PEOPLE OFTEN ASK ME, “IS THERE SUCH A THING AS AN EXERCISE RUT?”. THEY WANT TO KNOW WHY THEY DO NOT SEEM TO BE IMPROVING WITH THEIR EXERCISE PROGRAM. They exercise 3-4 times a week for 30 to 45 minutes and they feel frustrated and STUCK in a rut.
The purpose of this column is to offer suggestions to improve or get more out of a “stale” exercise program. Last week’s column offered tips to improve a stale cardiovascular and strength program. We will discuss flexibility and functional training tips, including the components necessary for a healthy mind, body and spirit connection.
Flexibility training involves the careful stretching of the muscles, tendons and joints to improve range of motion in order to safely perform daily activities and sports without injuring or tearing soft tissues. It is probably the most neglected part of the fitness program. However, while the amount of inherent flexibility varies for each person, a minimal range is necessary as it relates to daily activities and sports. For example, as you age it is important to have enough flexibility in your back, hips and knees to wash your feet, put shoes and socks on. After a warm –up activity, perform flexibility exercises slowly and gently. There are two types of flexibility exercises; dynamic and static. Perform dynamic stretching with movement such as pushing the ankle up and down like a gas pedal. Complete passive stretching using an outside force, such as a towel to pull the ankle up to stretch the calf. Dynamic should be performed before an activity (before running or playing tennis) and static performed after the activity is over in order to increase range of motion for future activities.
In order to prevent an exercise program from getting stale, one must incorporate all aspects of wellness…a healthy mind, body and spirit!
It is easy for fitness enthusiasts to get so focused on maintaining a routine that they allow their program to become stale and ineffective. It is essential to reassess and update your program to prevent stagnation.
Make sure the routine has all three fundamental components of a well-balanced exercise program; cardiovascular, strength and flexibility training. Moreover, to be truly healthy, one must work toward a “Healthy Mind, Body, and Spirit. Therefore, in addition to traditional exercise one must incorporate the following: nutrition; meditation, relaxation techniques, yoga, core fitness; functional/sports specific training; leisure sports and activities
In order to prevent an exercise program from getting stale, one must incorporate all aspects of wellness…a healthy mind, body and spirit!
While each component offers its own specific benefit, the combination of all three cooperatively provides unique value. Too often, fitness enthusiasts concentrate on the exercises they LIKE or are good at more than the ones they NEED.
Sources: National Institutes of Health; American Council on Exercise
Model: Lily Smith, Physical Therapy Student, University of Scranton, PT aide, Mackarey Physical Therapy
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!
PEOPLE WILL OFTEN ASK ME, “IS THERE SUCH A THING AS AN EXERCISE RUT?” THEY WANT TO KNOW WHY THEY DO NOT SEEM TO BE IMPROVING WITH THEIR EXERCISE PROGRAM…they exercise 3-4 times a week for 30 to 45 minutes and they feel frustrated and STUCK in a rut. While initially responding favorably to exercise, after 6 -9 months or more, they do not notice progress in weight loss, strength, tone, endurance or daily function.
The purpose of this column will be to offer suggestions on how to improve or get more out of a “stale” exercise program or an exercise rut. Step one is to build an exercise program that is grounded in the basics. Next step two, which begins after the basics have been mastered, includes the components necessary for a healthy mind, body and spirit connection and translates into functional activities of daily living including work and leisure sports.
Make sure your routine has all three fundamental components of a well-balanced exercise program; cardiovascular, strength and flexibility training. While each component offers its own specific benefit, the combination of all three cooperatively provides unique value. Too often, fitness enthusiasts concentrate on the exercises they LIKE or are good at more than the ones they NEED. A well-balanced program includes what you like and need! In fact, recent studies show that those performing all three components surpassed those performing one or any combination of two of the training types when tested for efficient oxygen uptake (VO2 Max), production of HDL (good cholesterol), lower body fat percentage, and lower blood glucose levels.
Cardiovascular exercise is any activity that raises your heart rate and respiratory rate. This type of exercise strengthens the heart muscle and the muscles that assist in breathing. When these muscles are stronger, they in turn work more efficiently to deliver oxygen to your muscles and other parts of the body. Ultimately, these oxygenated muscles can work harder and longer to burn fat during exercise and at rest.
Examples of Cardiovascular Exercises: Running, Brisk Walking, Swimming, Biking, Rowing, Elliptical Training and Stepper Training. Most experts recommend at least 30 minutes of sustained cardio, 3-4 days per week. However, recent studies support the notion of performing 10-15 minutes, twice daily, 4 days per week. For those “stuck” in a fitness or exercise rut, to advance your program, cardio should be performed 5-6 days per week for 45-60 minutes.
Strength training is an activity that provides any type of resistance to muscle contraction to build strength in the muscle. The resistance can be without movement against an immovable object such as pushing against a wall (isometric) or with movement such as lifting up or lowering a weight down against gravity (isotonic/dynamic). There are two types of isotonic muscle contraction; concentric, which involves raising the weight against gravity as the muscle shortens and eccentric which involves lowering a weight against gravity as the muscle lengthens. A standing biceps curl is an example that incorporates both concentric and eccentric contractions. A progressive strength training program includes all three types of muscle contraction. By using the classic bicep muscle curl these photos will demonstrate all three types of muscle contraction:
-Isometric Bicep Muscle Curl – pull up on door knob without allowing any movement of the arm.
-Concentric Bicep Muscle Curl – raise a dumbbell up against gravity as the muscle shortens.
-Eccentric Bicep Muscle Curl – lower a dumbbell slowly (4-6 seconds) against gravity as the muscle lengthens.
Sources: National Institutes of Health; American Council on Exercise
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
NEXT WEEK! Read Stuck in an Exercise Rut…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 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!
American Heart Month is not just for lovers. Long after the Valentine’s roses wilt, our hearts will require special attention for a long healthy life. It is the goal of The National Heart, Lung, and Blood Institute to motivate Americans to adopt healthy lifestyles to prevent heart disease.
A recent study by the Center for Disease Control (CDC) found that while many Americans believe that they are “young at heart”, it turns out that many have hearts older than their actual age. For example, the study found that the average American male heart is eight years older and the average American female heart is five years older than their chronological age.
The CDC’s findings may offer some explanation for the fact that many Americans die from heart attacks, strokes, and heart failure when compared to other people around the globe. Furthermore, while more Americans use heart medications more than other people in the world, heart attack and stroke continue to be the leading cause of death in the US, killing more than 80,000 each year.
The CDC has developed a new test to determine “Heart Age,” which has been found to be a much more reliable indicator of a person’s risk for heart disease. The heart age test will determine if your heart is older, younger or average for your age, which can be much more important for longevity than chronological age.
The CDC is encouraging people to take matters into their own hands …be proactive. In addition to calculating your Body Mass Index ((BMI), the CDC is asking people to use an online calculator to determine their heart age. The calculator will give a person a more accurate percentage of risk for heart attack or stroke. Based on the outcome, one must see their family physician or cardiologist to discuss the results and implement a plan.
Heart Age is very easy to use: You just need to enter your age, sex, blood pressure, whether you are treated for high blood pressure, whether you smoke or have diabetes, and your body mass index (BMI), with a handy calculator if you don’t know it. The tool gives you your risk for heart disease in the next ten years, compared with normal.
Visit: www.framinghamheartstudy.org or www.heartfoundation.org
Enter: sex, blood pressure, (list if controlled), diabetes (list if controlled), smoking history, and body mass index (BMI), a simple height/weight calculation found on-line at www.bmicalculator.cc
Example: A 53 year old women with an acceptable BMI, may actually find that she is at great risk for suffering a heart attack or stroke because she smokes cigarettes and has uncontrolled high blood pressure. The calculator includes all the significant factors proven by science to affect a person’s risk of heart attack or stroke. These include: blood pressure, weight, BMI, blood sugar, cholesterol, age, sex and smoking history.
Example: 50 year old male smoker has uncontrolled high blood pressure of 140/96, no history of diabetes, and a BMI of 30 has a predicted heart age of 72 years. A female with a similar profile would have a heart age of 74 years.
To some, the solution may be obvious and for others it may be impossible. In the previous example of the 50 year old smoker, if he quit smoking for one year, he would halve reduced his heart age by 14 years (15 years for a woman). If he would reduce his blood pressure to 120, he would reduce his heart age by 6 years (10 years for a woman). And, if both risk factors were removed, he would reduce his heart age by 19 years (23 for a woman).
In the above examples, the 53 year old man does not have to take his 72 year old heart age as a death sentence.
BY THE WAY…I took the test:
Male: 65
Systolic Blood Pressure: 110
No high blood pressure or diabetes; non smoker
BMI: 22.5
HEART AGE: 62
SOURCES: WWW.CDC.GOV
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!
As most sports enthusiasts know, Aaron Rodgers, former Green Bay Packer quarterback and recent New York Jets QB (for just over a minute and half) suffered a season ending injury when he tore his Achilles tendon in the first game of the 2023/24 NFL season. Since then, I have been answering many questions from patients and sports fans about the nature of the Achilles Tendon rupture injury, recovery, and how to prevent it.
As the days continue to get shorter and temperatures begin a slow steady decline, athletes and exercise enthusiasts will work harder to warm-up and exercise during the winter months. A little caution and preparation are in order to avoid muscle/tendon strain, or worse yet, muscle/tendon tears, especially Achilles Tendon rupture. The Achilles tendon is one of the more common tendons torn.
This is the second of two columns on Achilles tendon rupture. Last week, I discussed the definition, sign and symptoms of the problem. This week will present examination, treatment and outcomes.
A thorough history and physical exam is the first and best method to assess the extent of the injury and determine accurate diagnosis. While a complete tear is relatively easy to determine, a partial or incomplete tear is less clear. Ultrasound and MRI are valuable tests in these cases. X-rays are not usually used and will not show tendon damage.
Consultation with an orthopedic or podiatric surgeon will determine the best treatment option for you. When conservative measures fail and for tendons completely torn, surgical intervention is usually considered to be the best option with a lower incidence of re-rupture. Surgery involves reattaching the two torn ends. In some instances, a graft using another tendon is required. A cast or walking boot is used post-operatively for 6-8 weeks followed by physical therapy.
Most people return to close to normal activity with proper management. In the competitive athlete or very active individual, surgery offers the best outcome for those with significant or complete tears, to withstand the rigors of sports. Also, an aggressive rehabilitation program will expedite the process and improve the outcome. Walking with full weight on the leg after surgery usually begins at 6 -8 weeks and often requires a heel lift to protect the tendon. Advanced exercises often begin at 12 weeks and running and jumping 5-6 months. While a small bump remains on the tendon at the site of surgery, the tendon is well healed at 6 months and re-injury does not usually occur.
Prevention of muscle and tendon tears is critical for healthy longevity in sports and activities. In addition to the Achilles tendon, the tendons of the quadriceps (knee) and rotator cuff (shoulder) are also vulnerable. A comprehensive prevention program includes: gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions. Also, utilizing interval training, eccentric exercise (lowering body weight slowly against gravity – Photo 1) and proprioceptive and agility drills are essential (Photos 2 & 3).
In PHOTO 1a & 1b: Eccentric Lowering and Lengthening: for the Achillies tendon during exercise. Beginning on the ball of both feet (1a), bend the strong knee to shift the weight onto the weak leg (1b). Slowly lowering the ankle/heel to the ground over 5-6 seconds. Repeat.
In PHOTO 2: Proprioceptive Training: for the Achillies tendon. Standing on a Bosu Ball while exercising the upper body (for example, biceps curls, shrugs, rows, lats) while maintaining balance on the ball.
PHOTO 3: Agility Drills: for the Achilles tendon involves stepping through a “gait ladder” in various patterns and at various speeds.
MODEL: Kerry McGrath, student physical therapy aide at Mackarey Physical Therapy
Sources: MayoClinic.com;Christopher C Nannini, MD, Northwest Medical Center;Scott H Plantz, MD, Mount Sinai School of Medicine
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 GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!
As most sports enthusiasts know, Aaron Rodgers, former Green Bay Packer quarterback and recent New York Jets QB (for just over a minute and half) suffered a season ending injury when he tore his Achilles tendon in the first game of the 2023/24 NFL season. Since then, I have been answering many questions from many about the nature of the injury and how to prevent it.
As the days continue to get shorter and temperatures begin a slow steady decline, athletes and exercise enthusiasts will work harder to “fit in” a warm-up before running or other activities during the winter months. But, no matter how limited time is, skipping the warm-up is risky. This time of year, one can expect to feel a little cold and stiff, especially if you are over 40, and therefore a little caution and preparation are in order to avoid muscle/tendon strain, or worse yet, muscle/tendon tears. The more commonly torn tendon is the Achilles tendon . Prevention of muscle tears, including the Achilles tendon includes; gradual introduction to new activities, good overall conditioning, sport specific training, pre-stretch warm-up, stretch, strengthening, proper shoes, clothing, and equipment for the sport and conditions.
A muscle contracts to move bones and joints in the body. The tendon is the fibrous tissue that attaches muscle to bone. Great force is transmitted across a tendon which, in the lower body, can be more than 5 times your body weight. Often, a tendon can become inflamed, irritated, strained or partially torn from improper mechanics or overuse. Although infrequent, occasionally tendons can also snap or rupture. A tendon is more vulnerable to a rupture for several reasons such as a history of repeated injections of steroids into a tendon and use of medications such as corticosteroids and some antibiotics. Certain diseases such as gout, arthritis, diabetes or hyperparathyroidism can contribute to tendon tears. Also, age, obesity and gender are significant risk factors as middle-aged, overweight males are more susceptible to tendon tears. Poor conditioning, improper warm-up and cold temperatures may also contribute to the problem.
Tendon rupture is very painful and debilitating and must not be left untreated. While conservative management is preferred, surgical management is usually required for complete tears. The purpose of this column is to present the signs, symptoms and management of Achilles tendon ruptures.
The Achilles tendon (also called the calcaneal tendon), is a large, strong cordlike band of fibrous tissue in the back of the ankle. The tendon (also called the heel cord) connects the powerful calf muscle to the heel bone (also called the calcaneus). When the calf muscle contracts, (as when you walk on the ball of your foot), the Achilles tendon is tightened, tension is created at the heel and the foot points down like pushing a gas pedal or walking on tip of your toes. This motion is essential for activities such as walking, running, and jumping. A partial tear of the tendon would make these activities weak and painful, while a full tear through the tendon would render these activities impossible.
With age, the Achilles tendon (and other tendons) gets weak, thin, and dehydrated, thus making it prone to inflammation, degeneration, partial tear or rupture. The middle-aged weekend warrior is at greatest risk. A full or complete tear (Achilles tendon rupture) usually occurs about 2 inches above the heel bone and is associated with a sudden burst of activity followed by a quick stop or a quick start or change in direction, as in tennis, racquet ball, and basketball.
In some instances, the tendon can be injured by a violent contraction of calf when you push off forcefully at the same time the knee is locked straight as in a sudden sprint. Other times, the tendon is injured when a sudden and unexpected force occurs as in a trip off a curb or sudden step into a hole or a quick attempt to break a fall.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog Next Week: Achilles tendon Part II of II.
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!
Runners will attempt to conquer 26.2 miles from Forest City to downtown Scranton in the 26th Annual Steamtown Marathon this Sunday. Participants may want to consider new research that suggests the use of compression socks may prevent post race blood clots.
Completing the long and arduous 26.2 mile journey is not an easy task. In fact, the mechanical and physiological toll on your body is tremendous; from painful joints, muscles, tendons, to black and blue toes. Not so obvious, however, is the damage to your deep veins and tissues of the circulatory system. New research indicates that strenuous endurance exercise, such as marathon running, stimulates the clotting mechanisms in your body in response to the multiple micro traumas sustained over 2 or more hours. While most healthy athletes will naturally heal from post exercise clot formation, others may be at risk…those traveling more than 1 hour (by car, bus, train or plane). The risk increases substantially for those with a longer period of travel/sitting post-race, history of previous trauma, blood clots or have the genetic predisposition for clot formation.
Compression socks are familiar to most people as the tight knee-high support stockings worn after a surgical procedure such as a knee or hip replacement to prevent blood clots. They are made with a special fabric and weave design to provide graduated compression (stronger compression at foot and ankle and less at the top of the sock) to promote better circulation and movement of fluids from the foot, ankle and calf back to the upper leg and ultimately the heart. Compression socks work similarly in runners. As the stagnant fluid with lactic acid and other byproducts of exercise is removed from the space, fresh blood, nutrients and oxygen is replaced to foster healing of micro damage to tissue and promote more efficient use of the muscles.
The Journal of Strength and Conditioning Research published a study that found wearing compression socks improved running performance. However, similar studies have failed to support this claim. One finding that has been repeatedly supported in the literature, including The British Journal of Sports Medicine, found that compression socks worn in soccer players and runners improved the rate and magnitude of recovery. Moreover, recent studies, including a study with the Boston Marathon, have demonstrated the reduction in clotting mechanisms in those wearing compression socks AFTER the marathon, as compared with those wearing “sham” socks. Benefits seem to be less obvious for short duration activities or when running 10km or less.
In conclusion, only time will tell if compression socks will improve performance in runners will or be merely a fad based on placebo or true fact supported by scientific research. Based on current wisdom, these socks may offer value and benefit AFTER activities of long duration (more than 1 hour) or long distance running (more than 10km) to expedite the recovery from exercise-induced blood clot formation, muscle soreness from the accumulation of lactic acid and other muscle damage byproducts.
It is this author’s opinion that this product is worth a try. However, whenever you try something new for your sport, trials should occur during practice and if successful used during competition. Consider trying a lower compression to begin (the socks come in different degrees of compression). Even if one is hesitant to use the product while running, it appears the greatest value of the sock is after a prolonged training session or competition to reduce exercise-induced muscle soreness and prevent blood clots, especially in athletes at risk for clotting and those traveling for an hour or more after the race. Additionally, in view of the fact that some studies which showed only minimal to moderate improvement in well-trained athletes, it may be that those in greater need, such as deconditioned individuals attempting to begin a fitness program and novice weekend athletes, may benefit more from compression socks than elite athletes.
TAKE HOME: Runners, cyclists, triathletes, soccer players and others participating in endurance sports should consider compression socks, if not during the activity, certainly following the activity for 24 to 48 hours…especially those at risk for blood clots and those traveling for more than one hour after the race.
Sunday consider trying compression socks and see if they work for you during and more importantly, after your long training runs.
Where to find compression socks:
2XU Compression Racing Sock – www.2XU.com
Scranton Running Company – Olive Street - Scranton
Visit your family doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our exercise forum!
Studies have shown a recent escalation of joint replacements in a much younger and more active group than previously noted…the baby boomer! While the end result is mostly physical, the cause is often psychological. We all know the personality type: type A, hyperactive, goal-oriented, driven, possessed and highly organized – almost at all costs! Many of you have seen fitness enthusiasts running through the streets at 5:30 AM for 5-10-15 miles each day. Moreover, many of these runners have more activities planned later in the day: golf, tennis, ski, swim, play sports with their kids. Well, after 20 years of this behavior, many of these enthusiasts are now suffering the effects of long term multiple micro traumas. They are suffering from what orthopedic surgeons at the University of Pennsylvania call “Boomeritis! Boomeritis is inflammation of the baby boomer from overuse. Lower back pain, hip, groin, and knee pain is almost a daily event.
As baby boomers continue to enjoy sports with the same vigor and intensity as when they were younger, they are finding that their older bodies just can’t keep up. While these individuals often succeed in finding the balance of fitness and craziness, they have had times when they took it too far. Furthermore, nearly all compulsive exercisers suffer from over training syndrome. When take too far compulsive behavior is rationalized by insisting that if they didn’t work to extreme then their performance would suffer.
*Each sign is worth 1 point:
If you have two or more of the warning sings, consult your family physician to rule out potentially serious problems.
Avoid weight bearing exercises two days in a row. Run one day, walk, swim or bike the next.
Use the elliptical instead of the treadmill.
Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.
Visit your family doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
For all of Dr. Mackarey's articles, visit our exercise forum!
Fall is here, cross-country running season has begun and the 26th Steamtown Marathon is only a few weeks away! With that in mind, running injuries, some very specific to women, are on the increase…
While driving to or from work have you noticed more local running enthusiasts in the past few years? Moreover, have your noticed that most of the runners are women? Scranton Running Company has contributed to NEPA’s participation in a national trend; more women are engaged in running than men! Female runners account for 9.7 million runners (57%) while 7 million males run on a national level.
With this surge, the female runner has been subjected to a host of related injuries, including shin splints, which often lead to stress fractures. New research has found that stress fractures may be related to the loss of weight and body mass associated with the sport.
A recent study from Ohio State University found that female runners with a Body Mass Index (BMI) below 19 may have a higher risk of developing stress fractures than women with a BMI of 19 or above. Furthermore, the study also found that these women took longer to recover from these injuries.
According to Timothy Miller, MD, “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture,”
The study also found that female runners with a BMI of 19 or higher with severe stress fractures required 13 weeks to recover from their injuries and return to running. Runners with a BMI lower than 19, however, took more than 17 weeks to recover.
They concluded that women should know their BMI and consult with a medical professional to maintain a healthy number. Additionally, women should cross-train and include resistance training to improve the strength and muscle mass of the lower extremities to prevent injury.
The current BMI wisdom, according to the National Institutes of Health, is 19.8 for men and 24 for women, however, strong and competitive women tend to have a BMI of 26. A BMI of 18 is considered malnourished.
Body mass index (BMI) is a measure of body fat based on height and weight of adult men and women over 20 years of age, according to the National Institutes of Health.
BMI = (weight in pounds / height in inches squared) X 703)
Example 1: a person who weighs150 pounds and is 68 inches (5 feet 8 inches) tall has a BMI of 22.8
Example 2: a person who weighs 110 pounds and is 66 inches (5 feet 5 inches) tall has a BMI of 17.7
Underweight < 18.5%
Normal weight 18.5 to 24.9%
Overweight 25 to 29.9%
Obesity 30 and over
A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin bone) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.
FEMALE RUNNERS WITH BMI LOWER THAN 19 – is a primary risk factor.
10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.
The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).
Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.
Source: Ohio State University, Science Daily
Visit your doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy!
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Paul's Articles, visit our exercise forum!
Fall in NEPA is one of my favorite times of year. For outdoor enthusiasts, there is nothing more refreshing than activities in the bright sunshine and crisp, clean air. The hot humid summer weather can be a deterrent to outdoor activities and this time of year provides an opportunity to get fit by beginning a walking program. For many who have not maintained an active lifestyle or have health issues, it is challenging to know where to begin. Moreover, beginning without a good plan can lead to injury and leave you discouraged. For example, those overweight and de-conditioned should not start a walking program too aggressively. Walking at a fast pace and long distance without gradually weaning into it will most likely lead to problems.
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!
“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.” According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:
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.
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.
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!
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!
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:
Visit your doctor regularly and listen to your body.
Sources : Sapiens.org; WebMD; Mayo Clinic
NEXT MONDAY BLOG and in print in THE SUNDAY TIMES TRIBUNE – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Paul Mackarey's articles, check out our exercise forum!
There is little doubt that the workplace has been redefined since the pandemic as many employees continue to work from home. Sitting for many hours at a workstation that may not be optimal has also changed the way we define workplace health and safety. It may be more important than ever to pay close attention to designing an ergonomic workstation, changing position, and stretching regularly to prevent injury.
Since 1894 Labor Day has been designated as the national holiday that pays tribute to the contributions and achievements of American workers. Research supports the notion that healthier employees are happier and more productive. When employers encourage healthy behavior and safety at work, they benefit in many ways. For example, in addition to improving job satisfaction and productivity, healthy employees save money by using less sick time, worker’s compensation benefits and health benefits. For example, according to the Centers for Disease Control and Prevention, approximately 75 percent of employers” health care costs are related to chronic medical problems such as obesity, diabetes, high blood pressure, and high cholesterol. De-conditioned, overweight employees are more likely to suffer from these preventable conditions and are at greater risk for injury. Employers, please consider using this holiday as an opportunity to start a health promotion program at your workplace…have a health fair, offer healthy snacks, encourage walking, smoking cessation, exercising at lunch, and offer fitness club stipends.
Lower back pain, one of the costliest illnesses to employers, is one example of a problem which can be prevented with a good health and safety program. It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics are essential in the prevention of LBP. At our clinic, significant time and effort is spent emphasizing the importance of these concepts to our patients, employees, and the businesses we work with through industrial medicine programs. A comprehensive approach can produce significant reductions in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonomics.
As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.
Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back. Also, consider sitting on a physio ball, which promotes proper posture for part of the day.
Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
Chin Tuck: Tuck your chin back to bring your head over shoulders.
Shoulder Blade Pinch: Pinch your shoulder blades together.
Standing Extension: While standing, put your hands behind back and extend lower back 10-20 degrees.
Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the surface resistance of the floor. Does it require two people to lift? Can I safely lift that high or bend that low?
When bending to lift an object think about safety:
Proper Lifting Technique:
Visit your doctor regularly and listen to your body.
Model: Lexi DiGregorio, PTA
NEXT SUNDAY IN THE PAPER AND EVERY MONDAY'S BLOG – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Paul's articles, check out our exercise forum!
