Recently, two patients asked me when I thought it would be safe for them to return to their exercise programs after abdominal surgery. She stated that she was not sure how to properly and safely implement or return to her program.
This column will attempt to ensure a safe return to activity and exercise following general surgery such as gall bladder, appendix, hernia, etc. The post-operative patient has many questions: When is it safe to begin an exercise program? How do I begin? What is the best exercise? Which exercises are best? How do I know if the activity is too intense or not intense enough? Are there safe guidelines?
Before you begin, discuss your intention to exercise with your surgeon and primary care physician. Get medical clearance to make sure you can exercise safely. With the exception of short daily walks, don’t be disappointed if your surgeon requires you to wait at least until your 6 week post-op check-up to begin exercise.
While a 60 minute workout would be the long term goal, begin slowly at 15-20-30 minutes and add a few minutes each week. Make time to warm up and cool down.
Warm-up 5-10 minutes
Strength Training 10-15-20 minutes
Aerobic 10-15-20 minutes
Cool down 5-10 minutes
How to Monitor Your Exercise Program:
First, determine your resting heart rate by taking your HR (pulse) using your index finger on the thumb side of your wrist for 30 seconds and multiply it by two. 80 beats per minute is considered a normal HR but it varies. This is a good baseline to use as a goal to return to upon completion of your workout. For example, your HR may increase to 150 during exercise, but you want to return to your pre exercise HR (80) within 3-5 minutes after you complete the workout.
For those who are healthy, calculating your target heart rate (HR) is an easy and useful tool to monitor exercise intensity.
220 – Your Age = Maximum Heart Rate
EXAMPLE for a 45 year old: 220 – 45 = 175 beats per minute should not be exceeded during exercise.
For those concerned about calories expended during exercise.
NOTE: Keep the level at a light/moderate level for the first four to six weeks and advance to the moderate/heavy at week six. The Very Heavy Level may not be appropriate for 12 weeks post op is for those who have a reasonable fitness level and exercise 4-5 days per week.
Example of Data Found on Fitness Equipment
Remember, this is only accurate if you program your correct height, weight and age.
Level kCal/min MET
Light 2 - 4.9 1.6 – 3.9
Moderate 5 - 7.4 4 – 5.9
Heavy 7.5 - 9.9 6 - 7.9
Very Heavy 10 - 12.4 8 – 9.9
Always secure physician approval before engaging in an exercise program.
If the patient is on beta blockers (Atenolol, Bisoprolol, etc), it is important to use the Borg Rating of Perceived Exertion Scale (RPE) scale to determine safe exercise stress since exercise will not increase HR as expected:
0 - Nothing at all
1 - Very light
2 - Light
3 - Moderate
4 - Somewhat intense
5 - Intense (heavy)
6
7 - Very intense
8
9 - Very, very intense
10 - Maximum Intensity
NOTE: Keep the RPE at 2-3 the first 6 weeks post op and advance to level 3-4 at 8-12 weeks post op. Levels 5-6-7 are for those with a reasonable fitness level and exercise 4-5 days per week. The advanced levels should not be attained until 2-3 months of exercise and 3-4 months post op.
MEDICAL CONTRIBUTOR: Timothy Farrell, MD, is a general surgeon at GCMC.
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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!
Osteochondritis dissecans, also called OCD, is the most common cause of a loose body or fragment in the knee and is usually found in young males between the ages of ten and twenty. While this word sounds like a mouth full, breaking down its Latin derivation to its simplest terms makes it understandable: “osteo” means bone, “chondro” means cartilage, “itis” means inflammation, and “dissecans” means dissect or separate. In OCD, a flap of cartilage with a thin layer of bone separates from the end of the bone. As the flap floats loosely in the joint, it becomes inflamed, painful and disrupts the normal function of the joint.
Typically, OCD is found in the knee joint of active young men who participate in sports which involve jumping or full contact. Although less common, it is also found in other joints such as the elbow.
Often, the exact cause of OCD is unknown. For a variety of reasons, blood flow to the small segment at the end of the bone lessens and the weak tissue breaks away and becomes a source of pain in the joint. Long term, OCD can increase the risk of osteoarthritis in the involved joint.
To properly diagnose OCD a physician will consider onset, related activities, symptoms, medical history, and examine the joint involved for pain, tenderness, loss of strength and limited range of motion. Often, a referral to a specialist such as an orthopedic surgeon for further examination is necessary. Special tests specifically detect a defect in the bone or cartilage of the joint such as:
Radiograph (X-ray) may be performed to assess the bones.
Magnetic Resonance Imaging (MRI) may be performed to assess bones and other soft tissues such as cartilage, ligaments, muscles and tendons.
The primary goal of treatment for OCD is to relieve pain, control swelling, and restore the complete function (strength and range of motion) of the joint. The age of the patient and severity of the injury determine the treatment methods. For example, medications assist with pain and inflammation reduction.
Young patients who are still growing have a good chance of healing with conservative treatment. Rest and physical therapy are the conservative treatments of choice. Rest entails avoiding any activity that compresses the joint such as jumping, running, twisting, squatting, etc. In some cases, using a splint, brace and crutches to protect the joint and eliminate full weight bearing, may be necessary for a few weeks. Physical therapy, either as a conservative or post operative treatment, involves restoring the range of motion with stretching exercises and improving the strength and stability of the joint through strengthening exercises. Modalities for pain and swelling such as heat, cold, electrical stimulation, ultrasound, compression devices assist with treatment depending on the age of the patient and severity of the problem.
Conservative treatment can often require 3 to 6 months to be effective. However, if it fails, arthroscopic surgery stimulates healing or reattaches the loose fragment of cartilage and bone. In some cases if the defect is small, surgery involves filling in the defect with small bundles of cartilage. In other cases, the fragment is reattached directly to the defect using a small screw or bioabsorbable device. More recently, surgeons are using the bone marrow of the patient to repair the deficit by stimulating the growth of new tissue (bone marrow stimulation).
In other cases, a plug of healthy tissue from the non-weight bearing surface of a patient's knee relocated to the defect to stimulate healing (osteochondral autograft transplantation OATS). While there are many surgical options for OCD, an orthopedic surgeon will help the patient decide the most appropriate procedure based on age, size of defect, and other factors.
While prevention is not always possible, some measures can be taken to limit risk. For example, if a child playing sports has a father and older brother who had OCD, then it would be wise to consider the following: Avoid or make modifications for sports requiring constant jumping. Cross-train for a sport to avoid daily trauma (run one day and bike the next). Also, do not play the sport all year round (basketball in the fall/winter and baseball in the spring/summer). Seek the advice from an orthopedic or sports physical therapist to learn proper strength and conditioning techniques. Learn proper biomechanics of lifting, throwing, squatting, running, jumping and landing.
Sources: Mayo Clinic
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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!
Congratulations to more than 1,000 courageous runners who finished the 27th Annual Steamtown Marathon today. Most, if not all of you are waking up this morning with a little less jump in your step than you had yesterday.
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.
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.
The Effects of Running 26.2 Miles on the Body:
(RunNow.com - Jim Peskett)
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!
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.
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.
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.
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.
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!
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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!
Like many of you, I have always enjoyed the outdoors...walking, running, biking, hiking etc. However, recently, I have been more concerned about being safe, (getting older and more cautious, distracted drivers) when doing these activities on the side of the road.
Almost 15 percent of all motor vehicle injuries to people happened to those not in cars but while walking, running or hiking, so one needs to be safe. In fact, over 4,000 walkers or runners were fatally hit by a motor vehicle according to the Centers for Disease Control (CDC). These statistics continue to increase as the number of distractions to drivers increases (phone calls, texts, etc). Consequently, walkers, runners and cyclists must be more aware than ever to prevent injury from motor vehicles and stay safe.
Source: http://www.runnersworld.com
Visit your doctor regularly and listen to your body.
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
“When is it safe for my child to start weight training?” This is a very common question asked by parents of young athletes who are looking for advice regarding their children’s participation in weight training. This month, for example, I received three such inquiries. While some who are eager to get a “competitive edge” may not be satisfied with the answer, these recommendations are grounded in the scientific literature and medical specialist with the hope to prevent injury and dispel fear and fallacy.
Weight training, weight lifting or resistive training all describes the use of a resistive force on a muscle to improve strength. While much attention has been given to the benefits of weight training in adults, much less has been written about its application in children.
According to the Journal of Pediatric Orthopedics, children less than 12 years old are considered prepubescent or before puberty. Teenagers who are between 12 and 19 are considered to be adolescents. Studies consistently demonstrate that strength gains are much more significant in adolescents than in preadolescents. It is important to note that these strength gains are not only from the enlargement of muscle fibers (hypertrophy), but also from the improvement in the coordination and efficiency in muscle contraction and the recruitment of motor units and fibers within the muscle.
Preadolescents lack the hormones necessary to develop masculine characteristics. Adolescents begin to produce the hormones of testosterone and androsterone to develop secondary sexual characteristics such as pubic hair and enlarged genitalia. In view of this, age 13-14 is the optimal age to safely begin and benefit from a well-designed weight training program.
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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!
Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what type of exercise is best for those suffering from osteoarthritis (OA). Osteoarthritis is also known as degenerative arthritis. It is the most common form of arthritis in the knee. It 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 and weakness with loss of function due to disuse.
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 do the wrong exercise, use poor technique, or are too aggressive, you could flare-up your joints and do more harm than good.
When performed correctly, exercise for those with OA has many benefits:
Pain Control
Exercise controls OA pain by releasing natural pain control chemicals in the body called endorphins. It also controls pain by assisting in weight loss and improving range of motion.
Weight Control
We all know how well exercise burns calories and that increased body weight creates increase stress on the joints.
Prevention of Joint Stiffness
Exercise will help maintain joint range of motion. A stiff joint is a painful joint.
Prevention of Muscle Weakness
Exercise will help maintain muscle strength. Weak muscles will allow or increase in joint wear and tear.
Maintain Lifestyle
If a joint is stiff and weak, then they become painful which negatively impacts your lifestyle. Exercise can prevent this problem.
Start Slowly
Wean into exercise because if you advance too quickly, you will flare up the joint and have increased pain. For example, walk for 5-10 minutes the first session. If you do not have pain, add 1-2 minutes each session.
Lose Weight
Every pound lost equates to less stress on your joints. For example, a loss of 5 pounds of body weight translates to 20-30 pounds of stress through the knee, according to David Borenstein, MD, President of the American College of Rheumatology. Also, body weight has a direct impact on daily activities. For example, walking upstairs creates stress through the knee equal to 4 times body weight and seven times body weight going downstairs. Therefore, less body weight equals less stress.
Low Impact Workouts
Low impact exercise creates less stress on the joints while strengthening leg muscles and those who those who maintain leg muscle strength have less stress on their joints. It is even important not to load your arms with heavy objects when walking or using stairs to limit joint stress.
Some examples of low-impact exercises are: walking, swimming, elliptical trainer, and biking. Strength training is also low-impact and should be performed with low weight and high repetitions. Water therapy is great for those with OA, especially in a heated pool. It is a great low-impact exercise with less gravity and stress on the joints. Walk, swim and do mild resistance exercises in the water. Use a snorkel and mask for swimming to limit excessive neck turning and back extension.
Walking is a great form of exercise; however, walking softly is important for those with OA. Wear good running shoes and orthotics if necessary. Discuss this with your physical therapist or podiatrist. When possible, use soft surfaces like cinder, mulch or rubber. Avoid grass and soft stand due to instability and torsion that may irritate your joints.
Warm-Up
Warming up your body is critical to prevent injury to the muscles and tendons. This can be done by marching in place or using aerobic equipment such as a bike for 5 to 10 minutes before exercise. Always perform the warm-up activity at ½ your normal pace.
Balance & Relaxation Techniques
Tai Chi and ballroom dancing are two good examples of activities which promote balance and relaxation. Studies showed that those with OA who participated in Tia Chi two times a week for eight weeks reported less pain, increased range of motion and improved daily activities and function. They also noted less low back pain and better sleeping.
Proper Clothing
Stay warm in winter and consider wearing compression shorts. Be cool in the summer months with DrytechR type material.
Pre/Post Exercise First Aid
If you are sore for longer than 12 to 24 hours after exercise, then you overdid it and must make adjustments next time. Otherwise, use hot packs, bath or shower before you exercise to loosen up and apply ice to your joints after exercise, especially if they are sore.
Post Exercise Stretch
Gentle, active range of motion stretches after exercise is important to maintain mobility. Do not bounce or cause pain. For example: Low Back – knees to chest; Arms – row –the – boat, arms behind head, arms behind back; Legs – wall lean calf stretch, bend and extend knees, open and close hips.
SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons; www.lifescript.com
Visit your doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy 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!
Tennis elbow, also called lateral epicondylitis, is an inflammation of the lateral (outside) bony protuberance at the elbow. It is at this protuberance that the tendon of the long muscles of the hand, wrist and forearm attach to the bone. As the muscles repeatedly and forcefully contract, they pull on the bone, causing inflammation. The trauma is irritating when working the muscles in an awkward position with poor leverage like hitting a backhand in tennis.
It is not unusual for a patient to come to my office with severe pain on the outside of their elbow. Especially, after intensifying their tennis workouts or changing the racquet string tension. Others come to me with pain on the inside of the elbow (“golfer’s elbow”) from wrist action that advanced golfer’s use at impact. However, this problem is not only for tennis players and golfers. Laborers working with wrenches or screwdrivers with an awkward or extended arm can also develop tennis elbow. Others who are vulnerable are: those working for hours at a computer using a mouse as well as those working hard maintaining their lawns and gardens.
In a more chronic problem, lateral elbow pain may arise by a degenerative condition of the tendon fibers on the bony prominence at the lateral elbow. Sporadic scar tissue forms from a poor attempt by the body to overcompensate and heal without eliminating the cause.
While symptoms may vary, pain on the outside of the elbow is almost universal. Patients also report severe burning pain that begins slowly and worsens over time when lifting, gripping or using fingers repetitively. In more severe cases, pain can radiate down the forearm.
Conservative treatment is almost always the first option and is successful in 85-90 percent of patients with tennis elbow. Your physician may prescribe anti-inflammatory medication (over the counter or prescribed). Physical/Occupational therapy, rest, ice, and a tennis elbow brace to protect and rest may be advised. Ergonomic changes in equipment, tools, technique and work-station may be necessary. Improvement should occur in 4-6 weeks. If not, a corticosteroid injection may be needed to apply the medication directly to the inflamed area. Physical therapy, range of motion, and stretching exercises may be necessary prior to a gradual return to activity. Deep friction massage can assist healing.
Exercises performed in a particular manner to isometrically hold and eccentrically lengthen the muscle with contraction.
New Conservative Treatment: Platelet-Rich-Plasma (PRP) is a new treatment for the conservative management of degenerated soft tissues that has recently received great media attention. In great part, due to its success in several high profile athletes. According to the Journal of the American Academy of Orthopaedic Surgeons,(JAAOS), platelet-rich plasma (PRP) is autologous (self-donated) blood with an above normal concentration of platelets. Normal blood contains both red and white blood cells, platelets and plasma. Platelets promote the production and revitalization of connective tissue by way of various growth factors on both a chemical and cellular level.
The actual PRP injection requires the patient to donate a small amount of their own blood. The blood is placed into a centrifuge (a machine that spins the blood at a high velocity to separate the different components of blood such as plasma, white and red blood cells), for approximately 15 minutes. Once separated, the physician draws the platelet-rich plasma to be injected directly into the damaged tissue. In theory, the high concentration of platelets, with its inherent ability to stimulate growth and regeneration of connective tissue, will promote and expedite healing.
Surgery for tennis elbow is only considered in patients with severe pain for longer than 6 months without improvement from conservative treatment. One surgical technique involves removing the degenerated portion of the tendon and reattaching the healthy tendon to bone. Recently, arthroscopic surgery developed to perform this technique. However, research does not support the value of one over the other at this point. Physical/occupational therapy is used after surgery. Return to work or athletics may require 4-6 months. More recently, a surgical technique using ultrasound to guide a needle to debride (clean) the area of scar tissue has been developed. If eligible for this procedure, the time required for healing, rehabilitation and return to activity is much shorter.
If you feel you suffer from tennis elbow, ask your family physician which of these treatment options are best for you.
Visit your doctor regularly and listen to your body.
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
Several years ago, while hiking to the bottom of the Grand Canyon with my family, my wife Esther developed “canyon knee,” also known as “hiker’s knee” or in medical terms, “patellar tendonitis.” Regardless of the term, the end result was that she had severe pain in the tendon below her knee cap and was unable to walk up the trail to get out of the canyon. In addition to ice, rest, bracing, and non-steroidal anti inflammatory medications, the National Park Ranger insisted that she use two trekking poles on her ascent to the rim.
Prior to that experience, I always thought that “walking, hiking sticks or trekking poles” were for show or those in need of a walking aide. Well, I could not have been more incorrect. Needless to say, Esther made it out of the canyon safely and, with the use of our life saving trekking poles; we have lived “happily ever after!” Now, 15 years later, I rarely walk more than 5 miles without my poles.
As a result of this experience, I have been recommending walking or trekking poles to my patients. These poles are an essential part of hiking or distance walking gear, for the novice and expert alike. Specifically, for those over 50 who have degenerative arthritis and pain in their lower back, hips, knees, ankles or feet, these simple devices have been shown to improve the efficiency of the exercise and lessen the impact on the spine and lower extremities. Additionally, using poles reduces the likelihood of ankle sprains and falls during walking. Trekking poles are also a safe option for those with compromised balance. If you want to walk distances for exercise and need a little stability but don’t want the stigma of a cane, trekking poles are for you.
Early explorers, Europeans and Native Americans have been using walking sticks for centuries. More recently, in the 1968 classic hiker’s bible, “The Complete Walker,” Colin Fletcher praised his “walking staff” for its multipurpose use: for balance and assistance with walking and climbing, protection from rattlesnakes, and for use as a fishing rod. Today, these sticks are now versatile poles made from light-weight materials.
Trekking poles are made of light-weight aluminum and vary in cost and quality. But, like most things, “you get what you pay for!” These hollow tubes can telescope to fit any person and collapse to pack in luggage for travel. Better poles offer multiple removable tips for various uses, conditions and terrains. For example, abasket to prevent sinking too deeply in snow, mud or sand; a blunt rubber tip for hard surfaces like asphalt or concrete, or the pointed metal tip to grip ice or hard dirt/gravel. Better quality poles offer an ergonomic hand grip and strap and a spring system to absorb shock through your hands, wrists and arms upon impact.
The poles should be properly adjusted to fit each individual. When your hand is griping the handle the elbow should be at a 90 degree angle. Proper use is simple; just walk with a normal gait pattern of opposite arm and leg swing. For example, left leg and right arm/pole swings forward to plant while the left arm/pole remain behind with the right leg .
This pattern is reciprocated with as normal gait advances (opposite arm and leg). I have been very pleased with my moderately priced poles (Cascade Mountain Tech from Dick’s Sporting Goods ($34.99 per pole). Prices range from $19.99 to 79.95 per pole. dickssportinggoods.com; montem.com; leki.com; rei.com. However, if you travel frequently to hike the State and National Parks, you may want to purchase more expensive poles that collapse and retighten more efficiently. (montem.com; leki.com;)
Montem Trekking Poles - with close-up of easy adjustable locking clasp.
There are numerous studies to support the use of trekking poles, especially research that supports their use for health and safety. One study compared hikers in 3 different conditions; no backpack, a pack with 15% body weight and a pack with 30% body weight. Biomechanical analysis was performed blindly on the three groups and a significant reduction in forces on lower extremity joints (hip, knee, and ankle) was noted for all three groups when using poles compared to those not using poles.
Another study confirmed that trekking poles reduced the incidence of ankle fractures through improved balance and stability. Additional studies support the theory that trekking poles reduce exercise induced muscle soreness from hiking or walking steep terrain and another study found that while less energy is expended in the lower body muscles using poles, increase energy is used in the upper body; therefore, the net caloric expenditure is equal as it is simply transferred from the legs to the arms.
In conclusion, it is important to remember that trekking poles for hiking or distance walking are much more than a style statement. They are proven to be an invaluable tool for health, safety and wellness by reducing lower extremity joint stress, improving stability and balance, and enhancing efficiency for muscle recovery.
Sources: Medicine and Science in Sports and Exercise. The Complete Walker, by Colin Fletcher
Model: Andrea Molitoris, PT, DPT at Mackarey Physical Therapy
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
I enjoy the privilege of working with people recovering from a wide variety of medical conditions. Many of these conditions can directly affect activities of daily living, particularly, the ability to drive safely: orthopedic and sports injuries, fractures, sprains and strains, joint replacements, hip fractures, shoulder and elbow surgeries and spinal fusions. Despite the many different types of problems, there is one question that is invariably asked, “When can I return to driving?” Unfortunately, the answer is not as simple as the question because it depends on many factors. Furthermore, the implications, such as a serious accident causing further damage to the injury or surgical site or harm to someone else, are significant and possibly critical. So, the next time you ask your physician this question, please follow instructions and be patient…remember, it could be your child or grandchild running into traffic to chase a ball and you would want the driver to be at optimal function to apply the brakes!
In our culture, the inability to drive has a significant impact on lifestyle and livelihood. A study published in the Journal of Bone and Joint Surgery, found that 74% of those unable to drive due to injury or surgery are dependent on family and most of the remainder depend on friends. 4% of those unable to drive have no help at all and more than 25% suffer major financial hardship.
The report also found that family physicians, orthopedic surgeons, podiatrists, and physical therapists are keenly aware of this dilemma but often fail to communicate effectively to patients about driving. Most medical professionals express serious concerns about liability regarding return to driving following an injury or surgery. They feel that there is a lack of data to support decisions and inadequate communication among each other. They agree that they must do a better job communicating with patients and their families so they can better prepare for a period of time during their recovery in which they cannot drive.
Recent studies published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) and the Journal of Foot and Ankle Surgery (JFAS),determined that there are two significant components in the decision of safely returning to driving after an injury or surgery; the time required for healing and the time required for a return of function. Additionally, it was found that those wearing a surgical shoe or walking boot demonstrated a significantly slower braking response time even in healthy/non-injured individuals wearing the shoe/boot.
During the time required for healing, in addition to the fear of an additional trauma from a motor vehicle accident to the healing body part, there is a general concern about the potential damage that may come from over using the body part to drive before it is adequately healed. For example, a healing fracture in the right lower leg might be compromised or delayed if one must suddenly and forcefully apply the brakes. Also, during this time, it is not unusual for post-injury or post-surgery patients to use pain medications, including narcotics. This will also compromise judgment and reaction time while driving.
Most orthopedic conditions heal in 6 to 8 weeks. However, as many of you may fully know, once a cast or splint is removed, you are not ready to run or jump. Depending on the severity of the injury, it may take many weeks of aggressive physical therapy to regain strength, range-of-motion, agility and dexterity to function at a safe level for a full return to daily activities, including driving.
The current research reinforces the fact that driving safely requires good function of the entire body. For example, just because you broke your shoulder bone but did not fracture your right leg does not mean that you are able to drive safely. Wearing a sling after arm surgery also compromises driving. First, you need a stabilized and healed injury prior to driving. Then, you must work in rehab to make modifications to return to safe driving. Apply the same scenario to injuries or surgery to the spine (neck and lower back).
*Based on research using driving simulators
7 TIPS TO KNOW WHEN YOU ARE READY TO DRIVE:
Remember, every case is unique and there is no substitute for communication with your orthopedic surgeon, podiatrist, family physician and physical therapist.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
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 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!
Holiday shopping is stressful to your body, as well as your wallet, having the potential for a backache afterwards. Driving from store to store, getting in and out of the car, bundled in a sweater and winter coat, the expert shopper carries package after package from the store, to the car, over and over again. Six, eight, or ten hours later, the shopper arrives home exhausted, only to realize that 15, or 20 packages must be carried from the car into the house. This dilemma is compounded by the fact that the rain turned to sleet, and the sleet to snow. Travel by car and foot are treacherous.
You are slipping and sliding all the way from the car to the house while carrying multiple packages of various sizes and shapes. The shopping bags get wet and tear, forcing you to tilt your body as you carry the packages. Of course, no one is home to help you unload the car and you make the trip several times alone. You get into the house exhausted and crash onto the couch. You fall asleep slouched and slumped in an overstuffed pillow chair. Hours later you wake up with a stiff neck and a backache from shopping. You wonder what happened to your neck and back.
Plan Ahead: It is very stressful on your spirit, wallet and back to do all of your shopping in the three weeks available after Thanksgiving. Even though we dislike “rushing” past Thanksgiving to the next holiday, try to begin holiday shopping in before
Use the Internet: Supporting local businesses is important. However, Internet shopping can save you lots of wear and tear. Sometimes, you can even get a gift wrapped.
Gift Certificates: While gift certificates may be impersonal, they are easy, convenient and can also be purchased over the internet.
Perform Stretching Exercises: Stretch intermittently throughout the shopping day…try the three exercises below, gently, slowly, hold 3 seconds and relax, repeat 5 times.
Model: Paul Mackarey, PT, DPT, Clinic Director, Mackarey PT
Visit your doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. 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!
