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.
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!
It is four months since many people have made their health and fitness resolutions and hopefully some have stayed the course. If you are looking for another reason to stick to your New Year’s Resolution to get fit and lose weight in 2024 try this…to improve or prevent hip and knee pain!
There are three major weight-bearing joints in the body, the hip, knee and ankle/foot. Consequently, wear and tear and arthritis are common among these joints. There are almost 800,000 knee replacements and 450,000 hip replacements annually in the United States alone. While there are many recommended methods to avoid or delay joint replacement, only a few are within our control. Genetics, trauma, degenerative diseases such as rheumatoid arthritis and osteoarthritis are difficult to control. However, body weight, aggressive weight bearing sports and overdoing exercises as you age like excessive running, jumping, lifting and squatting can be modified or eliminated to limit the progression of joint damage. According to WebMD, “your knees are powerhouses. They’re the biggest, strongest, joints in your body, and most people use them throughout the day to sit, stand, walk, jump, and bend. They bear 80% of your body weight when you stand still and 150% or more when you walk across the room. In a 160-pound person, that’s 240 pounds of force!”
According to the National Institutes of Health, body weight or body mass index (BMI) has a direct impact on hip and knee degeneration, pain and dysfunction. In fact, one study found that people with or at risk of significant hip/knee osteoarthritis had a 2-3% reduction in risk of hip or knee replacement for every 1% reduction in weight, regardless of the baseline BMI.
It is commonly known that the primary cause of osteoarthritis is normal wear and tear, especially for those over 50. However, extra body weight can accelerate this process. As the joint degenerates, the cartilage at the end and in between your joints gets compressed and dehydrated which leads to deterioration. Eventually, the bones rub directly on each other as the cushion wears away, leading to pain, swelling, and stiffness, loss of motion, strength and function.
While it may seem obvious that extra weight will put more strain and stress on the hip and knee joints; another mechanism involved in this degenerative process. Excess body fat can increase chemicals in your blood stream that can cause inflammation in your joints.
If you need a goal and a motive, how about this: losing even 10 pounds will equate to 40 pounds less force compressing and stressing your hips and knees. Moreover, reducing body fat will limit the hormones that cause inflammation in your joints. Talk to your primary care physician or visit www.cdc .gov to find a BMI calculator. Just plug in your height and weight and it calculates it for you. For example, a 155-pound male at 5 feet 8 inches tall has a BMI of 23.6. (A BMI of 18.5 to 24.9 is considered a healthy weight for this person).
The Mediterranean Diet is a solid start to eating healthy. It is less of a diet and more of a lifestyle. The foundation of this diet is plant foods built around vegetables, fruits, herbs, nuts, beans and whole grains. Moderate amounts of fish, dairy, poultry and eggs with limited consumption of red meat are paramount. The Mediterranean lifestyle also includes shared meals with family and friends, small portions, regular exercise, and wine in moderation with food and friends.
Exercise has many more benefits than just losing weight. Physical activity is one of the most important factors in improving a lifestyle in a positive way. A minimum of 30 minutes of physical activity, 5 days per week can greatly contribute to weight loss and longevity.
Researchers have found that the benefits of regular physical activity are numerous. Some of the more important benefits are:
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well
SOURCES: WebMD, National Institutes of Health; CDC, American Council on Exercise
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!
A myth is a traditional story, idea, or belief, especially one concerning early history of a people or explaining a natural or social phenomenon. It is a widely held but false belief or idea. In medicine, health myths are also widely held beliefs about health issues such as medicines, herbs, treatments, cures, antidotes, etc. which are partially or totally false and unsubstantiated in the scientific literature. This is a partial list of the most common health myths:
SOURCES: WebMd; National Institutes of Health, Mayo Clinic
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
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This article does not intend 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 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
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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!
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
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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
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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!
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
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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. 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!
