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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!”

Body Weight and Hip & Knee Pain

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.

How to Maintain a Healthy Body Weight

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).

Diet

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

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:

Some simple suggestions for beginning an exercise program 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

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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!

Spring, Summer, Winter or Fall…weather changes can cause joint pain!

It is not just a cold weather problem…

“Everybody talks about the weather, but nobody does anything about it,” said Mark Twain. Just ask 93% of the arthritis sufferers who believe that the weather affects their pain level. History tells us that Benjamin Franklin, Leonardo da Vinci, and Christopher Columbus also felt this way about the weather.

Patients at our clinic have been particularly sensitive to joint pain on cold, damp days, especially during the past few weeks. In my clinical practice of orthopedic and sports physical therapy, an informal survey found that 95 out of 100 patients (95%) with arthritis reported increased pain with weather changes. While most people report that the coldness and dampness seem to irritate their joints, they also report more pain with weather changes in the summer. There is a reasonable explanation…

Joints in the body have a lining called synovium that secretes a lubricating fluid called synovial fluid. In joints with arthritis, there is an overproduction of synovial fluid. In theory, when the barometric pressure changes, so to will the pressure inside your joints, especially if it is already overfull with extra fluid from arthritis. This added pressure stimulates the nerve endings in the joint to produce inflammation and pain.

Despite this overwhelming response from patients, scientific studies vary in their support of this claim. According to the Mayo Clinic, in 1961, a famous arthritis doctor (rheumatologist), built a climate chamber and discovered that when high humidity was combined with low barometric pressure, patients reported increased joint pain and stiffness. A recent study found that changes in barometric pressure and cooler temperatures are associated with joint pain. However, other studies have found increased joint pain with high barometric pressure in both warm and cold weather while another study found pain with low pressure.

What does this mean? It means that patients with arthritis consistently report pain with weather changes but science has not found an accurate method to consistently support these claims. Some of these inconsistencies may be attributed to the fact that there are differences in sensitivity among individuals. For example, some patients have symptoms before the weather changes, while others notice symptoms during or after the weather changes. Still yet, some report more pain in colder conditions while others notice more pain in warmer weather. It appears that changes in the weather, such as a high to a low or warm dry to cold damp and vice versa is the culprit when it comes to irritating arthritis in a joint.

If I have arthritis, should you move to Arizona? Yes and no! Yes, the warm and dry climate of Arizona will probably make you feel better overall. However, it will not cure the degenerative changes in your joints and you may still have pain when CHANGES in the weather occur. This is proven to be true by the fact that there are many very busy rheumatologists in Arizona!

In conclusion, it is safe to say that there is some evidence to support the claim that most patients with arthritis have increased symptoms of joint pain and stiffness with CHANGES in the weather:

Therefore, each patient must be individually evaluated by their physician to determine the extent of their arthritis and its relationship to the changes in the weather. While the cause of their increased symptoms with changes in the weather may not be completely understood, each patient must determine the adjustments in their lifestyle and/or medications according to the particular weather patterns that affect their problem most.

Visit your doctor regularly and listen to your body.     

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 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!

Have Fun and Get in Shape!

Memorial Day is the unofficial kickoff to summer…outdoor furniture is out, the grill is fired up and the pool is open! This summer try to think of your pleasure puddle in different light…a health spa! It may very well be the exercise of choice for many people. Many have discovered the benefits of moving their limbs in the warm water of a home pool following knee or shoulder surgery. Also, long distance runners who often look for cross training methods without joint compression and arthritis sufferers who are often limited in exercise choices by joint pain from compressive forces when bearing weight, can enjoy the buoyancy effects of  water. These are good examples of the benefits or water exercise…aerobic and resistive exercise without joint compression.  

Exercise and Arthritis

Most doctors recommend some form of exercise with arthritis. Pain and fatigue are the most limiting factors for the person with arthritis. Pool exercise may be the answer. With proper technique, adequate rest periods, appropriate resistance and repetitions, water exercise can be very effective.

Benefits

The following are some of the benefits of water exercise:

Getting Started

  1. Start Slowly – Don’t Overdo it
    • 5-10 minutes and repetitions first time and add 2-3 minutes/repetitions each week
    • Long Term Goal: 20 – 40 minutes per session - 3-4 times per week
  2. Submerge The Body Part - That you want to exercise into the water and move it slowly
  3. Complete The Range of Motion - Initially 5 times, then 10-15-20-30 times
  4. Assess - Determine if you have pain 3-4 hours after you exercise or into the next day. If so you overdid it and make adjustments next time by decreasing repetitions, speed, amount and intensity of exercise.
  5. Warm-Up - Make sure you warm up slowly before the exercise with slow and easy Movements
  6. Advance Slowly - By adding webbed gloves, weighted boots, and buoyant barbells to increase the resistance.
  7. Exercises – standing in shallow end of pool
    • Heel Raises - push toes down and heel up
    • Toe Raises – lift toes up and heel down
    • Leg Kicks – extend leg up and down
    • Hip Hike – raise knee up 4-6 inches and down
    • Leg Squeeze – squeeze knees together and apart
    • Leg Curl – bend knee
    • Torso Twist – slowly turn arms/torso to right, then to left
    • Shoulder Forward and Backward – like paddling a boat
    • Shoulder Out and In – like a bird flying
    • Bend Elbow Up and Down

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

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 Health and Exercise Forum!

10 Ways To Protect Your Joints This Winter!

The Problem:

Osteoarthritis, the most common type of arthritis, is often considered to be a normal part of aging. Usually by the age of forty our joints, especially those which are weight bearing (lower spine, hips, knees, ankles, feet) begin to show signs of wear and tear. The cartilage begins to thin, joint surfaces are not as smooth, and fluid which lubricates the joint becomes diluted, dehydrated and less protective. Consequently, these aging joints become stiff, sore, weak, and  swollen. Most people with osteoarthritis report additional pain and stiffness in the winter and early spring due to cold, damp weather and NEPA has plenty of it! The cold, for example, restricts the flow of blood to the joints, leading to more pain and stiffness. While moving to a warmer and less humid climate is one solution, it is not practical for most. But all is not lost because there are other alternatives to protect and keep your joints healthier this winter and early spring. And, if you are looking for some practical gift ideas for your loved ones suffering from arthritis, these tips may be valuable.

1.Parafin Bath and Hot Packs:

A paraffin bath is one of the best methods to apply heat to your hands and feet to ease pain and stiffness associated with osteoarthritis. A special heating unit works like a crock pot to melt the wax to liquid form. The hands and/or feet are dipped into the wax several times to create a warm coating around the entire area. A 20 to 30 minute treatment while watching TV or listening to good music will provide pain relief, improve mobility in the joints and bring life back to winter damaged skin. $39.99 to $159.99 (www.bedbathandbeyond.com). Hot packs, electric and microwavable, offer heat to bring blood flow and lessen joint pain and stiffness. They are great for neck and lower back pain, depending on the shape of the pad. Consider rectangle for lower back and cylinder/round to wrap around neck and joints of arms and legs. SourceMed.com offers an electric pad which creates moist heat for $59.95 and a microwave “bed buddy” (herbal or nonherbal) can be found for $9.99 to $43.95 at TheWarmingStore.

2.Hand and Toe Warmers:

Hand and toe warmers are small packets placed in the gloves or boots of skiers, campers and hikers to keep the hands and feet warm. These throw away warmers can also be used by anyone with cold hands or feet whether you are shoveling snow, attending an outdoor event in the cold or sitting in a cold, drafty room watching TV. (Walmart, Dick’s, Gander Mountain, www.amazon.com)

3.Knee, Ankle, Wrist, Elbow, Wrist Sleeves:

Supportive sleeves for the joints can provide protection and warmth year round, but especially during the cold winter and early spring. Those made with neoprene material offer warmth and compression and can be valuable when participating in activities such as skiing, walking, running, basketball  name a few. Additionally, it can be helpful for those having joint pain with daily activities such as grocery shopping or house work. These devices should not be used when sitting for prolonged periods of time or sleeping. There is no scientific evidence that supports the use of cooper or magnets weaved into the sleeves for additional pain relief. (available at most pharmacies and medical equipment stores)

4.Compression Shorts and Shirts:

Similar to neoprene sleeves, compression shorts, pants and shirts can be invaluable to those participating in outdoor activities in cold temps. UnderArmor, Reebok, Nike, and others make these products which can also be worn indoors for those working in cool, drafty environments.

5.Hot Tub:

It seems obvious how and why hot water and massaging water jets can soothe the sore joints and muscles. To ensure additional pain and stress relief, add a candle, soft music and a cocktail!

6.Low Impact Exercise for Legs:  

If you suffer from osteoarthritis to the joints of your lower body, you would be well-advised to limit impact activities such as running and basketball. Instead, walk, swim, use the elliptical and bike to protect your joints.

7.Low Impact Exercise for Arms:

As above, if you have arthritis in the joints of the upper body, use low weights, avoid push-ups and dips, which transfer your body weight through the arms.  

8.Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):

These over-the-counter, non prescription drugs include aspirin and ibuprofen (Advil, Motrin) which are very effective in the treatment of the pain and inflammation associated with arthritis. However, like all drugs, they are not without their risks so one must consult with their primary care physician and pharmacist before using them. For example, NSAIDs can thin the blood, irritate the stomach and may interact with other medications.

9.Topical Creams: Lidocane, Capsacian

Topical analgesics or pain relievers can be rubbed into or sprayed on the skin over the affected area. Some products are counterirritants using menthol, methylsalicylate and camphor which provide a sensation on the skin other than pain. Salicylate based products can work like aspirin to provide relieve from mild pain and inflammation. Capsaicin based products can also provide temporary relief due to the counter stimulation of warmth and tingling. A few things to keep in mind when using these products: one, discuss it with your physician or pharmacist. Two, topical agents are more effective in superficial joints such as the fingers, toes, wrist, elbow, knee and shoulder than in the deep tissues of the hip, buttocks, or lower back. Three, wash your skin thoroughly ater using these products and before using heat, cold or electric stimulation.

10.Massage: The therapeutic benefits of massage are well documented. However, like most treatments, it is important to find a qualified professional that meets your needs. Licensed physical therapists, physical therapist assistants and massage therapists are the best choice. Benefits include; relief from pain, headaches, muscle spasm, and stress, improved relaxation, posture, and breathing.

SOURCES: www.apta.org; www.webmd.com

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

For all of Dr. Mackarey's Articles visit https://mackareyphysicaltherapy.com/forum/

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.

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.

Benefits of Exercise for Those with OA

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.  

Tips How To Exercise With Osteoarthritis

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

EVERY MONDAY – Read Dr. Paul J. Mackarey NEW Article in“Health & Exercise Forum!”

For all of Dr. Mackarey articles visit https://mackareyphysicaltherapy.com/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.