Coordinated Health Magazine March/April 2011

YOUR PRESCRIPTION FOR BETTER HEALTH

The Magazine In a Workout Rut?

5 Ways to Bust Out

Spring Into Health

Recover from Work Injuries Faster!

March/April Nov/Dec WWW.COORDINATEDHEALTH.COM

2010 2011

2011 March/April

L

ETTER  FROM THE EDITOR



Dear Patient, Spring is in the air! Well almost. As we wrestle with the daily flux in temperature, our thoughts turn to all things warm, green, and sunny. Now’s the time to work outside on our yards, get organized, and do a little spring cleaning.

With all the focus on taking care of your house and yard, have you stopped to think about your health? Jeanette Richards, our newest member of our Care on Call team, explains a few easy ways you can do a little ―Spring Cleaning‖ for your health.

At Coordinated Health, we’ve done a little ―spring cleaning‖ ourselves. We’ve gotten rid of our old website and in its place is a dynamic, interactive site where you can manage your appointments, learn more about your pain or conditions, and learn more about our team and services. Be sure to check out the new site and let us know what you think.

Congratulations to Dr. James Reid, one of our newest Orthopedic Surgeons from EOG Orthopedics. You voted him as our Featured Physician for our March/April 2011 issue.

Are you or someone you know diabetic? Don’t miss our Diabetic Foot Care 10 Step Checklist. These quick tips will help you keep your feet healthy and avoid diabetic foot complications.

You work hard every day, but what happens if you are injured at work? Work injuries are an unfortunate hazard in many workplaces. Learn how to protect yourself immediately after an injury and reduce your pain.

One of our Athletic Trainer’s, Nicole Karasek, answers a very common question: Water or Sports Drinks - Which is better? Find out which drink you should choose and when. Are you bored with your workouts? Stuck in a rut? Pulse Performance Specialist, Ron Hoffman, offers 5 simple tips to kick start your workout back into high gear.

Text messaging is unbelievably commonplace. It’s understandable, considering it makes communications so quick and convenient. However, there’s a hidden danger to all the typing and texting. Thumb and hand injuries are on the rise as a result of all those repetitive movements. Find out two common hand injuries and what solutions we offer to treat them.

Amanda Boyce

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The Magazine

in every issue

features

2 Editor’s Letter

6 Back Pain

5

8 In a Workout Rut?

Contributing Team

Bust out with these 5 simple tips

10 Feature Physician: Dr. James Reid

12 Tendonitis or Texting

19 Q & A

issue

20 My Story: Diane DeVivo 22 What’s New at CH

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26 CH Physician Gives Special Athletes a

2011

Chance to Shine

34 Who’s New at CH WWW.COORDINATEDHEALTH.COM

2011 March/April 3

features 14 Diabetic Foot Care 10 Step Checklist to protect your feet.

VS.

16 Spring Into Health Spring Cleaning for your body

32 Water vs. Sports Drink And the winner is….

36 Work Injuries Learn how to quickly minimize your pain right after a work injury

24 Avoid Running Injuries 5 easy ways to make sure you aren’t sidelined with a running injury

38 How to Tell if a Bone is Broken Find out the signs and symptoms of a fracture and when you need to seek

28 Vibram Five Fingers Healthy lifestyle or running nightmare?

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OUR CONTRIBUTING TEAM

The Magazine

Amanda Boyce

Hannah Ropp

Editor

Writer

Jeffrey Zlotnick, MD

James Reid, MD

Primary Care & Sports Medicine Physician

Orthopedic Surgeon

Sarah Yodlosky, PA-C

Amy Pucklavage, PA-C

Physician Assistant

Physician Assistant

Denice VanDriesen, OTR/L

Sean Harkcom, ATC

Occupational Therapist

Certified Athletic Trainer

Frank Camaratta, PT

Adam Webb, PT

Physical Therapist

Physical Therapist

Jeanette Richards, RN, CRNP

Nicole Karasek, ATC

Nurse Practitioner

Certified Athletic Trainer

Ron Hoffman, NASM, PES

David Bower, COTA/L

Pulse Performance Specialist

Occupational Therapist Assistant

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2011 March/April 5

Several imaging techniques are used to evaluate back pain:

Back

X-rays look at the bones in the spine.

They are a good test to identify fractures & check alignment

Pain Over three quarters of the population will experience back pain at some point in their lives. It is one of the most frequent complaints in primary care and Emergency rooms and the most common cause of job related disability and missed work. While there are many causes of back pain, it is most often triggered by overuse of your muscles or ligaments, a herniated disc, arthritis or fractures.

CT scans are a more detailed test to look at anatomical structures not seen on x-ray

MRI scans provide details about the discs and nerves

Back pain can be divided by its location, cervical, thoracic, lumbar or sacral/pelvic. It can also be categorized as acute or chronic.

Chronic pain is defined as anything lasting longer than three months.

Contributing Author: Sarah Yodlosky, PA

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Treatment Most acute back pain can be treated with over the counter analgesics like Tylenol and Motrin. Ice is also used to help with inflammation. Heat can be used to help alleviate muscle pain. However, the key is prevention. There are several things you can do to help prevent back pain: Proper lifting – always lift with your legs and not your back.

Strengthen your abdominal muscles – this helps support your back and promotes good posture.

Maintain a healthy weight – being overweight puts you at an increased risk for back pain & injury

Avoid long periods of sitting – prolonged sitting puts increased pressure on the discs, which can cause pain.

Visit a doctor In most cases back pain will resolve itself on its own with time and rest. However, it’s a good idea to see your doctor if you have any of the following symptoms: Numbness/ tingling Severe pain that doesn’t improve with rest or OTC medicines Trouble urinating or incontinence Weakness in your legs

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2011 March/April 7

Contributing Author: Ron Hoffman, NASM - PES

In a Workout Rut? Have you ever started an exercise program only to find it doesn’t hold your interest for long? Are you doing the same exercises day after day, workout after workout? Are you in a workout rut? If this sounds familiar and you’re not sure what to do, here are a few suggestions to take to your next workout to the next level.

Think 3D Since your body moves in all directions, you should exercise in all directions. Your exercise movements should include, upper and lower body movements, front to back movements, back to front movements, side to side movements, rotational movements, and combinations of all of these movements.

Proper Progression Movement direction, speed and weight are essential elements of a safe progression. Exercise from slow to fast, controlled to dynamic, low weight and volume to high weight and volume, and most importantly; use correct form in each exercise to increase your intensity.

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Change your base of support and body position Think about the exercises you typically do – you probably do most of them standing, sitting, or lying on the floor. By adding in other options, you can make an exercise more challenging boosting your intensity level. Can you do the exercise lying or sitting on a stability ball or on an unstable surface, like a piece of foam or a towel?

Can the same exercise be done while lying on your back, your stomach, your side, kneeling, half -kneeling to increase its difficulty?

Change your lower body position Does your exercise have to be performed standing on two feet? Try a staggered-stance position, a staggered stance position on an unstable surface, on one-leg, or on one-leg on an unstable surface?

Change the upper body position Can you perform an exercise without using both arms? Try performing the exercise using alternate arms, alternate arms at different angles, or one-arm, one arm with rotation?

Try these tips to challenge you during your workout and build up your intensity level. With a little imagination and creativity, the variations of your exercises are limitless. Put the fun back into your workouts!

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2011 March/April 9

FEATURE PHYSICIAN DR. JAMES REID Coordinated Health is proud to announce that this month’s featured physician is Dr. James Reid. Dr. Reid joined Coordinated Health in January when Easton Orthopedic Group merged with Coordinated Health.

He is a graduate of the Hospital of the University of Pennsylvania and has been seeing patients in the Easton and Phillipsburg area for almost 25 years. In addition to seeing patients in an office setting, he is also the team physician for Easton Area High School.

Dr. Reid focuses on both general orthopedics and total joint replacements, specifically knees and hips. He says the best advice he has for patients who are considering a joint replacement is to consider all the options. ―The most important thing is to try all the other conservative treatments first. That way you know you’ve Contributing Author: Hannah Ropp

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Click here to vote for the May/June issue Feature Physician

done everything you can and you can go into the surgery with that peace of mind,‖ says Dr. Reid.

Some of the more conservative approaches he suggests include, weight loss (when appropriate), cortisone injections, and hyaluronic acid injections.

Because Dr. Reid is an avid athlete, he an relate to many of his patients who come into his office with sports related injuries or even those who are just anxious to return to their everyday activities. He participates in an over 40 soccer club that meets twice a week and says that his love of healthy competition and team sports help keep him active. He also enjoys running and is a big believer in the advantages of yoga. ―Yoga is great because it has two main benefits and that’s increasing flexibility and encouraging mental wellness,‖ claims Dr. Reid. He also says it is something that almost anyone can do.

One of the main reasons that Dr. Reid chose to become an orthopedic physician is because he enjoys interacting with his patients and being able to talk to his friend’s everyday. He also truly enjoys being able to help others.

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2011 March/April 11

Tendonitis or Texting Thumb?

Contributing Author: Denice VanDriesen, OTR/L

Thumb injuries are on the rise, due in part to the popularity of computers and cellular phones. These injuries range from trigger thumb to DeQuervain’s Tenosynovitis and anonymous thumb pains.

Thumb pain related to basal joint arthritis is also more common. Basal joint arthritis causes pain at the base of your thumb that may radiate to the tip of your thumb or up your arm.

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DeQuervain’s Tenosynovitis

Trigger Finger

Trigger thumb – or stenosing tenosynovitis – often occurs with a sudden onset of pain, with catching and snapping of the tip of your thumb. Activities like buttoning a shirt, picking up a coin or even hitting the space bar on the computer may cause pain. In some cases, catching may be strong enough that using your other hand to unlock the tip of your thumb is necessary.

For some individuals, a cortisone injection may suffice to relieve the symptoms.

However, a simple surgery to release the pulley located at the base of the finger on the palm side may be offer the best relief from your symptoms.

After the surgery, one or two stitches is required and it’s necessary to follow up with one or two visits to Occupational Therapy in order to review the home exercise program for active range of motion, scar massage, and strengthening exercises.

DeQuervain’s Tenosynovitis is a thickening of the tendons and/or covering of the tendons, which are used in straightening or lifting the thumb. This may be caused by trauma, repetitive motion or it may not have an apparent cause. Activities like grasping, reaching behind your back or putting a handbag over your shoulder may be painful.

Treatment to increase blood flow and stretching may be tried prior to injections.

Bracing your thumb during activity may also help. Although it is a last resort, surgery for this problem is simple with a few stitches required followed by one or two visits to Occupational Therapy for a home exercise program.

Ultimately, there is no need to suffer or procrastinate when it comes to treating your thumb problems. Our orthopedic hand and wrist surgeon, Dr. Jon Hernandez, has many options to treat your pain.

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2011 March/April 13

Diabetic Foot Care: 10 Step Checklist 1. Inspect your feet daily One of the most simple, important parts of caring for a diabetic foot is daily inspection.

Things to look for include cuts, blisters, redness, swelling, or any nail problems.

Daily inspection makes you aware of any problems quickly, allowing for more prompt and easy treatment. You can do the inspection yourself by using a magnified hand mirror. If you suspect any problems, contact your physician immediately.

2. Cut nails carefully Because wounds take longer to heal on a diabetic foot, it is important to minimize the risk of any type of injury.

Nails should be cut straight across, and filed at the edges. Be sure not to cut nails too short, as this could leave you susceptible to an ingrown toe nail. If any concerns come up when cutting your own nails, contact your physician.

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Contributing Authors: Adam Webb, PT & Frank Camaratta, PT, MSPT

3. Do not trim corns or calluses by yourself Corns or calluses should always be treated by a trained individual. Treating them yourself may result in unnecessary injury. Please see your physician for appropriate treatment.

4. Avoid overly tight or bulky socks Because the likelihood of nerve and blood vessel damage is higher in the diabetic foot, it is important not to wear socks with tight elastic bands. These bands may further cut off the circulation of an already compromised area. Bulky socks may bunch up and become a skin irritant to the skin, possibly producing an open sore.

5. Shake out shoes and inspect the inside before putting them on Because of decreased sensation in your foot that may develop from having diabetes, it is always important to check

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the inside of your shoes for any object that could cause irritation. Even a small pebble in your shoe could produce an open wound, which always has the chance of turning into something more serious.

6. Keep feet warm and dry Keeping your feet warm is important because of the compromised circulation.

Keeping your feet dry is also important as damp or wet skin is more prone to breakdown. By changing your socks daily, or even multiple times a day, it will provide a warm, dry sock. Special diabetic socks are also available.

7. Never walk barefoot It is very important to protect your feet from any type of irritant injury. Walking barefoot increases your risk of stepping on an object that could break the skin, producing an open wound. You should always wear shoes, even at home.

8. Wash feet in lukewarm water Always check the temperature of the water on a body part with normal sensation before washing your feet. Decreased sensation and compromised circulation may prevent you from feeling the actual temperature with your feet. Too hot water can burn your feet, too cold water could further compromise the circulation.

9. Moisturize feet, but not between toes It is important to maintain healthy skin. Moisturizing your skin may help prevent cracking and itching. You should not moisturize between the toes, as this may predispose you to a fungal infection.

10. Take care of your diabetes Managing your diabetes is not only beneficial for the diabetic foot, but also for your health in general. Consistent monitoring of your blood glucose levels will assist you in keeping your diabetes under control. If any concerns arise, contact your physician, as early detection and treatment will be most beneficial.

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2011 March/April 15

WHAT TO EXPECT

Spring

Contributing Author: Jeanette Richards RN MSN, CRNP, ANP-C

Into Health

It’s that time of the year again! The time we anxiously wait for all winter…

Spring! This is the time when we start to feel invigorated.

We’re able to get outside and enjoy nature, clean our house, get organized, and plan our summer vacation. It’s also a great time to start taking care of your health!

There are simple steps you can take to adjust your habits and live a healthier lifestyle, without making drastic changes. It’s almost like giving your body a ―Spring‖ cleaning!

PRIMARY CARE VISIT Visit your primary care office for an annual checkup and preventative services. In addition to treating you when you are sick, your primary care provider can help you stay healthy.

The preventive services you need are dependent on your age, sex, medical and family history and may include the following: Tests (also called screenings) to check your general health or the health of certain parts of your body Regular measurements of weight, cholesterol levels and blood pressure Immunizations ("shots") for both children and adults

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Special tests at certain times in your life, such as during pregnancy and after age 50.

Adult men and women should have their weight, blood pressure and cholesterol levels checked regularly. Women should also have a Pap test at least every three years to screen for cervical cancer starting at age 21 or approximately three years after they have sex for the first time.

After the age of 50, women should have a mammogram every two years to screen for breast cancer. Women at higher risk for breast cancer may need to have mammograms more often or start having them earlier. After the age of 50, men and women should be tested for colorectal cancer.

The choices you make about the way you live are important to your health.

Here are some choices you can make to stay healthy: Don't use any form of tobacco.

Eat a healthy diet.

NUTRITION Consider making your diet healthier by eating less processed food and changing your cooking techniques. Once the weather is warmer, think about grilling your food rather than deep frying or pan frying with fats or oils. Also, visit your local farmers market! They will have more organic choices and your produce may be less costly.

Another great trick is to shop the outer rim of your supermarket. At most stores, the non-processed foods like lean meats, poultry, fish, dairy, and produce are situated around the perimeter of grocery store. If you avoid the middle aisles, you will steer clear of the processed foods that are higher in sodium and sugar and other unhealthy additives.

Fruits and vegetables are a crucial part of your diet. They are important sources of vitamins, minerals and fiber. To improve your eating habits, you’ll want to cut down on foods that are high in fat and calories.

Exercise regularly.

Drink alcohol in moderation, if at all.

Don't use illegal drugs.

Practice safe sex.

Use seat belts (and car seats for children) when riding in a car or truck.

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By replacing those foods with healthier choices, such as fruits and vegetables, you’ll get better nutritional quality from the foods you eat. Also, adding fruits and vegetables, and learning new ways to prepare them, can keep you from getting bored with healthy diet.

EXERCISE Ideally, we would all get enough exercise to burn the energy we get from eating.

Unfortunately, since many people drive everywhere, and have jobs that require them to sit at their desk for much of the day, getting enough exercise can be difficult.

Take the stairs instead of the elevator, park farther away so it forces you to walk, or squeeze in a couple of 15-minute walking breaks during the day.

You can improve your chances of being physically active by exercising with other people. Set up a walking group at work or in your neighborhood, or ask a friend to be your exercise buddy. This will provide you with support and make physical activity more enjoyable.

Unhealthy behaviors can become habits, so changing them can be difficult. You’re more likely to make changes if you set a specific goal. The kind of goal you choose and how you think about it is very important. If you set a goal that focuses on an outcome, like losing 20 pounds, it may be difficult to know where to begin.

Instead, set a goal that focuses on a specific behavior. Choose one thing to change about your diet, such as limiting your soda intake. Once your new healthy behavior becomes a habit, you can move on to another goal.

One obvious way to burn more energy is to participate in structured exercise like classes or sports. However, you can also burn energy by adding more movement to your everyday activities. For example, try walking in place or riding a stationary bicycle while you watch TV.

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Q&A Q: I’m considering surgery as a treatment option for my back pain. How do I know if I’m a candidate for spine surgery?

Q: Can I request an appointment online?

A: Yes. You are now able to manage your appointments on our website. Request, reschedule, or cancel an appointment when it’s convenient for you. If you request or reschedule an appointment online, one of our Patient Service Representatives will be in touch with you within 24 hours to confirm the date and time of your appointment.

A: Not everyone is a candidate for surgery. Our minimally invasive spine surgeon, Dr. Christopher Wagener, explains in a series of videos who benefits from surgical treatment and what can you expect before, during, and after surgery.

Got a Question?

Click Here to submit your question.

Your question and the answer

Click Here to watch now.

may be featured in an upcoming issue.

Q: What is Diabetic Neuropathy and how do I treat it?

A: Diabetic Neuropathy is a common complication of diabetes in which nerves are damaged as a result of high blood sugar levels (hyperglycemia) and decreased blood flow. The resulting nerve damage can be either temporary or permanent. Diabetic Neuropathy is managed by Primary Care Physicians and Endocrinologists. There are no known cures for Diabetic Neuropathy so treatment focuses on slowing the progression of neuropathy. You can help minimize your symptoms by maintaining good foot care , keeping your blood pressure low, eating and exercising right, and not smoking.

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2011 March/April 19

My Story

Diane DeVivo

I’

m nobody special. I’m not an athlete or exercise fanatic. I’m just an ordinary person who happens to be a teacher. My story started last spring when I got ambitious and started running. I joined First Strides to start moving. It was exercise and that’s supposed to make you healthier and fit. I figured it would help with the stiffness and soreness I felt every morning when I woke up. And guess what—it did.

I learned to stretch and run, though not quickly. I even managed to finish two 5K races, lowering my time by over 5 minutes from the first race to the second. This was a significant improvement; the reality, however, was I was in pain and did not know why.

I called up Coordinated Health. Coordinated Health is a great place. It’s a place where you are put in the hands of a team who works together to get you better. My first point of contact was with the foot and ankle center. I saw Dr. Brigido and he told me I had Achilles tendonitis and heel spurs.

The good news is he knew how to fix it. He is not surgery happy and is always happy to discuss options. Physical therapy with Katie was non-invasive and improved my strength and flexibility. Unfortunately, it did not eliminate the pain and tightness I still felt.

Dr. Brigido ended up doing endoscopic gastroc release and my left leg felt much better.

After surgery came more physical therapy, this time with Brett and Kiira. They were incredibly patient teaching me new ―tricks‖ to improve my strength and increase flexibility. I even got lessons on muscles and tendons in the legs. I found out where the quads and calves are. Who would know there is a right and wrong way to walk?

Apparently the right way is heel, ball, toe.

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Then, when your face looks very intense, (I suspect Brett did this for fun) I had to walk and count backward from 100 by threes. Now, on a good day I don’t walk and chew gum at the same time. Often I have bad math days, but the point was for me to walk without thinking about it.

And the neat part,--it worked and entertained anyone who listened to my version of subtraction. Brett and Kiira were incredibly patient. Every time I got comfortable doing an exercise they increased the difficulty.

The best part of physical therapy was when Kiira or Brett stretched me. For some odd reason Brett said he was going to torture me, but the reality is it felt awesome! Kiira stretches patients very well and she gets the prize for best stretcher overall. I credit them for teaching me how to walk down steps correctly again. They listened to me as I told them how I felt and adjusted the physical therapy program accordingly.

Sadly as my left leg got stronger the right leg got tighter. It was the Achilles tendon, one of the biggest tendons in the body. I did not get relief so I had a second surgery last week. This surgery has improved the quality

of my life since it relieved the tightness that woke me up every night for over a month.

To imagine how I felt, think of a guitar string which is stretched very tightly and looks likes it’s going to pop.

I am only 6 days out of my surgery and I feel like a new woman. I know I have physical therapy ahead of me. But I take comfort in the fact that I know Coordinated Health will be able to assist me. Most importantly, they will listen to me and help me to resume a normal, productive, and happy life.

Interested in sharing your story? Click here to tell us more about your experience!

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2011 March/April 21

What’s New At CH?

Urgent Care Little things, like a skinned knee, can be treated at home. Life-threatening conditions, like chest pain, require a trip to the ER. For everything in between, there’s Coordinated Health Urgent Care.

Urgent Care is not meant to replace necessary trips to the ER. Rather, we are here to complement that option, with fast, expert care for most injuries and illnesses. Our Urgent Care services fill the gap between an ER and your doctor’s office. One look at everything we offer and you may start to feel better already!

ILLNESS

INJURY

OTHER MEDICAL NEEDS

Concussions

Colds, Coughs, Sore Throat

Routine Exams

Fractures

Flu

Sick Visits

Muscle Strains/Sprains

Vomiting & Fevers

Lacerations

Abdominal Pain

Sports Injuries

Back Pain

Preventative Care - including management of chronic medical conditions like diabetes or hypertension

Minor Burns

Dehydration Allergies Rashes & Skin Infections Other common illnesses

Sports or Driver’s License Physicals Immunizations/Vaccinations EKG’s Digital X-rays Lab work IV fluids Minor surgical procedures

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Advantages of Coordinated Health Urgent Care No appointments necessary Schedule same day appointments by phone or online to accommodate your busy lifestyle

URGENT CARE

Shorter wait times Full service capabilities including digital x-ray, labs, EKG’s, laceration repair, IV fluids, and minor surgical procedures Most insurance plans accepted but not required

No ER copays or Emergency

Affordable services for the uninsured

Room fees!

Electronic Medical Records to ensure prompt communications with your Primary Care Physician

Coordinated Health Urgent Care is located at our Bethlehem Campus on Highland Ave. and Lehighton Campus

Walk-in & Appointment Hours: Bethlehem Hours: Monday - Friday 7am - 11pm Saturday & Sunday 8am - 8pm Lehighton Hours: 8am - 5pm

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Directions: From 22, take a right off Center St. exit .Take a right at the intersection of 512 & Highland Ave. Urgent Care is one mile down on the right.

2011 March/April 23

Avoid Running Injuries in 5 Easy Steps

1

Many running injuries are actually the result of overtraining, which means doing too much too soon. You should only increase your mileage by about ten percent each week. By building up slowly, you will be able to reach your goals without the frustration of dealing with pain.

2

Make sure your shoes aren’t worn out and they fit you properly. If you know you’re going to be doing a lot of running, but haven’t bought shoes in a while; go to a specialty store where they can fit you with the right size and shoe for how you run. Running in the wrong shoe can cause pain in your feet, legs, knees and hips. Shoes generally need to be replaced every 300-500 miles.

Spring is in the air and that means many people are anxious to get outside and resume their running routine. But, while you might be excited to get back outside, if you haven’t been training it’s important to ease back into your running regimen.

Even if you have been running inside on a treadmill, running outside can present a whole new set of challenges.

If you’re not careful, you could end up sidelined with a running injury. Below are some tips on how you can enjoy running and prevent injuries.

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3

Avoid running on concrete as much as possible as it’s actually ten times harder than asphalt and a poor running surface. Grass surfaces and dirt trails are actually the best running surfaces, especially when it comes to those higher mileage runs. In order to prevent an injury, it’s also important to look for areas with slow curves and straight paths.

4

One of the most important parts of any routine is regular stretching before and after running. Areas that should be stretched include the calves, quadriceps, hip flexors, and hamstrings. Not stretching can lead to serious injury.

5

Break up your running routine with some other exercises as well. Water running, cycling and using an elliptical trainer are all lower impact ways to build muscle and give your body a break from running.

Contributing Author: Hannah Ropp

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2011 March/April 25

A Coordinated Health Physician Gives Some "Special" Athletes The Chance To Shine Each year, hundreds of children and adults take part in the New Jersey Special Olympics.

Wrist Fracture Studies have shown that special needs patients who participate in events like the Special Olympics actually function at higher levels and have a higher sense of self worth; however, some athletes have found themselves sidelined from the activities because they couldn’t get the necessary medical forms signed by a doctor.

Dr. Zlotnick says the New Jersey Special Olympics approached the New Jersey Academy of Family Physicians several years ago with a need for a better screening process for their athletes.

Normally, when an athlete goes for a screening, they can’t be cleared to take part in physical activity until any serious medical conditions encountered during the exam are resolved. Dr. Zlotnick felt that many doctors didn’t feel they could

That’s why Dr. Jeffrey Zlotnick and the New Jersey Academy of Family Physician’s developed a new screening process for the Special Olympics, making it easier for athletes to get the medical clearance necessary to participate.

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clear their patients to participate in the Special Olympics based on the existing guidelines so he decided to reverse the screening process.

He designed a screening process that allows physician’s to document medical conditions that exist in special needs patient and then turn over the examination results to the Special Olympics who by way of the ―Adaptive Sports Program‖ ultimately determine what level of activity the athlete can participate at.

In an effort to make the screenings more accessible to everyone, Dr. Zlotnick has also developed a yearly program called Med Fest, which is staffed by Family Medicine residents. He says that when residents take part in the screenings it’s a win for everyone involved.

Residents are able to fulfill their volunteer hours, get sports medicine experience, and gain valuable experience with special needs patients. To date, 600 people have taken advantage of the screenings that otherwise would have never had the opportunity to participate.

While the screening program was developed in New Jersey, Dr. Zlotnick says there are several other states that have showed have adopted similar programs including Virginia and Pennsylvania.

―It’s a very simple program to run and can be adapted depending on the size of the state,‖ says Dr. Zlotnick. New Jersey currently only has one screening day a year, but larger states like Pennsylvania and Virginia may benefit from multiple screenings a year.

Dr. Zlotnick has been overwhelmed by the success of the screenings and the impact it has had on the athletes. ―I’ve had these big weight lifters who are just so happy to be able to participate that they literally lift me off the ground.

You don’t see that kind of reaction normally, it’s just great,‖ says Zlotnick.

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Contributing Author: Hannah Ropp

2011 March/April 27

Vibram Five Fingers®: Healthy Lifestyle or

Running Nightmare??

Have you heard of the new craze hitting the roads or running trails? Finding yourself wondering what the fuss is all about, let alone, ―do they actually work?‖ You and I alike, are riding in that same proverbial boat known as skepticism. Hopefully with some general insight on the designs and benefits of the Five Fingers®, together we can venture down the same trail towards a healthy alternative and the ―barefoot revolution‖.

Vibram Five Fingers® claim to fame is that their product offers a ―healthy alternative‖ to the more traditional cushioned running shoes on the market today. With a variety of styles available, the ―sole‖ purpose is to deter a direct heel strike and encourage a more natural and healthy forefoot strike.

Initially a manufacturer of rubber soles for boots, Vibram put together a proto-type to simulate and promote a natural running habit and instill an enjoyable biomechanical rehabilitation.

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Their low-profile look ensures avid runners ample grip for various surfaces and an efficient amount of protection. As evidenced by their growing popularity, this craze was surely welcomed and praised by all that are looking for that change of pace.

Now, before I can fully endorse this product, let’s slow down and investigate the unique and eye-catching design. As you can see, the Vibram Five Fingers® have little or no cushion on or around the calcaneous (heel), medial, lateral longitudinal or transverse arch and each individual phalange (toe).

These specific landmarks make up the common points of contact during the running phase of biomechanics (heel strike, forefoot strike and toe-off with the

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first phalange leaving the ground last).

The less is more approach is adopted here. You should also note that the rubber sole does extend and wrap up and slightly around the phalanges to negate stones or debris from making direct contact.

Different styles can offer either a Velcro style wrap around the mid-foot, mid-foot and Achilles tendon or the traditional lace-up the mid-foot. A mesh layer, predominantly, makes up the rest of the Bikila style (pictured above) allowing for the foot to breathe and move freely; as intended by our natural body biomechanics.

Vibram labels five top reasons as to why their footwear is healthy but also safe and effective. They are as follows: 1. Strengthen the muscle bellies within the feet (intrinsic and extrinsic muscle groups) and lower legs (anterior, medial and posterior) 2. Improve range of motion within the sinus tarsi and forefoot and toes allowing for a ―natural‖ motion 3. Neurological adaptations to improve balance and agility 4. Eliminate heel lift and promote proper posture and spinal alignment (distribute bodyweight evenly) 5. And finally, move naturally!

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Now that we got that anatomical mumbo jumbo out of the way, let’s get down to the information you really want to know.

The Five Fingers®, in regards to running, can be used by those with almost all types of foot and ankle issues…from over-pronators to overzealous supinators, and even those who wear orthotics. These shoes are designed for you to run in as-is condition; meaning there is no necessity to add extra support or padding.

As with any pair of new running shoes, there is a transition period. This period may be a little more difficult than before.

Vibram insists a ―break in‖ period of progressively wearing the Five Fingers® more each day and for longer runs. With such a drastic change to muscle activation, this transition is strongly urged to prevent over-use injury and delayed onset muscle soreness (D.O.M.S). Along with this addition of new pain, adopting a new style of running becomes the most difficult process.

Learning how your specific body operates and relays pain and neuromuscular feedback to the brain can take time. Strong heel strikers feel the most pain, as the Five Fingers® utilize a forefoot strike; a healthy and safer alternative. It is also of interest to know that these shoes are not intended to be the ―be all, end all.‖ Although there are many styles of Five Fingers® to suit your running needs, you will still find the necessity to have common running shoes or boots accessible for more difficult terrain and situations.

Contributing Author: Sean Harkcom, ATC Pocono Mountain East High School

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2011 March/April 31

Water or Sports Drink: Which is Best for You?

purpose behind these ingredients is to replace those electrolytes lost through sweating during physical activity. It is important to check the labels of sports drinks for carbohydrate content. The National Athletic Training Association (NATA) recommends that sports drinks should contain no more than 8 percent carbohydrate content because any more will inhibit the rate of fluid emptying from the stomach as well as add unnecessary calories.

Many athletes and exercise enthusiasts are torn between consuming water or sports drinks, such as Gatorade or Powerade, during physical activity.

Whether you are an avid exerciser or someone who enjoys a long walk on a nice day, staying hydrated is important for your bodies’ overall health and wellness.

What exactly is a sports drink made of? A sports drink is essentially a combination of electrolytes (such as sodium and potassium) that are found naturally in the body, and carbohydrates (sugars). The

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For most of us, water is the best choice for hydration replacement. Water is recommended before, during, and after participating in any type of physical activity to keep the body in a proper state of hydration.

Sports drinks are usually only preferred over water when you are exercising at an extremely high intensity, for a long duration of time (greater than one hour, continuously), and/or in very hot temperatures.

The American College of Sports Medicine (ACSM) recommends a carbohydrate replacement, such as a sports drink, after an hour of high intensity activity or of lower intensity activity lasting longer than one hour.

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Water should be the main fluid replacement during lower intensity exercise as well as throughout periods of inactivity during the day while saving sports drinks for the longer, more vigorous periods of activity.

Drinking only sports drinks in lieu of water completely is never recommended for healthy individuals.

A more important concern might be; whether you’re properly hydrated on a daily basis. About 60 percent of our body weight is water and every system in our body depends on it in order to work properly. Water helps with everything from flushing toxins out of vital organs to carrying nutrients to our cells to keeping our body tissues moist.

According to the Mayo Clinic, even mild dehydration (not having enough water in the body to carry out normal functions) can drain our energy and make us feel sluggish. It is recommended that we drink eight glasses of water per day to maintain homeostasis, or a balanced environment, in our bodies. As a rule, you should drink enough water so that you rarely feel thirsty.

It is very important to remember to drink sufficiently throughout the day, even if you don’t feel thirsty. Whether your daily routine warrants a sports drink or you are content sticking to a bottle of water, staying hydrated will help keep you healthy and feeling your best.

Contributing Author: Nicole Karasek, ATC WWW.COORDINATEDHEALTH.COM

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Who’s New At CH? Sarah Yadlosky, PA-C Care on Call Bethlehem Campus @ Highland Ave.

Kate Liberty, CRNA Certified Registered Nurse Anesthetist

Amy Pucklavage, PA-C Care on Call Bethlehem Campus @ Highland Ave.

Jill White, PTA East Stroudsburg Campus

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Brian McElmoyle, DPT, CSCS Bethlehem Campus at Schoenersville Rd.

Lynn Schiavone Call Center Supervisor

Raymond DeArmas Director of Housekeeping

Roxanne Romano Director of Nursing at Bethlehem Hospital

Ralph Richards, MSPT Lehighton Campus

Jeanette Richards, RN, CRNP Lehighton Care on Call

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The typical American laborer works hard everyday, and unfortunately hard work does not always come without its consequences. The manufacturing, organization, and/ or packaging of products can lead to on the job injury, both from overuse or simple on the job accidents.

The quicker the treatment begins, the faster recovery can be, resulting in less time out of the job. Usually, medical access is readily available for the worker’s compensation patient, however, even before a trip is made to the doctor’s office, several steps can be done to aid in the recovery process.

A simple pneumonic called ―RICE‖ is a straightforward, non-medicinal treatment plan that can be apply to most any on the job injury even before presenting to a doctor’s office.

RICE stands for rest, ice, compression, and elevation.

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If you hurt yourself, stop. If a lower extremity or back injury occur, sit down.

Continuing to work can aggravate and make your injury worse. If attempting to re-start work, start slow and work your way back up to full performance.

With the acute injury, inflammation occurs. Inflammation increases blood flow, causing the injured site to swell. Ice cools the affected injury, preventing the affected area to swell as quickly. Also, ice partially numbs the area, decreasing pain. Icing should be done immediately for 20 minutes.

The ice should not come in direct contact with the skin. Do not use heat on an acute injury.

Compression puts pressure on the injured area, which also can prevent swelling. ACE wraps are often helpful because the are easily applied. With wrist, ankle, knees, or elbow injuries, wraps can also act to help stabilize the joint, decreasing pain. Be sure the wrap the area snuggly but not too tight.

Try raising the injured body part to an area above the level of your heart if possible. This technique is done decrease pain and swelling, and help drain and swelling that may have already started.

Overall, the RICE technique has the best results when using all four components together. After evaluation by your health care professional, antiinflammatory medications can be added aid in the recovery process; physical therapy may also be added later to help as well. However initially, the RICE technique can be started right away to essentially any acute injury. With early treatment strategies, comes a swift and successful recovery process, and at the end of the day, an earlier return to work.

Contributing Author: Amy Pucklavage, PAC WWW.COORDINATEDHEALTH.COM

2011 March/April 37

HOW TO TELL IF YOU

Contributing Author: David Bower, COTA/L

BROKE A BONE

Imagine you are walking down the sidewalk and slip on the ice. Your natural reaction is to put your hands out in order to ―catch‖ your fall. Once you get back up, you ask yourself ―is my wrist broken?‖ There are many signs and/or symptoms of a broken bone. There are also many myths regarding broken bones.

The first symptom is pain. Localized pain in one specific area (wrist, fingers, elbow) is your body’s reaction to the trauma that has occurred.

Along with pain, swelling can occur. While pain can just mean a sprain/strain, swelling is your first sign of a potential bone break.

Although swelling can occur with any 38

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trauma, increased swelling over an area that does not recede within a few hours can indicate a break has occurred.

Discoloration around the swollen area may also occur. If, for example, your wrist turns ―black and blue‖ within a few hours of the incident, this can be a sign of a broken bone. The bruising that occurs with a bone break is not the typical bruising you may see when you bump your elbow. If you say to yourself, ―wow I have never been this black and blue before‖, you should see a doctor immediately.

One the most obvious signs of a break are any noises your may have heard during the fall. When you fell, did you hear a pop? If any abnormal sounds were associated with the fall, you need to visit your doctor. Any abnormal sound can indicate a bone break or tendon or ligament rupture.

Another obvious sign of a bone break is deformity. If your wrist is crooked or presenting in an abnormal position, you need to see a doctor immediately. With that said, not all breaks will present in this fashion.

One of the biggest myths is the idea that if it’s broken you can’t move it. Unless there is a deformity, when you break a bone, you very well may be able to move the injured area. This myth leads many to believe they haven’t broken a bone which delays treatment.

Knowing this information, can help you determine when to seek urgent treatment for a fracture or when you are suffering from a strain or sprain. If you suspect a fracture call Care on Call to speak to a physician immediately or visit one of our Urgent Care locations in Bethlehem or Lehighton for an evaluation and x-ray.

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CAMPUS LOCATIONS

CAMPUS LOCATIONS

2775 SCHOENERSVILLE RD.

3101 EMRICK BLVD. SUITE 112

BETHLEHEM, PA 18017

BETHLEHEM, PA 18020

1503 N. CEDAR CREST BLVD. ALLENTOWN, PA 18104

123 ROSEBERRY ST. SUITE A PHILLIPSBURG, NJ 08865

2300 HIGHLAND AVE. BETHLEHEM, PA 18020

HOSPITAL LOCATIONS

400 S. GREENWOOD AVE. EASTON, PA 18045

2310 HIGHLAND AVE. BETHLEHEM, PA 18020

505 INDEPENDENCE RD. EAST STROUDSBURG, PA 18301

1503 N. CEDAR CREST BLVD. ALLENTOWN, PA 18104

RTE. 115 & SWITZGABLE DR. BRODHEADSVILLE, PA 18322

Phone

50 MOISEY DRIVE, SUITE 202 HAZLETON, PA 18202

(877) 247-8080

239 NORTH FIRST ST.

(610) 861-8080

LEHIGHTON, PA 18235

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