Part II of II

May is National Bike Month! For those who have a bike, now might be a good time to dust it off and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority. For those who don’t have a bike, it might be a good time to get one!

However, whether you head out for 5 or 50 miles, ensuring a proper bike fit should be on your checklist. Riding a bicycle that is properly fit for your style and body will not only help to prevent injury but allow for a more comfortable riding experience.  There are many things to take into consideration when checking your bike fit. First and foremost, you must choose a bike that fits your style of riding.

BIKE STYLES:

For the sake of simplicity 3 basic styles of bikes include Road bikes, Hybrid bikes and Mountain bikes. Road bikes are designed for long distance riders, hybrid bicycles can be used for longer distance riders, but usually accommodate a recreational cyclist, and mountain bikes are designed for dirt or gravel and technical trails. The next component of ensuring a proper bike fit is making sure that you have a good foundation by choosing the right sized frame. To find the right sized frame you can use the following guidelines as a way to start or simply ask the local bike shop or bike fit consultant of your choice for help.

• Road bikes: When straddling the bike, you should have about 1” of clearance between your body and the top tube if the bike has a straight top tube (which runs parallel to the ground). When lifting the bike, you should have 1” clearance between the tires and the ground. If the bike has a sloping top tube (semi-compact design) you should have a clearance of 2” or more.
• Mountain bikes: When straddling the bike lift the bike off the ground and you should have a minimum of 2” clearance between the ground and the tires. With full suspension bikes you will want 1”-2” standover clearance because when you sit on the bike the frame will become lower from compressing the suspension. More aggressive riders will likely have 3”-5” of clearance.
• Comfort bikes: Standing over a comfort bike to choosing the right sized frame is not necessary. They are commonly designed with a steep sloping top tube and allow the rider to put feet firmly on the ground when the rider comes to a stop.

PROPER FIT:

Now that you have right size for your bike you should adjust the components of the bike to allow for a more comfortable riding experience. Please use the diagram as a point of reference for the following tips. Also be sure to re-examine your bike fit after any bad falls. Keep in mind these measurements are meant to be used as a simple guideline and if you have any preexisting injuries or concerns please be sure to consult your local Physical Therapist or bike fit consultant.

Seat/Saddle:

1. Your Seat or saddle should be level (See “A” on diagram). If it is tilted too far forward there will be too much weight on hands, arms and lower back. If it is too far backward, there may be strain on LB and may lead to saddle related pain.
2. Your knee should be measured at the most extended position to adjust saddle height. (see “Knee to Pedal”)
3. The saddle should be a comfortable distance from handlebars. If it is too close it will place too much weight on your mid-back and arms. If it is too far it will put extra strain on your low back and neck. Also make sure seat is the proper width to ensure a more comfortable ride.

Handlebars (HB):

1. Your handlebar placement will affect your hands, shoulder, neck and back. The higher the handlebars are the more weight is placed on the saddle. Taller riders should have lower handlebars in relation to height of saddle
2. For road cyclists there should be a 90° angle between your arm (near the shoulder) and your trunk with a slight bend at your elbows of about 15° (See “B” on diagram).
3. Your trunk angle should be 25-35° if you are a road bike cyclist and 35-90° comfort/recreation cyclist

Knee to Pedal:

The knee to pedal measurement should be taken with the knee in the most extended position. There should be about a 25-35° angle at the knee (See “C” on diagram)

Foot to Pedal:

The ball of your foot should be over the pedal spindle (See “D” on diagram). This will allow for the best leverage, comfort and efficiency. Using a stiff soled shoe is recommended.

If you are a recreational cyclist, it’s a good idea to take all the proper steps in preventing injury. This article can be used as a reference point to help to prevent common cycling injuries, enhance your comfort and improve your riding efficiency. If you have any further questions about enhancing your bike fit, please contact your local physical therapist or bike fit consultant.

Sources: REI.com, APTA.org

Contributions & Illustrations: Sarah Singer, BFA, PTA

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

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 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!

Part II of II

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA 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 joint involved, especially after increased activity. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.

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 make poor lifestyle choices, do the wrong exercise, use poor technique, or are too aggressive, you could flare-up your joints and do more harm than good.

1. Don’t Burn the Candle at Both Ends
   • Poor sleep can affect your joints. One study found that people with arthritis felt more pain after restless nights. One theory is that when you don’t sleep well, it triggers inflammation in your body, which may lead toOA over time.
2. Don’t Slouch and Slump
   • Posture matters. Sit up straight. When you slump in your chair, it puts more stress on your muscles and joints and tires them out. Two good posture stretches are making a double chin by bringing your head over your shoulders and the second is pinching your shoulder blades together.
3. Don’t Ignore Pain
   • The exercise mantra “no pain, no gain” may be appropriate for a young healthy athlete, however, it may prove counterproductive for most of us. It’s true that some muscle soreness is OK, but not if it lasts for days or if your muscles are swollen or too sore to move or to touch. Joint pain isn’t normal, so pay attention to it. If you think you overdid it, ease up on your exercises. If the pain won’t go away, check with your doctor.
4. Don’t Overdo Computer Time
   • It can literally be a pain in your neck -- and your elbows, wrists, back, and shoulders. The problem isn’t just bad posture, but that you hold it for too long. That overworks your muscles. It also puts pressure on the discs in your back. Set up an ergonomic workstation. If you’re in a soft chair, prop up your arms with cushions to take the load off your shoulders and your neck. Be sure to get up and move every hour.
5. Don’t Get Rigid and Repetitive in Your Exercise Routine
   • If you perform the same exercise, sport or activity every day, you use the same muscles and joints repeatedly. Remember, overtraining problems commonly occur in single sport athletes. Mix in fun sports and activities to break the monotony by adding fun activities such as golf, swimming, biking, skiing, hiking or playing tennis. 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 on various days. Limit intensity – only work out intensely 2-3 times out of 5 days per week.
6. Don’t Squat
   • Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.
7. Don’t Smoke and Chew Tobacco
   • Nicotine from cigarettes and chewing tobacco cuts down on blood flow to your bones and to the cushioning discs in your back. It limits how much bone-building calcium your body can take in. It also breaks down estrogen, a hormone you need for bone health. And it slows new growth that thickens bones…which can lead to OA and osteoporosis.

SOURCES: WebMD, University of Pennsylvania

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part I of II

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what they should avoid, how to prevent and what is recommended to prevent or limit the progression of arthritis. Osteoarthritis (OA) is also known as degenerative arthritis. It is the most common form of arthritis in the knee. OA 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. While diet and exercise help, some people are more likely to develop OA based on previous trauma or injury, labor intensive occupations and genetics. Either way, we all get OA to some degree but there are a few things you can do to limit wear and tear to your joints.

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 make poor lifestyle choices, do the wrong exercise, use poor technique, or are too aggressive, you could flare up your joints and do more harm than good.

1. Don’t Carry Extra Weight
   • Your joints, which link your bones together, are sensitive to heavy loads. Every pound on your frame puts 4 pounds of stress on your knees. It also strains your back, hips, and feet.
   • That causes wear and tear that can lead to damage, aches, and pain. A poor diet, which can lead to being overweight, can also be the source of inflammation. That can make all your joints, including in your hands, stiff, painful, and swollen.
2. Don’t Text Too Much
   • “Texting thumb” is a real thing. Your tendons can get irritated and lock your thumb in a curled position. All that looking down at your phone is just as bad for your neck and shoulders, too. Every inch your head drops forward raises the load on your muscles.
3. Don’t Wear High Heels Too Often
   • While they might look styl”n, the higher the heel, the more your weight tips forward. Your leg muscles have to work harder to keep your balance and alignment, which can cause pain. When heels go up, so does the twisting force in your knees. If you wear them every day, you increase your odds of developing OA.
4. Don’t Wear the Wrong Shoes
   • Old, worn-out shoes will not adequately support your feet and ankles. That’ll throw your knees, hips, and back out of whack. Also, make sure your sneakers are right for your sport. High tops for basketball, for example, can protect your ankles from sprains and flip flops or summer beach shoes are not meant for long distances…especially if you are over 50.
5. Don’t Crack Your Knuckles
   • That satisfying pop comes from tiny bubbles bursting in the fluid around your joints, or from the ligaments snapping against the bone. While it might not cause OA directly, one study showed that this habit may cause your hands to swell and weaken your grip.
6. Don’t Carry a Heavy Bag
   • Whether it’s a purse, backpack, or messenger bag, packing too much can cause neck, back and shoulder pain. Heavy weight on one shoulder throws off your balance and your walk. If you tend to carry things only on one side, the constant pull overstretches your muscles and tires out your joints.
7. Don’t Use Wrong Muscles for the Job
   • When you put too much load on little muscles, your joints pay the price. If you need to open a heavy door, for example, push with your shoulder instead of your fingers. When you lift something off the floor, bend at your knees and push up with your strong leg muscles, instead of your arms.
8. Don’t Sleep on Your Stomach
   • While it might help with snoring, it may not be best for the rest of your body. Lying on your belly pushes your head back, which compresses your spine. Your head also will face in one direction for longer stretches than if you sleep on your back.
9. Don’t Skip Stretching
   • Gentle, comfortable, active stretching on a regular basis can help strengthen your muscles and tendons. It also can make them more flexible. That allows your joints to move more easily and helps the muscles around them work better.
10. Don’t Skip Strength Training
    • Once you turn 40, your bones start to get a little thinner and more likely to break. If you build muscle with strength training, it slows bone loss and triggers new growth. So, you not only get stronger muscles, but denser bones, too. Together, they stabilize your joints so you’re less likely to get hurt. In fact, studies show that the stronger your leg muscles, the less stress on your knees.

SOURCES: WebMD, University of Pennsylvania,

Visit your family doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

Next Week: Part II of II “Save Your Joints”

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 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!

More than 65 million people, almost 30% of the population in the United States, are actively involved in providing 20 or more hours of care for a chronically ill, disabled, or aged family member or friend each week. As our population continues to age, this number is expected to grow rapidly.

The role of a caregiver is multifaceted and often involves tasks and skills beyond the education or comfort level of most providers. Some examples include; managing money, paying bills, shopping, cleaning, maintaining and repairing a home, dispensing and injecting medications, cleaning wounds, changing dressings, catheter management, bed baths, assisting in position changes, transferring from the bed to the chair, ambulation, stair climbing, bathroom assistance for toileting and showering and many other responsibilities. Consequently, a caregiver is often at risk for mental, spiritual and physical fatigue or breakdown. It is no surprise that depression, illness and injury often plague a caregiver and eventually, the caregiver is in need of a caregiver. One of the most common injuries suffered by a caregiver is back pain.    

Lower back pain (LBP) is one of the most common problems in our society. Over 90% of all Americans will suffer from it at least once in their lives. It is generally agreed that prevention is the best treatment for LBP.

TIPS FOR THE PREVENTION OF BACK PAIN FOR THE CAREGIVER:

• Maintain Health & Fitness Level
  • 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 and exercise regularly.
• Aerobic Exercise
  • Aerobic exercise will help prevent weight gain and stiffness for a healthier lower back. It will also help with the stress and depression associated with providing care for a loved one. Perform mild aerobic exercise such as walking 3-5 times per week for 30-45 minutes. You can also use an elliptical or bike at home while your loved one is resting. Get outdoors and take multiple short walks …go around the block a few times per day.
• Core Exercises
  • Core stabilization exercises designed to strengthen the abdominal and lower back muscles will help prevent injury. Some examples of core exercises are:
    • Pelvic Tilt - lying on your back and performing a pelvic tilt as you flatten you lower back into the floor.
    • Pelvic Tilt and Heel Slide - lying on your back, hold a pelvic tilt as you slide your one heel up and down and repeat with the other heel.
    • Core on Ball - Perform arm exercises such as biceps and triceps with light weight while sitting on a therapeutic ball while simultaneously trying to hold an isometric contraction of your abdominal and lower back muscles.
• Do Not Smoke
  • Smoking effects natural healing because it constricts the small blood vessels. Smokers have a much higher incidence of LBP and failure from lower back surgery.
• Practice Good Posture & Body Mechanics
  • 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.
  • Caregivers spend much of the day with their spine bent over a bed or chair feeding, bathing, and lifting a loved one. Postural exercises are designed to stretch your back in the opposite direction of this forward flexed position. Examples include:
    • Chin Tucks - tuck your chin back to bring head over shoulders.
    • Shoulder Blade Pinch - pinch your shoulder blades together.
    • Standing Arch - while standing put your hands behind back, extend lower back 10-20 degrees.
      • Perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.
• Ergonomics
  • Sitting - When sitting, use an ergonomic work station and chair with a lumbar support and adjustable heights. Get close to your desk, keyboard and monitor.
  • Driving - If you drive long distances, use a lumbar support to keep an arch, sit close to your steering wheel to prevent bending forward.
  • Bending – Get an adjustable bed and raise it to a comfortable height when feeding, dressing or bathing your loved one.
  • Lifting - Think twice. First bend your knees and arch your back. Then, brace your abdominal muscles. Bend your spine forward as little as possible to lift the patient.
• From Lying to Sitting in Bed - Bend your knees, maintain an arch in the back with head up, and bend over as little as possible. Bend the knees of your loved one; roll their trunk toward you to get their legs over the edge of the bed as you pivot their weight on their butt to get them sitting upright.

• From Sitting in Bed to Sitting in Chair - Bend your knees, maintain an arch in the back with head up, and bend over as little as possible. Place your hands around the waist or on a transfer belt. Use your legs, turn with feet, and do not twist spine. Block the feet and knees of your loved-one with your feet and knees and use them to pivot and transfer from the bed to the chair. Be sure the chair is along side of the bed and arm of chair removed if possible before the lift.

• Transfer Belt - Use a transfer belt around the waist of the patient. Grip the transfer belt, instead of the patient or clothing, during the lift or when ambulating.
  • Lower Back Lifting Belt - Also, if you have a back problem, consider using a lifting belt or back brace to protect your back when lifting the patient. Immediately following the lift, stand up straight and stretch lower back into extension.
    • Transfer belts and lower back lifting belts can be found online or at your local pharmacy.
  • Lift Chair – For patients that require maximum or moderate assistance and only one caregiver is available to lift or transfer, an electric lift chair should be considered.

MODELS: Andrea Molitoris Kozlowski, PT, DPT, Associate Mackarey Physical Therapy, Doris Koloski, Scranton

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 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!

September is National Yoga Month - A Good Time to Begin!

 Healthy Mind, Body, and Spirit!

September is National Yoga Month! It is hard to believe that yoga, which is now a cultural mainstay, was once considered a foreign practice.  An ancient discipline that totes numerous health benefits, it is meant to cultivate inner peace, enlightenment, and a strong relaxed body. In the past, only major cities housed yoga studios but over time it has spread into small towns across the country.  Studios offer a variety of classes and each promotes their own unique philosophy. Whether you are looking for a new workout regime, compliment to your current program or simply to quiet your mind in a hectic world, yoga may be an option for you.

What is yoga?

Yoga is a discipline that developed over 5,000 years ago and is generally recognized as an ancient system for wellbeing. The word yoga, from the Sanskrit word “yuj”, literally means to yoke or to bind together.  The primary focus is to harmonize or unite the mind, body, and spirit through a combination of poses, breathing techniques, and meditation.

Where did it come from?

The specific origin of it is a topic of debate.  However, it is said to have originated in India and was brought to the Western world by gurus in the late 19^th and early 20^th centuries. The basis for most current practices is The Yoga Sutras of Patanjali.  In The Yoga Sutras, eight limbs of yoga are specified. The three most common limbs are meditation, pranayama or breathing exercises, and asana which are the physical poses.  Classes can vary greatly, however, most classes include a combination of meditation, breathing exercises, and physical postures.

Types:

There are numerous styles of yoga.  If you are a newcomer, deciding on a class may be difficult.  It is always a smart idea to call a studio before attending a class to gain information and have any questions answered.  Furthermore, if you have any health concerns you may want to consult your doctor prior to trying a new form of exercise.  Some common forms include but are not limited to:

• Hatha - Hatha yoga is a general broad-based term referring to any type of yoga that teaches physical postures. Typically, one will find Hatha classes to be slow and gentle and a great option for beginners.
• Vinyasa - This type of yoga focuses on the coordination of breath with movement. In Vinyassa classes, you can expect a continuous flow of movement from one posture to the next.  Classes can be fast paced and are often appealing to those looking for a more strenuous workout.
• Iyengar - Unlike Vinyassa, this type of yoga focuses on holding postures for a period of time to bring the body into it’s best alignment.  If you attend this type of yoga class you can expect to use props including yoga blocks, blankets, and straps.

• Ashtanga -  This type of yoga follows a specific sequencing of postures. This rigorous form of yoga always performs the same postures, in the same order at each class and is typically fast paced.
• Bikram - Typically performed in rooms heated to 105 degrees Fahrenheit and 40% humidity, the heat warms muscles and allows a deeper stretch. The difference between Bikram and Hot yoga is that Bikram follows a specific sequence of 26 poses from which hot yoga often deviates.
• Yin Yoga - This meditative practice is perfect for those who want to calm their mind. In this type of yoga, poses are held for 5 minutes or longer.  The purpose is to apply a deep stretch to the connective tissue (the tendons, fascia and ligaments) to improve flexibility.
• Restorative - Best for those who want to focus on relaxing and taking some time to slow down. Most restorative yoga classes will be slow moving with longer hold times to allow deep relaxation.  

Basic Poses:

Below you can find a few common poses or asanas that can be found in beginner classes.  These poses promote flexibility and strength and can be incorporated into your everyday workout routine. Remember, before you attempt the poses, begin by walking, biking or running to warm up. Don’t overstretch, perform slowly, and hold the position. You should feel  mild discomfort NOT pain.

Where to Practice:

There are a lot of options when it comes to where to start to practice. It is important that the studio you choose employs certified yoga instructors who have completed comprehensive training.  A good instructor can make all the difference in your experience. The studio should provide a clean environment and offer a variety of classes including beginner level if you are a newcomer.  The best way to get a feel for a studio is to stop in for more information.  You may want to ask about pricing as there are often discount introductory rates.  Ask about rentals if you do not own a yoga mat and request to see the space.  Some yoga studios have a strong sense of community while others are more like a gym. Try out a few different places until you find a fit for you.

Guest Columnist: Catherine Udomsak, PT, DPT | Model: Sarah Singer, PTA

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 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!

September is National Yoga Month - A Good Time to Begin!

Healthy Mind, Body, and Spirit!

Part I of II

September is National Yoga Month! It is hard to believe that yoga, which is now a cultural mainstay, was once considered a foreign practice.  An ancient discipline that totes numerous health benefits, yoga is meant to cultivate inner peace, enlightenment, and a strong relaxed body. In the past, only major cities housed yoga studios but over time yoga has spread into small towns across the country.  Studios offer a variety of classes and each promotes their own unique philosophy. Whether you are looking for a new workout regime, compliment to your current program or simply to quiet your mind in a hectic world, yoga may be an option for you.

What is yoga?

Yoga is a discipline that developed over 5,000 years ago and is generally recognized as an ancient system for well-being. The word yoga, from the Sanskrit word “yuj”, literally means to yoke or to bind together.  The primary focus of yoga is to harmonize or unite the mind, body, and spirit through a combination of poses, breathing techniques, and meditation.

Where did it come from?

The specific origin of yoga is a topic of debate.  However, it is said to have originated in India and was brought to the Western world by yoga gurus in the late 19^th and early 20^th centuries. The basis for most current yoga practices is The Yoga Sutras of Patanjali.  In The Yoga Sutras, eight limbs of yoga are specified. The three most common limbs are meditation, pranayama or breathing exercises, and asana which are the physical poses.  Yoga classes can vary greatly, however, most classes include a combination of meditation, breathing exercises, and physical postures.

Benefits of Yoga

So what is with all the hype?  Why has yoga become so popular?  Many would say it is due to its numerous mental and physical health benefits.  Research has shown that yoga, when practiced regularly, can reduces stress levels and even boost one’s immune system. Regular stretching releases tension in the body and the controlled breathing and mediation decrease anxiety. Studies show that those who practice yoga habitually can have decreased blood pressure and cholesterol making them less prone to heart disease. Other ailments which are shown to be positively impacted by yoga include insomnia, depression, and chronic pain including low back pain and headaches. Yoga is an excellent way to combat the negative effects of stress on the body and cope with anxiety and angst.

In addition to stress reduction, yoga has many physical benefits.  These include increased flexibility, strength, and balance. Those who practice yoga regularly are often less prone to injury, such as a muscle strain or tear, due to their increased flexibility. Furthermore, yoga can be an effective way to strengthen one’s core which is crucial to maintaining ideal posture and protecting the back.  For athletes, yoga can be a great way to challenge one’s balance and improve stability.  In the elderly, it is a safe way to improve overall body awareness and decrease the risk of falling.  Yoga has also been shown to improve respiration and many report an overall increase in energy when incorporating yoga into their lives.

With all of the positive impacts yoga has on the body it is easy to see why it has become such a popular form of exercise.  There are classes to meet almost all needs and most poses can be modified based on ability. Yoga can be practiced by those of all ages and all fitness levels. Whether you’re looking for a way to loosen up tight muscles or you simply wish to quiet your mind for an hour, yoga is a tool to improve and maintain health. The only thing you need is a mat and an open mind. 

Is yoga right for me?

Yoga can be practiced by anyone. From children to adults to the elderly, there are classes for all ages and abilities.  It can be a form of cross training for athletes, especially runners who tend to have tight musculature.  It also promotes balance and core stability which may be beneficial to sportspersons including football players, soccer players, boxers, etc.  Furthermore, there are classes for the elderly which focus on balance and maintaining mobility. There are even prenatal yoga classes for pregnant women to promote deep breathing, flexibility and muscle tone. 

Next Week: Types of Yoga and Basic Poses

Guest Columnist: Catherine Udomsak, PT, DPT

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

STAY TUNED for Yoga: TYPES OF YOGA AND BASIC POSES: 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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Happy Labor Day! 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. Deconditioned, 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. 

Prevention of Lower Back Pain:

Maintain Fitness Level:

 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.

Practice Good Posture & Body Mechanics:

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:

• Spread Legs Apart Shoulder Width
• Bend at the Knees and Limit Forward Bending the Spine
• Arch Lower Back Slightly
• Get and Maintain a Firm Grip
• Contract and Hold Abdominal (stomach) Muscles
• Lift With Legs (not back)
• Do Not Pivot or Rotate Spine With Load (use feet and step turn)
• Lift Slowly and Carefully (don’t hurry)
• Take Time to Perform Back Extension Stretches After the Lift
• Remember, Pushing is Better Than Pulling a Heavy Load

Visit your doctor regularly and listen to your body.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy 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!

Standing while studying, working, reading … good for children and adults to learn, work and be healthier!

I think we would all agree, technology is a wonderful thing. However, like all good things, it comes at a price. Students and workers alike are suffering from the many physical effects of sitting for too many hours. Studies show the impact of prolonged sitting, especially with proper posture, are multifaceted: pain, headaches, vision problems, poor concentration, excess fat storage with weight gain. Studies strongly support the use of good posture, ergonomic workstations, posture stretches, frequent changes of positions, including the use of standing desks to prevent pain and injury. In fact, standing desks are not a new invention; they have been used by many to promote health and stimulate thought…Hemingway, Franklin and Jefferson all stood while they worked.

The Problem is Gravity!

The average head weighs 10 to 12 pounds and when tilted down at a 45 degree angle the forces of gravity are multiplied by 5. While reading, studying or working on the computer with poor posture, one must support 50 or more pounds of pressure on the neck, middle and lower back for hours on end. It is no wonder why this activity is associated with headaches, neck and back pain, numbness and tingling in arms and legs, muscle spasms etc.  Some studies report the lifetime prevalence of neck and shoulder pain in office workers as high as 80%.

Recent research has also correlated the amount of time an individual sits to a decrease in their average life expectancy. Seriously, watching television and sitting is literally killing us. The Heart and Diabetes Institute of Australia conducted extensive research on sedentary behavior, including a review of almost one million people. They used actuary science, adjusted for smoking, waist circumference, and diet and exercise habits to assess the specific effects that the hours of sitting in a day impacts a person’s life span. They found that sitting too long results in a decrease in muscle contraction of the big leg muscles and because these unused muscles need less fuel, more unused glucose (fuel) is stored in the muscle. High glucose levels result in high blood sugar, which leads to adult-onset diabetes and other health issues.

Sitting in the Classroom…

The deleterious effects of sitting in children have also come under scrutiny and it may impact the classroom. Due to technology, today’s classroom is more advanced in many ways. However, the traditional hard chair and desk remain unchanged. Not only are these, “one size fits all,” desks uncomfortable, current research suggests that they may also limit learning.

Recent studies show that standing desks promote not only a physically healthier child by expending more calories and lowering obesity but also improves focus and concentration to improve academic outcomes.

Research from Texas A&M Health Science Center found two landmark things about children who worked at standing desks such as Stand2Learn^R, when compared to those seated: One, children burned more calories and obese children burned more than normal-weight peers. Two, children were more attentive in the classroom and engaged more with their teacher and their work when allowed to stand. Teachers in the study not only found the results to be favorable for fidgety, high-energy kids, but those who tend to be overweight and tired benefited greatly.

Researchers were quick to point out that there may be many ways to promote movement and limit sitting in the classroom that may also promote learning in a healthy way such as sitting on exercise balls or inflatable discs.

Sitting in the Office …

The average office worker sits for more than 10 hours per day between office work, sitting at lunch, checking email and social media at home. Amazingly, studies suggest that even vigorous exercise before and after work cannot overcome the damage from prolonged sitting. New products such as the “TrekDesk^R,” allows a worker to work on a computer, phone, or do paperwork, while walking on a treadmill, has great health value. Also, other products such as VariDesk^R, allows for frequent positional changes from sitting to standing while working. Even without using a standing desk, changing positions, such as standing during phone calls or meetings has proven to be valuable. Current Wisdom: Alternate standing (30-45 minutes) and sitting (15-30 minutes)

Prevention:

Spine problems can be prevented with good posture and proper body mechanics. Poor posture and improper body mechanics subject the spine to abnormal stresses that, over time, can lead to degeneration and pain. Good posture and proper body mechanics and frequent changes in positions, can minimize current spine pain and prevent recurrent episodes. Posture is the position in which you hold your body upright against gravity. Good posture involves positions that place the least amount of stress on the spine. Good posture maintains the spine in a “neutral” position. In a neutral spine, the three normal curves are preserved (a small hollow at the base of the neck, a small roundness at the midback and a small hollow in the low back). When viewed from the side, the upper back appears straight with a small hollow in the lower back.

Good Posture:

• Standing: Feet should be shoulder width apart. Distribute body weight evenly through feet. Do not lock knees. Maintain a small hollow in lower back with  “tailbone” slightly tucked down. Lift the breastbone by drawing shoulder blades back and down. Make chin level. Earlobes should be in line with the middle of shoulders. Relax jaw and neck muscles by resting tongue on the roof of mouth.
• Sitting: Sit in a firm, high-back, straight-back chair. Buttocks should touch the back of chair while maintaining a small space between the back of knees and the seat of the chair. Distribute body weight evenly on both hips. Maintain an arch in the low back.
  • A lumbar roll is recommended. It is a foam roll, 4” to 5” in diameter and 12” long, placed at belt level. Place feet flat on the floor with hips and knees bent at a right angle. Keep knees even with or slightly higher than hips. Use a footstool or footrest if necessary. Do not cross legs! Lift the breastbone by drawing shoulder blades back and down. Earlobes should be in line with the middle of shoulders. Position the armrests properly allowing elbows and forearms to rest with shoulders relaxed. If armrests are too high shoulders will shrug up and if too low will cause slouching.

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 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!

Recently, a young woman came to my office with complaints of severe middle and lower back pain. On her first visit, I noticed her beautiful pink purse (big bag) and asked her permission to weigh the bag and discovered that it weighed 8 pounds. While 8 pounds does not seem excessive, the woman weighed 120 pounds and based on the research, would be advised to carry a 2.5-to-3.5-pound bag, (2-3% of her body weight).

A recent study shows that the average weight of a woman’s purse has increased by 38% and now exceeds 6 pounds. Despite technological advances, women have not found a way to simplify their lives, or at least what they think they need in their lives. High tech gadgets have only added weight to a purse already filled to the brim.

On a whim, I decided to ask permission to examine the contents of some of my patient’s purses. A typical purse includes the following: hairbrush, cosmetic bag, mirror, feminine products, keys, and sunglasses, reading glasses, checkbook, wallet, coupons, water bottle, and medications. Additionally, I discovered heavy high-tech products such as cellular phones, tablets, digital Bluetooth earpieces, and rechargers. Lastly, some women add the weight of a book or Kindle to the bag. Studies also show that the larger the bag and stronger the straps, the more items are stuffed in, resulting in a very heavy purse.

It is a pervasive attitude that a woman should never be stranded without her purse full of essentials. So, where is the problem? The problem is that carrying a heavy bag, usually on one side of the body, forces the body to tilt forward and to the opposite direction to compensate. Over time, this change in posture leads to neck, middle and lower back pain.

SIGNS THAT YOUR PURSE IS TOO HEAVY:

• Change in posture when carrying the purse. The weight forces you to tip forward or to the opposite side to compensate.
• Struggling when putting on or taking off the purse. Due to a purse that is too heavy or straps that don’t fit properly.
• Pain when carrying or after carrying the purse. Due to a that is too heavy or straps that don’t fit properly
  • Neck, middle and lower back pain, headaches and muscle spasms.
  • Shoulder or arm pain can also be associated with a heavy bag.
• Tingling or numbness – in the arms or hands
• Red marks – on the shoulder

Consider the following suggestions to promote healthy use of a purse and prevent injury:

10 Suggestions:

• Limit Weight of Purse to 2% of Body Weight
  • (135 lb person = 2.7 lb purse)
  • Get on a scale without your purse and then get on with your purse to see the difference.
• Clean It Out!
  • Makeup, keys, planner, date book, address book, brush, cell phone, recharger, MP3 player, etc. Clean it out! Get rid of heavy coins. Use technology and consider getting a cellular phone that is also an MP3 player with a calendar and contact list. Recharge your phone in the car. Use a separate purse for some nonessential items and leave it in the car.
• Buy a Small Purse
  • Weigh your purse when it is completely empty. Some purses are too heavy, even without contents. Buy a small and lightweight purse.
• Ergonomic Bags: Padded Adjustable Shoulder Straps – Messenger Bag Style
  • If carrying a big bag, use a strap that is long enough to distribute weight evenly across the side of your hip like a messenger bag.
• Purse Weight Distributed to Small of Back/Hips – using adjustable straps
  • Not all the weight on shoulders and upper back
• Remove The Purse When Possible
  • While waiting for bus, etc
• Change Shoulders
  • Every 15 -20 minutes, change the purse strap from one shoulder to the other to balance out the stress on the spine.
• Stand Erect and Arch Small of Back
  • The correct posture while carrying heavy items is to make a hollow or arch the small of your back
• Perform Posture/Stretching Exercises
  • Pinch shoulder blades together and extend and arch your spine backwards intermittently throughout the day – especially every time you take your pack off

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 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!

...Labor Day is also the start of the school year

While many people celebrate the Labor Day holiday by firing up the grill, others will be shopping to get their students ready for the school year. One item on the shopping list should be a good quality and well-fitted backpack…to prevent lower back pain!

In 2018, the government of India announced a ban on homework and recently in Poland; the government ministers did the same. Can you imagine…a ban on homework? In an effort to promote student health and address recent surges in the incidence of back pain in the young, there will be no homework for students in grades one and two.

It was estimated that the majority of students ages 7 – 13 in India were carrying almost half their body weight. Not surprisingly, medical practitioners noticed a dramatic increase in reported cases of back pain among this group and decided to take action. In addition to the homework ban for grades one and two, Indian authorities have also implemented a limit of 10% of the student’s body weight.

Back pain in students seems to be universal. Each year, as students in the United States prepare to return to school from summer vacation, the subject of backpacks arises. The good news: when compared to purses, messenger bags, or shoulder bags, backpacks are the best option to prevent lower back pain. The bad news is, most of the 40 million students in the USA using backpacks, are doing so incorrectly.

Studies have found more than 33% of children had LBP that caused them to miss school, visit a doctor, or abstain from activity. Also, 55% of children surveyed carried backpacks heavier than the 10-15% of their body weight, which is the maximum weight recommended by experts. Additionally, the study noted that early onset of LBP leads to greater likelihood of recurrent or chronic problems. Backpacks that are too heavy are particularly harmful to the development of the musculoskeletal system of growing youngsters. It can lead to poor posture that may lead to chronic problems.

The following information on backpack safely is based, in part, by guidelines from The American Physical Therapy Association. Parents and teachers would be wise to observe the following warning signs of an overloaded and unsafe backpack:

WARNING SIGNS:

• Change in posture when wearing the backpack. The weight of the pack forces the child to tip forward to compensate. Weak or poorly fitted straps force the child to tip to the side to compensate
• Struggling when putting on or taking off the backpack due to a pack that is too heavy or straps that don’t fit properly.
• Pain when wearing or after wearing the backpack due to a that is too heavy or straps that don’t fit properly
• Tingling or numbness – in the arms or hands
• Red marks – under the armpits or on the back

Consider the following suggestions to promote backpack safely and prevent back injury:

12 SUGGESTIONS for Backpack Usage:      

1. Limit Weight of Pack to 10-15% of Body Weight (100lb child = 10-15lb pack)
2. Padded Adjustable Shoulder Straps - Use both straps to distribute weight evenly. Using one strap may look cool but it will lead to back pain.
3. Waist Belt – Proper Fit - An adjustable waist belt will distribute pack weight from back to hips and legs. Top of pack should be below the neck and bottom 2-3 inches above the waist
4. Pack Weight Distributed to Small of Back/Hips – using adjustable straps - Not all the weight on shoulders and upper back
5. Wheeled Backpack – if unable to make above adjustments - This is an option for some children; however, you may have problems     carrying/lifting it on the bus etc.
6. Purchase Extra Set of Books And Use Your Locker - Get list from teachers and use the internet to buy extra books to leave at home. Teachers and students might consider downloading text books on the iPads or electronic tablets. Also, put unnecessary books in your locker between classes
7. Remove Pack When Possible - While waiting for bus, hanging out between class, etc
8. Put Pack On/Off From Chair/Table/Bench – Not Floor - It is much easier to lift a pack up from a table and put it on your back than bending over to get it from the floor
9. Stand Erect and Arch Small of Back - The correct posture while carrying heavy items is to make a hollow or arch the small of your back
10. Perform Posture/Stretching Exercises - Pinch shoulder blades together and extend and arch your spine backwards intermittently throughout the day – especially every time you take your pack off
11. Consider a pack with multiple compartments - Use several compartments to carefully load your backpack and distribute the weight more evenly…and eliminate accumulated/unnecessary junk.
12. Use a back with reflective material to enhance visibility.

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!