The days are getting longer and warmer and for those who have the gardening bug spring is beckoning to get outdoors and in the dirt! The green poking out of the ground can be an irresistible call for those with green thumbs. Gardening can be a great way to enjoy the outdoors, get physical activity, beautify the community, and grow nutritious fruits and vegetables.  But those long, dark days of winter spent on the couch perusing gardening catalogs may have taken a toll and your body may not be ready to jump into the garden. A little bit of preparation before getting out there can help you enjoy your garden even more.

Common gardening chores such as raking and spring clean up can lead to back, neck and shoulders strains. Kneeling to pull weeds can strain both your back and knees. Gardening chores can become especially difficult as we age. But don’t despair! You can still get out and work in your garden just be sure to follow a few simple guidelines. Simply taking frequent breaks, using a cart to carry heavy objects and using long handled tools can go a long way to preventing pain or injury. By protecting your back and your hands while you are gardening you can ensure that you will enjoy the fruits, flowers and vegetables of your labor for years to come!

This tip is brought to you by the BMH Rehabilitation Services Department.

A wonderful part of living in New England is enjoying outside activities especially during the winter months. Participating in outdoor activities in our beautiful winter wonderland can make the short, cold days of winter fly by, help keep you fit and can even help boost your mood.

There are many ways to enjoy the outdoors in the winter. Skiing, snowboarding, snowshoeing, snowmobiling and skating are some more active ways. Building a snowman or igloo, having a snowball fight or making snow angels are all fun activities that get you and your family outside enjoying the weather.

As with any exercise or activity it helps to be prepared. If you are planning on participating in active winter sports there are many things you can do to prevent injuries.  Simple things like knowing the weather conditions and dressing appropriately can make your outdoor time much more enjoyable.

Children can especially benefit from spending time participating in outdoor recreational activities in the winter months. But you should remember that children aren’t just small adults and adhering to some safety tips for kids is important.

So get out those hats and gloves and get out into the great outdoors!

The Centers for Disease Control report that roughly 42% of people between age 45 and 64 do no physical exercise, that half the people aged 65-74 do nothing and two thirds of people over the age of 75 do absolutely nothing in terms of leisure time physical activity! Yet in study after study exercise and physical activity has been shown to improve mood and decrease depression, improve blood pressure, help manage weight and help manage chronic pain just to name a few things!

So will 2012 be the year that you decide to improve your health?

The most frequent mistake people make when starting an exercise program is starting too much, too soon. This leads to discouragement and potentially injuries. Start your exercise program gradually and build up your tolerance. Fitting exercise into your already busy life may seem difficult but  it can be easier than you think . To help you stick to your program it helps to have an exercise buddy or make exercise a family activity.

Physical activity should be part of your daily routine for a long and healthy life. So make 2012 the year to shut off that TV or computer, get off the couch and get moving!

To prevent hand injuries while using portable electronics and video games, ASHT recommends the following safety tips:

• Tell your child to use a neutral grip when holding the controller. A neutral grip is when the wrist is straight, not bent in either direction (not strong or weak). It will allow for wrist motion in a plane where more motion is available in the wrist.
• Ask your child to take a break every hour or switch to another activity. Overuse of repetitive motions, such as pressing buttons, can cause tendonitis of the elbow or lead to Carpal Tunnel Syndrome.
• Don’t let your child sit back on his/her knees. Bending the knees this far is not only a hard position for the knee joint, but it requires your child to push most of his/her body weight up with his/her hands and wrists, placing increased pressure on these joints as well.
• Make sure the monitor is at the correct height.  While looking at the horizon, your child’s eyes should be looking at the top of the monitor (this may vary if child wears glasses).
• If your child is typing, the keyboard should be at a height so that with his/her wrist/hands are straight, his/her forearms are parallel to the keyboard surface.
• When using a gameboy ( a hand held device), encourage your child to put pillows in their laps and rest arms on pillows. This will allow them to keep their head in a more upright position and therefore decrease neck strain.  The pillows will help support the arms so they do not have to be held up in the air.
• Whenever, possible your child should be sitting in an appropriate chair.  This would be a chair that allows your child to comfortably put their feet on the floor and also provides good back support.
• When s/he is using a single control device (like a mouse), encourage your child to switch hands frequently.  This will allow the one hand to rest and reduce fatigue.
• Have your child frequently focus on a distant object (away from the monitor) to help reduce eye fatigue.

Brattleboro Memorial Hospital employs Occupational Therapists and a Certified Hand Therapist that can help you with you upper extremity rehabilitation needs.

In addition to following healthy usage guidelines, ASHT recommends performing the following wrist exercises to reduce the risk of injuries when using handheld electronics:

• Fold your hands together and turn your palms away from your body as you extend your arms forward. You should feel a stretch all the way from your shoulders to your fingers. Hold for 10 seconds and repeat eight times.
• Fold your hands together and turn your palms away from your body, but this time extend your arms overhead. You should feel the stretch in your upper torso and shoulders to hand. Hold for 10 seconds and repeat eight times.
• Place your hand just above the back of the elbow and gently push your elbow across your chest toward the opposite shoulder. This is a stretch for the upper back and shoulder. Stretch both the right and left arms. Hold for 10 seconds and repeat eight times.
• Raise one arm overhead. Bend the elbow. Place the opposite hand on the bent elbow and gently push the elbow back further. This is a stretch for the triceps (muscle on the back of the upper arm). Stretch both the right and left arms. Hold for 10 seconds and repeat eight times.
• Extend an arm in front of you, making sure the elbow is completely straight. With your palm down, take the opposite hand and bend the hand down toward the floor. Then turn the palm up, and stretch the hand back toward the floor. This stretches the forearm and wrist muscles. Hold for 10 seconds and repeat eight times.
• Open up hands and spread the fingers as far as possible. Hold for 10 seconds and repeat eight times.

Note: These exercises should never be painful when completing them. You should only feel a gentle stretch.  Should you experience pain, please consult a hand therapist or physician.

ASHT stresses the importance of developing good habits early on in children to prevent hand and wrist injuries in adulthood.  Healthy techniques learned at a young age can carry over into other aspects of life where there is a similar injury risk such as sitting in front of a computer or playing musical instruments.

Source: American Society of Hand Therapists

The American Heart Association has tips on handling stress, healthy eating and maintaining your fitness during the holidays read below:

Carrie Quimby lays out an eating plan for the holidays on Brattleboro Memorial Hospital’s website under our Health Columns titled-Eat, Drink and Be Merry without Adding Those Holiday Pounds.

All of the staff here at Brattleboro Memorial Hospital wish you a happy and healthy holiday season!

The Brattleboro Memorial Hospital Travel Clinic should be your first stop 6 – 8 weeks prior to travel outside the United States. We can help you and your family stay healthy and safe while traveling. We will provide country specific, timely information about your destination, including local health and safety concerns from the Centers for Disease Control and Prevention (CDC) and The World Health Organization.

Effects of a Heavy Suitcase

• Lifting, lowering, pushing, pulling, carrying, holding, and dragging heavy loads involve static and dynamic efforts, which cause strain on muscles and joints, and wear and tear on the back.

Tips for Selecting the Right Suitcase

• Size: Buy different size suitcases for different occasions. The size should reflect the length of your trip.
• Type: If traveling by air, select wheeled luggage. If traveling by car, select duffels or garment bags.
• Material: Avoid selecting suitcases made of heavy material such as leather. This only adds extra weight. Instead, select a suitcase made of lighter, durable material such as vinyl and canvas.
• Handles: Select a suitcase with extending handles with a swivel feature, with padded handles to protect the joints in your hands and fingers from excess pressure, and with handles at both ends, which will make it easier to pull the bag out of a tightly packed overhead compartment.
• Wheels: Select a suitcase with large wheels. The suitcase should have 4 wheels, allowing for smooth rolling over various surfaces and better maneuverability through small spaces and aisles, or 2 wheels with a 360° turning radius.

Tips for Packing a Suitcase Correctly

• General: Make a list of what you will need on your trip to ensure that you only pack essential items. Instead of packing one heavy suitcase, consider distributing weight, and take two smaller suitcases to avoid back strain when lifting your suitcase into the overhead bin. If you are going on a long trip, consider shipping items ahead of time, and taking one small light suitcase on your flight.
• Clothes: Decide what you will wear in advance, and pack only those items. Consider packing less and making use of laundry facilities during your stay. Check the weather before your trip to avoid packing “just-in-case” clothes. Wear your heaviest clothing items on the plane.
• Footwear: Pack no more than 3 pairs of footwear. Pack shoes that can be worn with multiple outfits.
• Toiletries: Most hotels provide complimentary toiletries. Downsize toiletries and look for travel-size versions of your favorite products or transfer into small containers.

Tips for Carrying Your Suitcase Correctly

• Opt for carrying two light suitcases, one in each hand, rather than carrying one heavy suitcase in one hand or on your shoulder.
• Avoid carrying heavy suitcases for prolong periods. Carry heavy items close to your body. Switch positions frequently to avoid fatigue from muscle overuse.
• When using a 2-wheeled (360° turning radius) suitcase with adjustable handles, push the suitcase in front of you or to your right or left side instead of pulling it behind you.

Tips for Loading a Suitcase in an Airplane Correctly

• Do not rush—move slowly! Lift your luggage in stages. When loading your luggage into an overhead bin, first lift it to the top of the seat, rest, and then lift it into the overhead bin.

Source: Ergonomic Strategies for Using a Suitcase

The American Society of Hand Therapists (ASHT) offers the following tips to protect hands and to prevent injuries while in the kitchen:

1. Use the right tool for the job – Use easy-to-grip versions of tools like spoons, knives, and bottle/can openers to decrease the stress on your hands and use scissors to open bags (or packages) instead of your thumbs.  Look for tools that have oversize handles (rather than narrow/standard) – this will allow you to get the job done without requiring a tight grip and pinch.
2. Sit or stand up straight – Correct posture is important because the nerves that operate your fingers start in your neck. Slouching puts pressure on the neck and shoulders, which in turn can hinder the amount of motion in your arms and hands or may cause pain radiating down your arms.  During activities which require you to be looking down at what you are doing, like chopping vegetables, take a moment to stand up straight, turn your head side to side/up and down, and stretch your arms over your head.
3. Slide, do not lift – Do not lift heavy pots and pans – slide them off burners and onto hot pads along the counter whenever possible.  When working in the oven, always slide the shelf out so you can get a good, safe grasp of the panhandles.  If the pot is heavy, ask for help to take it out of the oven.  This may take more time, but always choose safety over speed in the kitchen.
4. Use mitt-style potholders - The mitt-style potholder is generally safer than the simple flat design.  Mitt styles protect both the top and bottom of your hands and let you concentrate on picking up the hot dish rather than trying to keep a flat potholder from sliding away from the hot handle.
5. Clean cutlery carefully – When washing your cutlery, do not put knives and sharp tools in the soapy dishwater and then search blindly to find them.  If you miss the handle and grab the blade, you may cut the tendons in your hand, which may require surgery and rehabilitation. Instead, clean knives individually with soap and water and rinse immediately.
6. Use lightweight kitchen equipment - Using plastic instead of glass when having a house full of guests is safer for many reasons.  Plastic is not likely to break and it is easier to stack. It is also easier to transport from room to room because of its lighter weight.
7. Keep your shoulders down – While working in the kitchen, your arms should be at your sides and the counters you work on should be waist high.  Many kitchen counters are too high for the average person. As a result, you may be forced to raise the shoulder you are using to cut the food and lean to the opposite side of your body when preparing food.  This causes increased stress on the neck, shoulder and arm muscles and nerves. 
8. Don’t use the naked hand with jars and tops – Unscrewing a tight jar lid can be tough on your finger and wrist joints.  Before you open any jar or bottle, turn it upside down and tap the bottom lightly against the countertop two or three times.  Listen for the jar to pop, indicating that the suction has been broken. If the jar has previously been opened, you may try running the lid under warm water to soften any dried product holding the lid closed. Then use a rubber top or a “Y” jar opener to finish opening the top.   Better yet, select those cans at the store that can be opened with an electric can opener. It is recommended to use an electric can opener whenever possible as this activity can be particularly difficult for those with weakened or sore hands.

Stretch

Note: These exercises should never be painful when completing them. You should only feel a gentle stretch. Should you experience pain, please consult a hand therapist or physician.

• Perform simple hand and arm stretches to improve flexibility as well as reduce the possibility of stress or strain in your upper extremities.
• Begin by bringing your arms to your side for a brief shake, just to relieve some tension.
• Then perform a “prayer stretch” by placing your palms together with your fingertips pointing towards the ceiling and stretching downward until a stretch is felt on the underside of your forearms. You may also accomplish this by placing your hand at the edge of the countertop and, keeping your hand flat on the counter, bend your wrist up and then down as far as comfortably tolerated.
• Next straighten out your elbows in front of you and make a GENTLE fist as you bend your wrists down. Continue until a stretch is felt on the back side of your forearms.
• Finally, make a tight fist and then straighten your fingers, spreading them apart as much as you can.
• Hold each position for a count of three, and then repeat three to four times.
• Just prior to resuming your cooking project, also perform about 5 slow shoulder rolls, emphasizing rolling away from your ears.

Pay attention

It is hard to focus on the task at hand when family and friends are vying for your attention.  When chopping, removing hot items from the oven, or carrying a heavy object, it is important to take your time and watch what you are doing.  These are prime opportunities to have an accident, which could result in a cut, burned or injured finger, hand or arm.

source: American Society of Hand Therapists

Brattleboro Memorial Hospital Occupational therapy department has a Certified Hand Therapist on staff to make sure you get the best care available for your hand injuries. For more information check out the BMH Occupational Therapy page.

The guidelines also recommend that patients with coronary heart disease:

• stop smoking and avoid exposure to tobacco smoke
• get at least 30 minutes of exercise 5-7 days a week
• reduce weight if overweight, obese, or have a large waist
• get an annual flu shot
• take low-dose aspirin daily unless a physician prescribes a higher dose or recommends against it because of medical contraindications

The guidelines are published in Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology.

BMH offers a nationally certified Cardiac Rehabilitation program that combines monitored exercise, education and support to patients that have had a heart attack, stent, coronary bypass, heart valve replacement or stable angina. For more information about our program please visit us on the Cardiac Rehabilitation page.

Make sure you use a sharp knife or an electric knife when carving your turkey.   It is a good idea to cut off the thigh and the leg first.  To learn more about safe carving techniques.

Brattleboro Memorial Hospital Occupational therapy department has a Certified Hand Therapist on staff to make sure you get the best care available for your hand injuries. For more information check out the BMH Occupational Therapy page.