.

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.

Other 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

Prevention & Treatment

• Maintain Ideal BMI – 24 for female runners
• 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%
• Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
• Perform lower body weight training – to strengthen the muscles of the lower body, thighs, knees, ankles, feet.
• 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 Foot ware – walk in new shoes first, then run 1-2 miles
• Consult Family Physician/Orthopedic Physical Therapist/Nutritionist

Source: Ohio State University, Science Daily

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 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, visit our exercise forum!

Fall in NEPA is one of my favorite times of year. For outdoor enthusiasts, there is nothing more refreshing than activities in the bright sunshine and crisp, clean air. The hot humid summer weather can be a deterrent to outdoor activities and this time of year provides an opportunity to get fit by beginning a walking program. For many who have not maintained an active lifestyle or have health issues, it is challenging to know where to begin. Moreover, beginning without a good plan can lead to injury and leave you discouraged. For example, those overweight and de-conditioned should not start a walking program too aggressively. Walking at a fast pace and long distance without gradually weaning into it will most likely lead to problems.

WALKING FOR HEALTH

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

BENEFITS OF WALKING

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.” According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

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

PLAN AHEAD

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

SET REALISTIC GOALS

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

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

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

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

TRACK YOUR PROGRESS

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

MARK YOUR CALENDAR

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

FIND A WALKING PARTNER

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

USE EFFICIENT WALKING TECHNIQUE

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

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

Visit your doctor regularly and listen to your body.     

Sources : Sapiens.org; WebMD; Mayo Clinic 

NEXT MONDAY BLOG and in print in THE SUNDAY TIMES TRIBUNE – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

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 Mackarey's articles, check out our exercise forum!

We are more than one month into the New Year and many people are still talking about their health and fitness goals. As you probably know, losing weight and getting fit are the most popular resolutions, however, for many who have not maintained an active lifestyle in years, it is challenging to know where to begin. Moreover, beginning without a good plan can lead to injury and leave you discouraged. For example, those overweight and de-conditioned should not start a walking program to aggressively. Walking at a fast pace and long distance without gradually weaning into it will most likely lead to problems.

WALKING FOR HEALTH

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

BENEFITS OF WALKING

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.”

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

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

PLAN AHEAD

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

SET REALISTIC GOALS

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

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

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

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

TRACK YOUR PROGRESS

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

MARK YOUR CALENDAR

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

FIND A WALKING PARTNER

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

USE EFFICIENT WALKING TECHNIQUE

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

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

Sources : Sapiens.org; WebMD; Mayo Clinic

* Visit your doctor regularly and listen to your body.     

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

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. Mackarey's articles: Visit our Healthcare Forum!

Dry Tech Exercise Clothing

Dry Tech is the best thing that has happened to exercise apparel since “jogging suit” was donned by all the “cool dudes” in the 70’s and 80’s . It is has great style and even better function. The specially made material is light weight and breathable and wicks moisture from the skin to the outer layers. Therefore, it will not get heavy with sweat which can weigh you down and cause friction with your skin which can lead to chaffing and blisters. The following exercise apparel is now available in Dry Tech:

• Short sleeve tee with a matching long sleeve shirt
• Shorts and compression under shorts
• Colorful socks; NOTE: Shoes are a very important aspect to safe and comfortable exercise but are unique for running and other specific sports (tennis, basketball). Sneakers may be too difficult to buy for someone else.

Exercise Mat

An exercise mat is helpful if you decide to exercise at home. Also, if you participate in yoga or Pilates classes, a mat is required equipment.

Hand Held Dumbbells and Sandbag Leg Weights

These are essential for those interested in home exercise. For the average beginner, 3-5-8-10 pound (two of each) weights will be adequate.  Dumbbells are good for shrugs, biceps, and triceps, bent over rows and lats, and lunges. Incremented and stackable dumbbells are also available by Bowflex SelecTech 552 (5-52 pounds for $299). and NordicTrack $189. Sandbags, which can be purchased as graduated weights from 1 to 5 pounds, are good for leg extensions, hamstring curls, hip hikes and hip abduction.  

Resistance Bands

These cheap and versatile bands are also essential for a home program. The bands come in different colors to represent the amount of resistance with yellow being the easiest and black the most difficult. They can be used for upper and lower body. For specific band exercises visit a previous column in “Health & Exercise Forum” at The Times Tribune or www.mackareyphysicaltherapy.com

Aerobic Equipment

• Bike – Plus: upright or recumbent bikes are an effective and affordable method of aerobic exercise. It is very useful for those suffering from lower back, hip, knee or ankle/foot pain because it can be performed with partial weight bearing. Minus: must be able to bend your knees at least 110/115 degrees.  
• Treadmill – Plus: great for those who love to walk or run and need and indoor alternative in inclimate weather. Minus: large and expensive
• Elliptical – Plus: a good alternative to the pounding of running. Minus: expensive, large, and require full weight bearing. 

Fitness Club Membership

• Location is important for convenience. The type of gym, such as, cross fit, exercise machines vs. traditional free weights, must be considered. Equipment and other services such as personal trainers, swimming pool, sauna, hot tubs, Pilates, and yoga classes are also important to some.
• If the person you want to gift already belongs to a gym, consider purchasing a gift certificate for massage, Pilates, yoga, spin class or aquatic exercises at their gym (which usually costs extra) or another studio.

Personal Trainer Gift Certificate or Home Virtual Trainers

This can be an opportunity for someone to either get the proper advice from a professional to begin a fitness program or to revamp and tune up an old stale program. Word of mouth is a good way to find a reputable certified trainer.

Peloton – ($1,495 bike, $2,495 treadmill); Mirror Exercise – ($995); FightCamp – ($1,219.)

Electronic Fitness Monitors or Wearable Tech Monitor

These devices use GPS technology to help the user track their activity to get more out of their exercise routines. They monitor activity, heart rate, distance, location, calories, and more. Some examples are:

• Pedometers – clips on a belt – best for tracking steps - tracks steps taken by walkers and runners and translates it to miles. Some also translate calories expended. Suggestions: “Perfect Fitness” or Timex” $5-$25.

• Activity Trackers – worn as wrist band – best for tracking general fitness, calories and sleep patterns 24/7. It can be connected wireless to your cell phone. Suggestions: “Fitbit” $119 to $149. Garmin Vivoactive 3  $159.

• Running Watches – are worn as a wrist watch – best for timing workouts and counting laps - a rugged, waterproof watch to be worn while running to track laps, splits, countdown, intervals and training logs. However, it does not track distance, speed or heart rate. Suggestions: Timex Ironman $38.97. Garmin Forerunner 45S $129.

• Heart Rate Monitors – worn as a chest-strap or wrist strap – monitors your heart rate in real time.  Suggestions: Garmin Vivofit 4 $62.; Polar H10  $89.95

• WHOOP – this next generation fitness and health monitoring is smaller and faster with new biometric tracking, including skin temperature, blood oxygen, and more. Whoop.com $30/month.

Weight Loss and Activity Monitoring Apps

Note: Basic Apps are free and more advanced versions are under $10.

• Weight Loss – Suggestions: “Lose It”; “My Diet Coach” - helps you keep a journal, calculates calories for free. The App gives calorie credits if you exercise and provides ongoing feedback to help you stay on track to attain your optimal weight.

• Activity Monitor – Suggestions: “Endomodo”; “Human” – uses GPS to track your every step when you go for a hike, run, fitness walk, touring walk at Disney, or bike ride on trails, ski cross country or downhill. It will calculate distance, speed, location, total time and total calories.

Nutritional Counselor Gift Certificate

Sometimes you need professional help to get started and stay focused. Just as with a personal trainer, a qualified and licensed nutritional counselor will assist you in establishing a safe and effective program to meet your nutritional and dietary goals. Again, ask around to see who has a good reputation or who may be a good fit for the recipient of your gift.

These gifts can be purchased at most local sporting goods stores or on-line.

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

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: mackareyphysicaltherapy.com/forum

According to the New York Times, there is a shortage and backorder of bicycles this summer due to COVID-19, especially in the cities where public transportation is discouraged. Fortunately, in NEPA, the problem is not so extreme. For those who have a bike, now might be a good time to dust them off and enjoy the many beautiful and well-maintained trails are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority.

WHY BIKE?

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

BENEFITS OF BIKING

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

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be in good working order such as tires, chain, brakes and pedals. Next, be sure to maintain a fairly good fitness level in order to bike safely. If you are a beginner, start slowly. Warm up and slowly bike for 10 to 15 minutes and build up over time. Practice the coordination of stopping, starting, shifting and braking. Work on good strength and flexibility of the hamstrings, quadriceps, calves and gluteal muscles. All of these muscles are necessary to generate pedal force. Balance is also important to safety and can be practiced on and off the bike. Be aware that adaptive equipment can modify your bike for added comfort and safety such as soft handlebar tape, seat post and front fork shock absorbers, padded biking shorts, c-out and gel pad saddle seats, and wider tires.

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

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

SAFETY

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

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

SOURCES: American Physical Therapy Association

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” at https://mackareyphysicaltherapy.com/forum/ or visit our website at https://mackareyphysicaltherapy.com/

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 in downtown Scranton and is an associate professor of clinical medicine at GCSOM. 

A healthy immune system may be the difference between recovery from illness and dying. While you may not be able to improve an otherwise healthy immune system, you can take steps to maintain its health and integrity. Exercise is one of the best ways to maintain a healthy immune system.

With the closing of fitness centers, school gyms and exercise classes due to COVID-19, it may be a good time to begin a home exercise program that is quick and easy. For some, home exercises can be done before or after working from home to gain or maintain muscle tone. For others, home exercises may help maintain independence and safety performing daily activities around the house such as; climbing stairs, getting in and out of a shower, putting on shoes and socks, cooking, cleaning, and carrying groceries or laundry. 

I have comprised 10 simple exercises including upper and lower body and balance and core. The only equipment you will need is a chair and resistance bands; yellow has the least resistance, black the most, red, green, blue in between. They can be purchased at any sporting goods or department store.

Remember, for most people it is more harmful not to exercise, so contact your physician to discuss whether independent exercise is appropriate for you. If you have special needs, you may need to consult with a physical therapist to get started. Good luck…I hope this helps you survive the COVID-19 quarantine!

Sitting Exercises with Resistance Band

These exercises are performed while sitting in a chair with a backrest, slowly. Hold the position for 3 seconds. Perform 5 -10 repetitions. Do these exercises 3-5 times per week. Begin with a yellow light resistance band. 

Row the Boat (PHOTO 1)

• Tie the resistance band to a doorknob. 
• Pull both arms back at a 45-degree angle with bent elbows as if “rowing a boat.”

Saw Wood (Photo 2)

• Tie the resistance band to a doorknob.
• Pull both arms back with arms at side with bent elbows as if “sawing wood”

Elbow Extension (Photo 3)

• Place band around your back or the back of the chair.
• Extend your elbows in a punching motion.
• Switch arms. 

Hip Spread (Photo 4)

• Tie the band around your legs, above your hips.
• Spread your legs apart and keep feet on the floor.

Hip Hike (Photo 5)

• Tie the band in a circle.
• Place the left THIGH under the loop while placing the right foot on the knot.
• Hike the right hip up 4-6 inches while pushing the left heel down.
• Switch legs. 

Leg Kicks (Photo 6)

• Set up as in Hip Hike BUT place the band on the left SHIN. 
• Extend the left knee as if kicking the foot forward to 45 degrees. 
• Switch legs. 

• 

• 

• 

• 

• 

• 

Standing Exercises with Resistance Band:

Shoulder Shrug (Photo 7)

• Stand on top of the band.
• Shrug top of shoulders up toward the ears.

Elbow Bend (Photo 8)

• Stand on top of the band.
• Bend elbows. 

Standing Leg Curl (Photo 9)

• Stand and face countertop, and hold on for balance.
• Tie the band in a circle.
• Place the left calf under the loop while placing the right foot on the knot.
• Bend the left leg up to 90 degrees while pushing the right foot to hold the band. Then, switch legs. 

Standing Walk Aways  - Backward (Photo 10)

• Tie a long band around a door knob or pole and then around your waist.
• Facing the doorknob, pick up slack in the band and slowly walk away backwards 5-7 steps.
• Hold for 3 seconds.
• Slowly return to starting position by walking forwards. 

Standing Walk Aways  - Forward 

• Using same set-up as backward walkways, but turn around so the doorknob is at your back.
• Slowly walk away forward 5-7 steps.
• Hold 3 seconds.
• Slowly return to starting position by walking backwards. 

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Visit your doctor regularly and listen to your body.      

Keep moving, eat healthy foods, exercise regularly, and live long and well!

Read Dr. Mackarey’s "Health & Exercise Forum" every Monday in the Scranton Times-Tribune.

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.