Part II of II: Gardening with Disabilities

Summer (and Memorial Day, the kickoff of the gardening season) will be here soon and gardeners in northeast PA are anxious work in their gardens and enjoy the fruits of their labor. Last week, Health & Exercise Forum presented tips for gardeners for preventing hand and arm injuries such as carpal tunnel syndrome. This week’s column is dedicated to prevention of lower back and lower body injuries when working in the yard and for gardeners with disabilities.

A relaxing and enjoyable activity for many, gardening can turn dangerous without proper precaution as repetitive stress injuries, back pain, muscle pulls, can stem from raking, weeding, digging and pruning, can turn into serious problems if not treated appropriately.  Since prevention is the best approach, the US Dept of Agriculture promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

People with various disabilities enjoy gardening at different levels. For example, those suffering from neurological diseases with muscle weakness, paralysis and poor balance as well as those with musculoskeletal problems such as neck and LBP or hip and knee arthritis can safely enjoy gardening at some level. This outdoor labor of love is very therapeutic.

Warm up and stretching is important. Don’t garden first thing in the morning before you have a chance to warm up. Get up, go for a short walk, have breakfast and maybe warm up with a hot shower before working in the garden. Some stretches include:

Corner Stretch: Stand facing a corner wall with arms and shoulders at 90 degrees. Lean into corner and stretch shoulders and back. (PHOTO 1)

Knees to Chest Back Stretch: While lying on your back, bring both knees up towards your chest. (PHOTO 2)

Note:  These exercises should never be painful when completing them.  You should only feel a gentle stretch. Hold the stretch10 seconds and repeat 5 times before you garden and every 2-3 hours while working. Should you experience pain, please consult your family physician or physical therapist.

The following guidelines to prevent injury and foster healthy gardening for those with and without disability:

• Listen To Your Body – Aches and pains are signals from your body that you may be doing something wrong or overdoing it. Just like a baseball player in spring training, you must ease into a new activity slowly and stop before you get pain. Do not try to do it all in one day.
• Take Frequent Breaks – Perform work in short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue and pain.
• Change Positions Often – Alternate positions from standing, sitting, bending, and kneeling every 15 to 20 minutes.
• Use Large Muscles- When possible use the large muscles of the body to do the work. For example, use your legs to push a shovel blade into the ground instead of your arms. Also, lift with your legs and not your back.
• Avoid Awkward Motions – Do not squat, twist and bend at the waist for prolonged periods or with repetition. 
• Use Supportive Devices and Braces – Remember to wear wrist and knee supports if you have a problem. A lower back brace or corset is also advisable when working in the garden to protect the spine and add support.
• Use Well Designed Tools.  Use the right tools for the job. Padded, ergonomic handles with extensions to add reach are helpful.   
• Use Sun Block, Sun Glasses and bug spray – to protect your skin and eyes from the sun and ward off ticks and other bugs.
• Plan ahead.  Use a container with wheels to carry supplies to the garden.  When necessary it should be carried/pulled with hands, distributing the workload equally and decreasing stress in the joints of your body.
• Eat Well and Stay Hydrated – When working outdoors eat and drink properly for the climate and temperature.
• Use Adaptive Devices -  Special gardening carts, wheel barrels, motorized carts, and a garden tractor with a cart can make a job easier, especially for those with disabilities.

1. “Easy-Grip” tools are available for those unable to grip strongly. For example, hand shovels and weed cultivators that attach to the wrist/forearm with Velcro straps and tools with telescoping extensions are available. (www.wrightstuff.biz)
2. Mobile Adjustable Stools – with arm rests and 2-3 steps that allow you to go from sitting upright to a position closer to the ground.
3. Elevated and Raised Beds – allows gardening from a standing, sitting or wheelchair height for improved safety and enjoyment.
4. Pipe Planter or Seeder – a PVC pipe 5-6 feet long allows planting and seeding without bending or kneeling. For example, a 6 or 8 inch pipe allows plants to slide down and be tampered into a hole and a 1-2 inch pip allows seeds to slide down to the ground for cover or planting.
5. Kneeling Pads, Mats, Carts – are healthier for your knees and back.

Source: Karen Funkenbusch, MA; Willard Downs, PhD.: U. S. Department of Agriculture - Agricultural Engineering Extension

Model: Ashley Ottaviani, PTA

NEXT 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. Access all of Dr. Mackarey's articles at our Health and Exercise Forum!

Part I of II: Prevention of Hand Injuries Associated with Gardening

Farmers and gardeners in NEPA always say that Memorial Day, the “kick off” day for planting without the fear of frost, however, it is not too early to start to prepare…not only the beds but your body! While gardeners are anxious to work in their gardens and enjoy the fruits of their labor, a relaxing and enjoyable activity can turn dangerous quickly. Precautions are necessary as repetitive stress injuries such as shoulder and elbow tendonitis and carpal tunnel syndrome can stem from raking, weeding, digging and pruning. Additionally, simple scrapes, blisters, and bites can turn into serious problems if not treated appropriately.  Since prevention is the best approach, the American Society of Hand Therapists (ASHT) promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

ASHT recommends following these upper extremity warm-up exercises prior to gardening:

Note:  These exercises should never be painful when completing them.  You should only feel a gentle stretch. Hold 10 seconds and repeat 5 times. Should you experience pain, please consult a physician or hand therapist.

1. Forward Arm Stretch: Fold your hands together and turn your palms away from your body as you extend your arms forward.  You should feel a stretch all the way from your shoulders to your fingers. (PHOTO 1)

2. Overhead Arm Stretch: Fold your hands together and turn your palms away from your body, but this time extend your arms overhead.  You should feel the stretch in your upper torso and shoulders to hand. (PHOTO 2)

3. Crossover Arm Stretch: Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder.  This stretch for the upper back and shoulder and should be performed on both sides. (PHOTO 3)

ASHT recommends the following guidelines to prevent injury and foster healthy gardening practices:

• Wear gloves at all times.   Bacteria and fungus live in the soil and a small irritation or cut can develop into a major hand infection.  Glove choice should be specific to the specific task.  Thick, leather or suede gloves may protect your hands from thorns, cuts and scrapes while pruning roses.  Rubber or latex coated gloves may be appropriate to aid in grip when working in the soil.
• Keep your hands and arms covered.  Be especially careful if you live in an area where you may disturb a snake, spider or rodent living in your garden.  You will be better protected from poison ivy, insect bites, ticks and other common skin irritants that may inhabit a garden.
• Take a break every hour or switch to another activity.  Overuse of repetitive motions, such as digging, and sustained/constant gripping can cause tendonitis of the wrist, elbow or lead to carpal tunnel syndrome.  Break up large tasks into short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue.
• Use a tool when digging into unfamiliar or new areas.  Buried sharp objects can cause tendon lacerations or punctures.  Use the correct tool for the task at hand in order to avoid accidental injury. 
• Store your tools to prevent accidents.  Learn how to use and store your tools correctly to prevent accidents, and keep sharp tools out of the reach of children at all times.  Also make sure to put all tools away after use to prevent future injuries.
• Regular/periodic tool maintenance.  Keep garden tools in top working order to reduce the physical effort required for yard and garden work.
• Use well designed tools.  Use tools with non-slip rubber or padded hands to protect the smaller joints in your hands.  Make a circle with your index finger and thumb—that is how the grip of the tools should be.  The shape of the handle should provide equal pressure along the palm. 
• Avoid awkward motions.  Using better body positioning minimizes muscle pain.  Work with the wrists in a neutral position by avoiding the extremes of motion (up, down and sideways).  Hold objects with a light grasps or pinch. To avoid a tight sustained grip.  Use both hands for heavy activities like lifting a bag of potting soil and alternate hands on more repetitive tasks like scooping dirt out of the bag into a pot.
• Plan ahead.  Use a basket or large handled container to carry supplies to the garden.  The basket should be carried with both hands, distributing the workload equally and decreasing stress in the joints of your upper body.

Professional Contributor: Nancy Naughton, OTD, CHT, is an occupational therapist and certified hand therapist practicing in NEPA. Model: Heather Holzman

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  Next Week: “Prevention of Gardening Injuries” Part II of II.  

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. Access of all of Dr. Mackarey's articles at our Health and Exercise Forum.

OVERTRAINING CAN LEAD TO STRESS FRACTURES

After enduring the challenges of a cold and snowy winter, late spring and early summer is the time of year when long distance runners ramp up their training in preparation for the some of the best half and full marathons in the fall: Steamtown, Philadelphia, New York, Marine Corps in DC to name a few. But, runners beware; overtraining can lead to stress fractures.

I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon to keep the intruders 26 miles away from their families in Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to the capital to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!

In the modern age, marathon and recreational runners enjoy testing their mental and physical stamina in pursuit of fitness and wellness. If not careful, many runners (and other competitive athletes) will develop pain in their shins (shin splints). Unfortunately, in many of these well-intended athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture. Some very good athletes have been hindered by this problem.

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

Who is at risk?

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.

Causes of Stress Fractures

1. Overuse, Overload, Overtraining – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
2. Inadequate Fitness Level – or inadequate activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program too quickly for cross-country in August/September.
3. 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.
4. Recent Change in Training Schedule – sudden increased intensity or speed
5. Recent Change in Running Surface – sudden change to a hard or soft surface
6. Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
7. Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
8. 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
9. History of Stress Fractures – makes the athlete two times as likely to have another

Treatment & Management

1. Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
2. Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
3. Correct Biomechanics - Orthotics, Running shoes, see a Podiatrist
4. Gradual Change in Training Schedule
5. Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
6. Gradual Change in Footwear – walk in new shoes first, then run 1-2 miles
7. If Overweight – gradual exercise with diet, not too much too quickly. Mix run & walk every 10 minutes
8. If Underweight – improve diet maintain healthly body fat%
9. Consult Family Physician – Early management often involves immobilization, rest, pain medicine 4-6 weeks for healing. non weight bearing cross training such as the recumbent bike, swimming, elliptical.
10. Physical Therapy- Physical therapy modalities such as ultrasound, cold with electrical stimulation, biomechanical taping or orthotic supports, and exercises for foot, ankle muscles.

Visit your doctor regularly and listen to your body.

NEXT 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

To read all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.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.