Congratulations to more than 1,000 courageous runners who finished the 29^th Annual Steamtown Marathon today. Most, if not all of you, will wake up tomorrow morning with a little less jump in your step than you had yesterday as your body begins it's recovery.

As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom. Based on science, to encourage you to adequately rest and allow your body to recover.

GREAT EXAMPLE OF REST AND RECOVERY:

With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks. While an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident. Following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.

RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body: (RunNow.com - Jim Peskett)

Muscle-Skeletal System:
- One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!
- Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!

Cellular Damage:
- Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness.
Immune System:
- It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

If I don’t have pain, then I did not damage my body. I can run again soon after the marathon.
- FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
- FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
If I don’t run, I will lose all of my conditioning in one week.
- FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi!

Expedite Your Recovery:

Rest – Take it easy for a few days. Let you muscles/body heal. Take short walks.
Elevate – Elevating your legs to allow blood/fluid in you muscles to return to the heart without using gravity.
Massage – This can be an effective method of relaxing muscle spasms, cramps and mobilizing fluids from your muscles to your heart after the marathon. It should be very comfortable. You may find even more benefit from massage 24-48 hours after the race to assist in the recovery of delayed onset muscle soreness from lactic acid build-up in your muscles.
Slowly Reintroduce Exercise and Running – Gradually introduce longer walks and slow jogging after a few weeks. Cross-training is good for less joint compression and allows the use of other muscles. (Elliptical, bike, swim)
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!

PART III OF III

This is the third of three columns dedicated to healthcare for college students. Please find these “10 Tips to Keep Yourself Healthy in College” helpful. However, no discussion regarding the health and wellness of college students would be complete and thorough without addressing what health care and university experts consider the two most dangerous behaviors on college campuses across the nation: binge drinking and unprotected sexual activity.

While it is not my intent to offend the religious and moral values of any reader, it is my purpose to provoke direct and meaningful conversation between parents, religious leaders and students. To prevent serious health problems in college, parents must share their experience and discuss their values regarding sexual activity and alcohol consumption with children before they leave home to live independently in college. If you are unable to have a direct conversation about these issues, consider doing what several readers have done; mail a copy of this column to your child!

10 Tips to Keep Yourself Healthy in College: (American Academy of Pediatrics)

Sleep – somehow, despite a busy academic and social schedule, you MUST get enough rest. Lack of sleep may be the single unhealthiest habit of a college student. It can lead to many negative consequences such as lack of concentration, poor emotional stability, and vulnerability to germs and disease. While one may get by on 3-4 hours sleep for short periods of time, eventually, your body will take control and shut down. Do your best to develop a regular sleep pattern and factor in short naps to catch up on needed rest if necessary.
Diet – the “freshman fifteen” is no joke, it is the real thing. Skipping breakfast, “pigging out” on junk food, late night eating, and drinking high calorie soda and beer all factor into weight gain and poor dietary habits. Make time to eat breakfast, snack on yogurt, fruit and nuts. Fill up on a healthy salad. Avoid a constant diet of fried foods and sweets.
Water – even adults forget to drink plenty of water throughout the day. Carry a water bottle and skip the soda.

Get regular check-ups – see your doctor when home on semester break for an annual check-up or more often if needed. Many college health centers offer this service. Many serious problems can be avoided with early detection.
Get a flu shot, vaccines and mask up – remember, college campuses breed germs and most schools offer inexpensive flu shots and Covid vaccines.
Exercise – make time to exercise regularly (30-45 minutes 3-5 days per week). Walk, run, bike, lift weights, play tennis, racquetball or swim. Colleges have the best facilities for sports and exercise. Just DO SOMETHING! It will help you sleep, relax and feel better.
Relax – make time to relax. Read a book, go for a run, meditate, do yoga, or walk and have good conversations with friends. Mental health is important on a stressful college campus.
Emotional Health – is a vital component of a healthy person. College life can be very stressful. Depression, anxiety, addiction, eating disorders, and homesickness are some examples of emotional problems common among college students. If you feel emotionally unhealthy, get professional help. All colleges have trained counselors equipped to assist you.

Drink Sensibly – binge drinking might be one of the most dangerous behaviors on a college campus. Studies show 44% of U.S. College students engage in binge drinking uniformly among freshman through seniors. Of these, 50% binged 3-4 times in a two-week period. Binge drinking is defined as 5 drinks in a row for men and 4 for women. Binge drinkers are more likely to be victims of poor academic performance, addiction, trauma, auto accidents, assault, unprotected sex, sexual assault, and death. Some of the most common reasons reported for binging are: to get drunk, status, campus culture, peer pressure, academic stress. TALK TO YOUR CHILDREN!
Safe Sex – promiscuous sex is physically and emotionally unhealthy. Unprotected sex can be LIFE ALTERING! Studies by the Center for Disease Control found that almost 80% of college students 18 to 24 years old had sexual intercourse at least one time during college. 73% reported having unprotected sex and 68% of this group did not believe that they were at risk of contracting a sexually transmitted disease. TALK TO YOUR CHILDREN! GET THE HPV VACCINE!

SOURCES: American Academy of Pediatrics

Visit your doctor regularly and listen to your body.

Keep moving, eat healthy foods, and exercise regularly.

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We are in the middle of another heat wave this summer and ice baths, which people do all year, may sound like a very refreshing thing to do! But, before you take the plunge, know the benefits and risks of a frigid bath.

What is an Ice Bath?

Ice baths have become a new trend or fad in health and fitness, especially among elite athletes and some celebrities. In fact, it is impossible to scroll through social media without encountering someone “taking the frigid plunge!” However, it is far from a new treatment modality. The Ancient Greeks employed cold-water immersion for fever, pain relief, relaxation and socialization. In fact, Hippocrates documented the use of cold for medicinal purposes for its analgesic benefits.

Ice baths, a type of cryotherapy, is also referred to as cold water immersion (CWI) or cold-water therapy, involves immersing your body in ice water for approximately 5-15 minutes from the neck down at a temperature of 50-59 degrees. The ice baths are commonly used for pain, delayed-onset muscle soreness (DOMS), and inflammation and mood elevation.

In theory, the cold water lowers the temperature of your skin and body by vasoconstriction (narrow) of the blood vessels. When you get out of the cold water the vasodilatation (widen) of the blood vessels immediately brings fresh oxygen and nutrient-rich blood back to the tissues to warm the body and in the process, reduce pain, inflammation and promote healing.

Types of Cold Water Therapy

Ice Bath/Cold Water Immersion (CWI) - immersing your body in ice water for approximately 5-15 minutes from the neck down at a temperature of 50-59 degrees.
Cold Showers – Standing under a cold shower at the coldest setting (as close to 50-59 degrees as possible) for 5-15 minutes. It is often recommended as a good introduction to CWI.
Contrast Water Therapy (Contrast Baths) – Alternating between soaking or showering in hot water for a period of time followed by cold water for the same time (3-5 minutes). The period of time is flexible as some studies suggest alternating hot and cold at one-minute intervals.
Wim Hof Method – established by a Dutch athlete who recommends incorporating breathing techniques and meditation with CWI.

Purported Ice Bath Benefits

Pain Management – cold water therapy leads to vasoconstriction (narrowing the blood vessels) which can reduce swelling and inflammation associated with pain. Moreover, cold creates an analgesic effect to the skin to aide in pain control.
Reduces Muscle Soreness – cold water therapy has been found to reduce muscle soreness one hour after intense exercise including delayed-onset muscle soreness (DOMS0, however, strength was compromised following CWI. Moreover, it is important to note that studies showed heat therapy had similar results as CWI.
Improves Mood and Alertness – Some studies with small sample sizes have demonstrated that CWI improved self-esteem and alertness, reduced muscle tension, anger and nervousness. However, there was no difference soaking in 55 degree water verses 68 degrees for 18 to 20 minutes. Also, the studies were exclusively performed on healthy individuals.

Potential Side Effects of Ice Baths

Ice baths are not without risk and not everyone reacts the same way to ice immersion. It is recommended that one engages in ice exposure gradually, for short periods and in a controlled setting like a home shower. Furthermore, one must be mindful of age, general health, time of exposure, and water temperature. Remember, body temperature is 98.6 and water temperature of 65-70 degrees will feel very cold so 50-59 degrees can create problems such as:

Cold-Induced Rash – an itchy, painful skin rash
Cold Shock – sudden cold immersion can shock your body into rapid breathing, increased heart rate and blood pressure and is often associated with drowning.
Hypothermia – cold immersion can lead to hypothermia and organ failure.
Ice Burn – if your skin makes direct contact with the ice you can burn your skin or suffer from frostbite leading to skin and tissue damage.
Nerve Damage – prolonged exposure to cold can reduce blood flow and lead to nerve and tissue damage.

Potential Risks of Ice Baths

If you have the following health conditions, ice baths may not be the best therapeutic modality for you. Before you consider trying an ice bath, consult with your physician to avoid potentially serious problems:

Cold Hives – itchy welts, swollen lips and throat when your skin comes in contact with something too cold.
Heart or Lung Conditions – when vasoconstriction of the blood vessels occurs from the cold, your heart rate and blood pressure increase dramatically. The excess strain on your heart can be dangerous, especially if you have compromised cardiopulmonary function. It can also lead to an irregular electrical rhythm (arrhythmia), which can be serious.
Raynaud’s Syndrome – lack of blood flow to the fingers and toes cause a hypersensitivity and cause them to turn white or blue. It can lead to tissue damage.

In Conclusion

What the Science Says –

While some studies have shown that subjects report less muscle soreness following CWI when compared to rest, most studies suggest that the reported effects are placebo. Also, reports of improved circulation, reduced inflammation and improved recovery or performance has not been scientifically validated. In view of this, it is recommended that those considering the use of CWI for pain and inflammation management, reduced muscle soreness, and mood elevation, should consult their physician to determine if the potential risks are worth the purported benefits.

SOURCES: nih; health.com; health.clevelandclinic.org; prevention.com

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According to the United States Environmental Protection Agency, NEPA and all of Pennsylvania is experiencing a change in climate as indicated by a half a degree (F) in temperature, more frequent and heavy rainstorms and the tidal portion of the Delaware River is rising one inch every eight years. Last summer was one of our hottest on record and this summer more is expected. For those without air conditioning or access to a lake or pool, it will also be remembered as record setting warm temperatures. A local reader who cares for her elderly mother wrote to express her concern about dehydration in the elderly. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year-round.

Next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours). The consequences can be life threatening and the symptoms can be alarmingly swift.

In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.

Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.

Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. Older adults often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly people may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration.

Elders may suffer headaches, fainting, disorientation, nausea, seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated.

Those who care for the elderly whether at home or in a health care facility need to be alert to the following symptoms:

CHANGE IN MENTAL STATUS (CONFUSION)
WARM,MOIST SKIN WITH POOR SKIN ELASTICITY: gently pull the skin on the forehead and over the breastbone by pinching and releasing a skin fold; if the skin remains elevated for 3 seconds or more, dehydration is suspected
DRY, STICKY MOUTH WITH CRACKED LIPS AND DRY FURROWED TONGUE
DRYNESS IN NOSE
DECREASED BLOOD PRESSURE
INCREASED PULSE RATE (RACING HEART; HEART BEATING TOO QUICKLY)
CONSTIPATION
CONCENTRATED URINE WITH SCANTY OUTPUT: as the urine becomes more concentrated, it irritates the bladder and may increase the urge to void resulting in frequent, small voidings.
WEIGHT LOSS
SUNKEN, TEARLESS EYES
FAINTING WHEN STANDING UP (FEELING LIGHT-HEADED AND DIZZY WHEN STANDING AFTER SITTING OR LYING DOWN)

By the way, plain old tap water is a good way to replenish fluid loss. Keep in mind that some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed from the stomach. Consuming alcoholic and caffeinated beverages actually have an opposite, diuretic effect!

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New study recommends a 15 minute walk after a meal reduces blood sugar!

Spring has sprung in NEPA and summer is just around the corner... great news for outdoor enthusiasts! It is also good news for those who need walk for health reasons. However, 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.” A recent study demonstrated that a 15 minute walk after a meal is very effective in reducing blood sugar levels.

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.

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(and back, shoulders, etc)...

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:

10 Health Tips for Spring Cleaning:

Have a Plan - Take your time
- It doesn’t have to be done in one day or one weekend!
- Make a list, follow a schedule and do it over the course of 3-4 weeks
Do Not Move Heavy Furniture or Appliances by yourself
- Get Help –
- Use Sliders – to move heavy items like furniture
Be Cautious on Ladders and Stools
- Falls are a leading cause of injury mortality in the US and 43% of fatal falls have involved a ladder, according to the Centers for Disease Control (CDC).
- Avoid Reaching or stepping on the top step
- Open and lock the ladder properly instead of leaning it against a wall
Use Proper Ergonomics
- Lift Properly – back straight, knees bent
  - Incorrect Correct
- Work at Eye Level – don’t work overhead for extended periods of time. Working overhead extends the neck and back and can lead to compression of the spine. This can cause pain, muscle spasms, headaches and pinched nerves which radiate symptoms into the arms and legs. Also, overextending and reaching with the shoulder, such as when cleaning windows, can lead to shoulder pain and stiffness from tendonitis or bursitis.
  - Incorrect Correct
- Wear a support if needed: knee or back brace, tennis elbow strap, arch supports
- Avoid Prolonged Squatting – instead, kneel on a kneeling pad or wear knee pads
Use Caution Walking on Wet Surfaces
Use Caution Working Around Water and Electricity
Use Caution When Working with Household Cleaning Chemicals – provide adequate air circulation
Wear a Mask – when using cleaning chemicals or around dust, mold etc
Limit the Amount of Weight or Items You Carry – especially on the stairs
Take Breaks
- Hydrate, Eat, and Rest
- Stretch – neck, back, shoulders with a wall stretch

7 Safety Tips for Spring Cleaning:

Replace or Clean Filters for air and heat units
Clean out Medicine Cabinet
Get rid of unused and expired meds properly
- Call your local pharmacist for details
Clean Attic, Garage, Cabinets and Basement of Dangerous Chemicals or toxic trash
- Old paint cans, paint thinner, soiled rags, brushes etc
- Contact your local government agency or recycling center for details
Remove mold and fungus from bathroom and laundry room
Replace Batteries in Smoke, Fire and Carbon Monoxide Detectors
Clean the Chimney – call a professional to protect you from carbon monoxide exposure

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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Guest Columnist: Paul Mackarey, Jr. DPT

According to the Centers for Disease Control and Prevention (CDC), the 2025/26 flu season has been exceptional. Normally, elderly adults have the largest number of flu related hospitalizations while young children are second. This year, however, baby boomers between 50 and 64 years of age are the second most vulnerable. And, as of January 2026, the US flu season has resulted in an estimated 19 million illnesses, 250,000 hospitalizations, and 10,000 deaths. At the risk of creating an overreaction and promoting “germaphobic” behavior, if there is one time of year that diligent hygiene has merit, it is now…during flu season.

Contracting the cold or flu can make you feel run-down and under the weather for weeks. Unfortunately, your daily activities and responsibilities cannot take a sick day. The common cold and flu is most prevalent during late fall, winter and early spring. According to flufacts.com, “The influenza virus, more commonly known as the flu, is defined as a contagious respiratory infection that infects the nose, throat, and lungs. Thankfully, there are several easy and effective preventive measures that can reduce the probability of contracting the cold and flu. These preventive measures are designed to help keep your immune system strong and healthy. A healthy immune system fights against pathogens, such as the cold and flu virus. This article will focus on the ten best ways to prevent the flu and cold this season.

10 Ways to Prevent the Cold and Flu:

Get Vaccinated
- The vaccine produces antibodies that protect against the cold and flu virus within two weeks after vaccination. There are currently two different types of vaccines; an “intramuscular shot,” meaning it is injected into the muscle and a nasal-spray vaccination is available for people two to 29 years of age. The traditional intramuscular vaccine has been used for decades and has been approved for use in people six months of age and older. Recently, two new intramuscular vaccines are available. A hi-dose vaccine was designed for people 65 years and older and a vaccine designed for people 18 to 64 years of age is also available.
Wash Hands Regularly
- The most common way to spread the cold and flu virus is by direct contact. The virus can live on surfaces for hours and even days eagerly waiting to get picked up by the next individual.
Do Not Cover Sneezes With Your Hands
- Germs attach onto your hands and can be passed onto other public surfaces. The most effective ways to cover a sneeze are to use a tissue or your sleeve.

Exercise Regularly
- Exercising regularly causes an increase in your heart rate. Therefore, the heart can pump more oxygen rich blood throughout the body. Increased blood flow to the body has been proven to increase the body’s immune system and help to prevent illness.
Eat Well
- Eating nutrient rich foods is the best way to keep your immune system strong. Phytochemicals are natural immune boosting chemicals found in plants, fruits and vegetables, specifically, dark green, red, and yellow vegetables and fruits. Yogurt is also an effective way to prevent illness. Studies have shown that eating low fat yogurt regularly can reduce susceptibility to colds by 25 percent. Research also suggests that the natural bacteria found in yogurt stimulates and strengthens the immune system.

Stay Hydrated
- Staying hydrated is important. Water flushes your system by filtering out poisons as it replenishes your body. Dehydrated individuals feel tired and unfocused. A healthy adult requires eight 8-ounce glasses of fluid a day. The easiest way to determine if you are dehydrated is by the color of your urine. If it is dark yellow your body may require fluids.
Get Plenty of Sleep
- Doctors recommend a full eight hours of sleep a night. The demands of your busy life sometimes make that difficult. However, during the cold and flu season, it is particularly important. If you are not well rested, your body becomes tired and “run-down,” leading to a weakened immune system and leaves you more susceptible to illness.
Do Not Smoke
- Statistics show that smokers are at a higher risk of contracting more frequent and severe cold and flu symptoms. This is because the toxic chemicals in smoke are seen as pathogens or foreign contaminants in the body. As a result, your immune system is working overtime. Also, smoking is proven to paralyze cilia that line your nose and lungs. The cilia, or delicate hairs, are designed to remove cold and flu viruses out of your nasal passageway before they can infect the body. Smoking a single cigarette can paralyze the cilia for up to 40 minutes.

Drink Less Alcohol
- Heavy alcohol consumption negatively affects the body and its immune system in several ways. Heavy drinkers are more prone to cold and flu illnesses because alcohol suppresses the immune system and significantly dehydrates the body.
Most Importantly Relax
- It is important to relax and “unwind” at the end of a busy day. Relaxing lowers cortizol levels in the blood. Cortizol is a hormone released into the body’s blood stream when a person is feeling stressed or pressured. Over time, this hormone weakens the immune system. Relaxing causes interleukins, the main components of your immune system that fights against the cold and flu virus, to increase in your bloodstream. It is recommended that one makes time for at least 30 minutes of relaxation each day.

THE 10 MOST GERM-FILLED ITEMS YOU USE DAILY (webMD)

CELLPHONE – it is with us at ALL times; kitchen, bedroom, bathroom, office car. Bacteria loves its warm dirty surface and has been found to be 10 times dirtier than a toilet seat as E.coli, a harmful and potentially deadly bacterium has been found on it. Wash your hands often and swipe the surface with antibacterial swipes frequently.
TV REMOTE CONTROL – stuck between the dark and warm pillows and sofa cushions, bacteria flourish on the surface of this device which has been touched by every family member and their runny-nosed friends.
COMPUTER KEYBOARD – like the phone and remote, it is the most touched and dirty places in your daily routine. Wash hands and swipe surface.
DISH SPONGE – considered the dirtiest item in your home or office. Ring it out after each use, soak in bleach, clean in dishwasher and replace often.

TOOTH BRUSH HOLDER – the germs from your mouth drip from the brush onto the holder two or three times a day. Overtime, a buildup of germs becomes overwhelming and dangerous as those with illnesses share the holder with others. Dry the brush after each use and clean the holder often. During an illness, do not share the holder and start a new toothbrush after an illness.
MONEY - as much as we love the feel of money in our hands, studies show that the average dollar bill has 3,000 bacteria. Wash your hands after handling money.
OFFICE KITCHEN – not everyone in your office practices good hygiene. The sink, sponge, towels, cups, silverware, and dishes in your office area potential Petri dishes. While it is good to use reusable products, take care to clean them carefully and use wash, dry, bleach, and replace.
LAUNDRY – some studies show that dangerous viruses found in undergarments are able to survive the spin cycle and dryer. For those items, hot water, bleach, and long hot drying cycles are recommended.
PURSES/BRIEFCASES – money, food, tissues, and hundreds of hands. It goes wherever you go…bathroom, countertop, bank, and office. Clean and empty regularly.
ATM – countless strangers touch the ATM keypad in a public area where dirty money is handled regularly. Use antibacterial swipes and wash hands.

Sources: www.flufacts.com; www.webmd.com; www.lifescript.com; www.cdc.gov

Guest Contributor: Paul Mackarey, Jr. DPT, is a Doctor of Physical Therapy and partner at Mackarey & Mackarey Physical Therapy Consultants, LLC in Scranton and Clarks Summit.

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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.

Snow Shoveling as a Form of Exercise:

GOOD - For the Young and Healthy – studies show that snow shoveling for 15 minutes is considered moderate physical activity and extreme and vigorous physical activity when performed more than 15 minutes even for young healthy college students.
BAD – For the Older and Unfit – research clearly shows that there is a significant increase in heart attacks among snow shovelers. If you have any risk factors or medical condition and do not exercise regularly consult your physician.
Cold Weather – makes this activity even more difficult and physically stressful. Cold air makes breathing more labored and difficult and cold temps create added strain on the body.

People at High Risk of Illness Due to Snow Shoveling:

History of Heart Attack
History of Heart Disease
History of High Blood Pressure or High Cholesterol
Smokers
Inactive & Sedentary Lifestyle
Overweight
Elderly

10 TIPS FOR SAFE SNOW SHOVELING:

MEDICAL CLEARANCE: If you have any medical condition or risk factors consult your physician.
PAIN: Stop immediately if you experience any pain. Especially in the chest, left arm, jaw, face, neck, or lower back.
ERGONOMICS: Choose a snow shovel that is right for you:
- An ergonomic shovel with a curved handle allows you to keep your back straighter or arched when shoveling
- An ergonomic shovel with a shorter or adjustable handle length allows you to keep your back straighter and knees bent when shoveling. The right handle length allows you to arch your back 10 degrees with your knees slightly bent when the shovel is on the ground.A plastic shovel blade is lighter than a metal one and will be better for your spine.
- A smaller blade is better than a larger blade. It may take longer but will stress your back less.
PUSH: When possible, push the snow. Do not lift it. Lifting is much more stressful on the spine. You can find shovels that are ergonomically designed just for pushing snow.
WARM – UP: Be sure your muscles are warm before you start to shovel. Cold and tight muscles are more likely to strain than warm, relaxed muscles. Layer and consider compression shirts or tights can help prevent cold and tight muscles.
LEVERAGE: When you grip your shovel, spread your hands at least 12 inches apart. This will improve your leverage and reduce strain on your lower back.
TECHNIQUE: Shoveling technique is very important. The American Academy of Orthopaedic Surgeons recommends:
- Squat with your legs apart, knees bent and back straight.
- Lift with your legs. Do not bend at the waist.
- Scoop small amounts of snow into the shovel and walk when you want to dump it.
- Do not hold the filled shovel with outstretched arms.
- If snow is deep, remove in piecemeal, a few inches at a time.
- Rest and repeat as necessary.
- Move your feet and do not twist your back as you shovel or dump. Never throw snow over your shoulder
CAUTION: Be cautious shoveling wet snow. One full shovel can weigh 25 pounds.
- Shovel wet snow slowly in piecemeal.
PACE YOURSELF: Take frequent breaks and stretch your back in the opposite direction of shoveling. For example: 1. Lean backwards and extend your lower back. 2. Pinch your shoulder blades together.
TECHNOLOGY:
- Snow Blower - Use a self-propelled snow blower. It will put much less stress on your lower back than shoveling snow if used correctly. For example, push the blower with your legs and keep your back straight or arched and knees bent.
- Ergonomic Shovels:
- Rechargable Electric Snow Shovel: Toro, DeWalt, Voltask
- 2 Handle Shovels: ErgieShovel or Snow Joe ShovelutionPush Shovels: Garant Yukon or Garant Sleigh Shovel
- Snow Melting Alternatives:
  - www.warmlyyours.com
  - WarmlyYours - HeatTrak® portable snowmelting system for roofs, gutters, driveways, sidewalks, stairs and handicapped ramps uses electric mats or runners for home or office which can be customized.

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

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Part I of II

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface.

It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.

However, OA is not an excuse to avoid exercise, but it is important to be smart about it. Regular exercise is essential to maintain a normal lifestyle for those with OA. However, if you make poor lifestyle choices, do the wrong exercise, use poor technique, or are too aggressive, you could flare up your joints and do more harm than good.

Don’t Carry Extra Weight
- Your joints, which link your bones together, are sensitive to heavy loads. Every pound on your frame puts 4 pounds of stress on your knees. It also strains your back, hips, and feet.
- That causes wear and tear that can lead to damage, aches, and pain. A poor diet, which can lead to being overweight, can also be the source of inflammation. That can make all your joints, including in your hands, stiff, painful, and swollen.
Don’t Text Too Much
- “Texting thumb” is a real thing. Your tendons can get irritated and lock your thumb in a curled position. All that looking down at your phone is just as bad for your neck and shoulders, too. Every inch your head drops forward raises the load on your muscles.
Don’t Wear High Heels Too Often
- While they might look styl”n, the higher the heel, the more your weight tips forward. Your leg muscles have to work harder to keep your balance and alignment, which can cause pain. When heels go up, so does the twisting force in your knees. If you wear them every day, you increase your odds of developing OA.
Don’t Wear the Wrong Shoes
- Old, worn-out shoes will not adequately support your feet and ankles. That’ll throw your knees, hips, and back out of whack. Also, make sure your sneakers are right for your sport. High tops for basketball, for example, can protect your ankles from sprains and flip flops or summer beach shoes are not meant for long distances…especially if you are over 50.
Don’t Crack Your Knuckles
- That satisfying pop comes from tiny bubbles bursting in the fluid around your joints, or from the ligaments snapping against the bone. While it might not cause OA directly, one study showed that this habit may cause your hands to swell and weaken your grip.
Don’t Carry a Heavy Bag
- Whether it’s a purse, backpack, or messenger bag, packing too much can cause neck, back and shoulder pain. Heavy weight on one shoulder throws off your balance and your walk. If you tend to carry things only on one side, the constant pull overstretches your muscles and tires out your joints.
Don’t Use Wrong Muscles for the Job
- When you put too much load on little muscles, your joints pay the price. If you need to open a heavy door, for example, push with your shoulder instead of your fingers. When you lift something off the floor, bend at your knees and push up with your strong leg muscles, instead of your arms.
Don’t Sleep on Your Stomach
- While it might help with snoring, it may not be best for the rest of your body. Lying on your belly pushes your head back, which compresses your spine. Your head also will face in one direction for longer stretches than if you sleep on your back.
Don’t Skip Stretching
- Gentle, comfortable, active stretching on a regular basis can help strengthen your muscles and tendons. It also can make them more flexible. That allows your joints to move more easily and helps the muscles around them work better.
Don’t Skip Strength Training
- Once you turn 40, your bones start to get a little thinner and more likely to break. If you build muscle with strength training, it slows bone loss and triggers new growth. So, you not only get stronger muscles, but denser bones, too. Together, they stabilize your joints so you’re less likely to get hurt. In fact, studies show that the stronger your leg muscles, the less stress on your knees.

SOURCES: WebMD, University of Pennsylvania,

Visit your family doctor regularly and listen to your body.

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

Next Week: Part II of II “Save Your Joints”

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Happy Holidays Seniors! My gift to readers this holiday season is to offer some health tips for seniors. However, before I get accused of being a “Scrooge” about enjoying the food and drink associated with the season, please know that I was raised in an Italian kitchen. As such, it is fair to say that I have and will eat my fair share of the Italian Christmas Eve food celebration consisting of, but not limited to: Chianti wine, seafood antipasti, calamari, baccala, smelts, pasta with anchovies, seafood ravioli, cannoli, Italian cheesecake and Baci Perugina Dark Chocolate Hazelnut candy, cappuccino, espresso, sambuca and limoncello.

Overindulgence during the holidays causes many, including seniors, to make New Year's resolutions related to diet and exercise. But, this year, I propose that you incorporate healthy habits during the holiday season, and you may find that your resolutions are not as hard to keep. According to American Association of Retired Persons (AARP), seniors are considered those 50 years old and older. I will never forget how humbled I felt when I received my application to join AARP a few years ago. With this in mind, this year I offer healthy holiday tips for seniors, who are especially vulnerable to unhealthy holiday habits.

Exercise every day.
- Every day, get out of the house for a walk to view the outdoor Christmas lights and decorations. Dress for the weather, walk with a companion, and take along a flashlight if necessary to illuminate your path and use caution to avoid falls on slippery sidewalks.
Combine shopping and walking.
- In inclement weather, combine holiday shopping with your exercise. Indoor malls are great places to walk. Inquire with the mall management about walking clubs. Plan to shop early or late to avoid crowds. If you are planning on shopping in a particular store, park at the opposite end of the mall -- even if time is short, you will still get some exercise.
Remember to take your medications.
- Routines are disrupted during the holidays and you may forget important medications. Make a special reminder to take your medications or order re-fills. If you are traveling, be sure to take enough medications with you in case of delays and have a copy of your prescriptions in case of loss. Be sure to bring a phone number for your doctor along with your health insurance cards, in case of emergency. Carry your medications in your carry-on luggage if you are flying.
Eat your vegetables and salad first.
- Beginning your meal with healthy vegetables and salads will fill you up and reduce the temptation to over-indulge on high-fat, high-calorie foods. Taste your holiday favorites in small amounts to satisfy your palate.
Be aware of drug interactions.
- According to Dr. Amy Anderson, internal medicine physician on the medical staff at Baylor University Medical Center," says holiday spices like cloves, thyme and sage can interfere by as much as 50 percent with the body's natural ability to utilize common drugs." Talk with your doctor or pharmacist about your medications and find out if there are any foods you should avoid while taking them.
Know your food ingredients.
- If you have food allergies, ask about ingredients before you indulge. Be especially careful of home-baked goods if you have an allergy to tree nuts or peanuts. Those ingredients can be deadly if you are affected by these types of allergies.
Practice allergy-free decorating.
- If you suffer from allergic rhinitis, holiday decorations stored in the attic and basement can build up a coating of dust and mold that can trigger allergies. Some people may also need to rethink Christmas tradition and substitute an artificial tree.
Get a flu shot.
- The holiday season includes plenty of kissing and hand shaking. Getting a yearly flu shot and frequent hand washing are your best defense for avoiding the flu. If you are sick with a cold or flu, limit contact with others until you are well so you don’t infect others.
Get a good night's sleep.
- Holiday preparations and helping Santa means less sleep. Do your best to get to get at least 6-7 hours of sleep every night and avoid heavy foods, chocolate, caffeine and alcoholic beverages before bedtime. If you need to recharge, take a nap during the day.

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