If the Shoe Fits

All too often the topic of footwear comes up in our clinic, even if the person isn’t there for a foot problem. The shoes you choose to spend your day in will greatly impact all areas of your body including your knees, hips and spine. Your foot is the first part of your body to absorb the impact of the ground. That being said, it’s best to arm it with the right surface to stabilize against the force of the ground reaction.

First and foremost be sure to fit your shoe properly. Amazingly, many people have not recently measured their foot and commonly wear a shoe that is too small. Another frequent misconception is that if looks good on the outside, it’s good on the inside. Even if your shoes look clean, intact and gently used the guts of the shoe may still be worn and inadequate. This is where you want to consider the age of the shoe and how many miles or steps you’ve put on them. If you spend thirty minutes a day or 3-4 hours a week walking in a pair of shoes its a good idea to replace them in six months. Another tell tale sign is if the tread has worn. The cushion and shock absorbancy of the shoe tends to wear faster than the tread so at this point you are overdue.

When looking for a good shoe choose something that is comfortable for your whole body. Avoid the temptation of picking a pair of shoes simply based on looks. Depending on your activity level and how much you are on your feet be sure to consider the amount of cushion and stability the shoe offers. The type of shoe is extremely relevant when you consider your daily foot needs. If you spend a great deal of time on your feet throughout the day, explore a sturdier shoe with support and firmer cushion versus a sneaker. With this in mind, flats and backless shoes do not offer the shock absorption and motion control most of us seek, especially when we are on our feet for a good portion of the day. When in doubt on your footwear needs its a great idea to visit your local shoe store with experienced staff or contact your physical therapist for guidance.

Tips for Yardwork and Gardening

Summer is in full swing now and with this warm weather comes continued yard work and gardening that will lead us into the fall season. Most gardening activities such as digging, planting, weeding, raking and push mowing can cause stress and strain on muscles and joints. Though these activities may not seem like much in the moment, consider the length of time and the repetitive motions that take place. With a few simple strategies you can walk away without feeling like you need to crawl to get back inside.

First and foremost, warm up! A brief, brisk walk for about 10 minutes will help prepare your muscles and joints by increasing blood flow to your body offering you more flexibility as you get to work. Remember to switch positions frequently or alternate tasks every 10-20 minutes to give your body a break. For example, if you are doing an activity that has you bending forward stand up and stretch backwards ten times to counteract the effects repetitive bending can have on your spine. If your push mowing your lawn switch to watering the plants after 20 minutes to give your back a rest from the forward leaning.

Posture and positioning are everything. Use a kneeling pad or knee pads on the ground to protect your knees and provide more cushion. Another alternative is to make elevated planters or beds to bring your work to you. Utilize a wheel barrow, tarp or cart whenever possible and remember to lift with your legs and keep your abdominal muscles tight. Remember to avoid twisting your back and your knees and instead move your feet and your whole body as one unit.

Stay hydrated with water. Keep in mind coffee, tea and sugary drinks can act as diuretics and dehydrate you quicker. Although many of us can’t stand the idea of stopping until the job is finished, taking breaks and working in shorter bursts can help ward off the aches and pains that may accompany 2-3 hours of straight activity. Once you’re done for the day finish your body off by doing some gentle stretching of backward bending, reaching your arms up to the sky on your toes and a short walk to cool down. Once inside, be mindful of your posture and avoid surfaces that allow you to slouch and slump and consider a lumbar roll to support your spine after all of that hard work.

Exercise and Arthritis

Exercise and arthritis can and should coexist. Now, if you’re one of the estimated 54 million that live with arthritis, exercise may sound like a terrible idea. On the contrary, exercise has been proven to reduce pain, increase energy, improve sleep and overall day to day function in those who regularly participate in an exercise program. Too often, in cases of arthritis, the thought of pain with movement quickly causes people to become very inactive. This has a tremendous domino effect, thereby, weakening muscles and bones, further stiffening joints and limiting normal mobility. Beyond the arthritis related problems, are the other health related risks that quickly increase by being inactive such as Type II diabetes, cardiovascular problems and osteoporosis.

Starting off slowly with a low intensity, low impact exercise routine is key. Another helpful strategy is to have multiple exercise options or locations. For example, many counties offer community based programs which is a great motivator in getting out of the house and socializing with others while enjoying all the benefits of exercise. Generally, those with arthritis need to increase their exercise more gradually than those without it. It’s important to perform exercises that don’t increase your pain. Yes, that’s right, the appropriate exercises shouldn’t hurt. Muscle soreness is one thing, pain is another.

If you’ve tried to exercise and had to stop because it hurt, consider working with a physical therapist. Success can be had with the right exercises, done with the correct amount of weight, repetitions and sets. Being advised on proper posture, form and execution is also crucial in avoiding painful exercise and maximizing the benefits of all of your physical effort. The research is out there, exercise is one of the best ways to decrease pain, stiffness and improve range of motion and quality of life.

Sitting is the new Smoking

If you haven’t heard this phrase before then please read on because the gravity of the situation is real. Sitting for prolonged periods has been linked to higher risks of heart disease, obesity, diabetes, cancer, and even early death. This inactivity is not limited to just the time you spend sitting in front of the TV. Sitting times are greatly increased with long work commutes and sedentary jobs. Take a moment and think about that. How much time are you spending each day behind a desk or behind the wheel? How is this impacting your life? Even if you’re going to the gym or engaged in other vigorous activity a few hours a week, this still doesn’t seem to offset the risk.

By remaining still for long periods our body goes into “storage mode.” Our metabolism decreases, muscles imbalances form, increased strain on our spine and decreased ability to concentrate and focus occurs. The message here is to keep moving. You can reverse the detrimental effects of sitting by taking breaks every 30 minutes to an hour. At first this may seem impossible but a few simple ways of adjusting the way you work can be your ticket to improved overall health. For example, stand while talking on the phone or eating lunch, stand and stretch in all directions every half hour, stand during conference room meetings and shift your weight or try lifting up on your toes, take the stairs. This form of mobility, though simple, can have profound impacts on your overall health by kick starting many physiologic processes. If you find you would like to address specific areas of concern such as work station ergonomics, driving postures, current low back/neck pain or develop a conditioning program, a physical therapist can help advise on these issues.

Proper Hydration

Summer is finally here, and with summer comes the hot weather. For those who spend time outside during this time of year, staying hydrated is important for health and optimal function. Proper hydration benefits the whole body: it keeps cool in the heat by allowing our bodies to sweat and also by maintaining proper blood volume. The blood vessels dilate near the skin to allow heat to dissipate into the air (our faces get red for good reason). Maintaining proper hydration keeps joints lubricated, and allows for exchange of nutrients and waste products throughout the body.

Dehydration leads to the inability to sweat and to low blood volume, limiting the body’s ability to cool itself. The heart works harder to circulate blood through the body. Lack of hydration causes waste products to build up and limits delivery of nutrients to working muscles. All of this leads to poor function with work outs, or just general malaise, fatigue or headache with activities like yardwork or sightseeing. Severe dehydration can lead to heat exhaustion, or the more severe, heat stroke.

Heat exhaustion occurs when dehydration becomes serious. Symptoms include excessive sweating with cold/clammy skin, feeling faint/nauseous, headache, muscle cramps and weakness. At this time, it is vital to get out of the sun, and to rest and re-hydrate. Heat stroke is a medical emergency, and requires immediate medical attention via going the emergency room or calling 911. Symptoms include throbbing headache, rapid pulse, nausea/vomiting, dry/flushed skin, confusion, decreased urination and increased body temp (103-104). Heat stroke can lead to loss of consciousness, damage to the muscles/organs, seizures and in severe cases can be fatal.

So how does one stay properly hydrated? It’s difficult to know how much to drink throughout the day. A good rule of thumb is to divide your body weight by two. This should be the number of ounces consumed during a day. For example, if you weigh 150 pounds, 75 ounces is a good estimate of the necessary fluid intake. Remember, fluid rich foods like watermelon and cucumber contribute toward this. Many people like to add these same foods to flavor their water. Coffee and tea should not be the only source of fluids as they are diuretics (they increase urination).

Another helpful hint is to monitor the color of urine. It should be the color of light lemonade. If it’s darker, you are dehydrated. (Some medications may interfere with this “test”).

For those who exercise intensely, another way to ensure proper hydration is to “measure” your sweat rate by weighing yourself before and after the intense activity. For every pound, you have lost, 2 ½ cups (16oz) of fluid are needed to replenish it.

Sports drinks can be helpful to athletes who exercise at a high intensity for 60-90 minutes or more. It's necessary to replace losses of sodium, potassium and other electrolytes during long duration/intense exercise. Under normal situations most exercisers are not likely to deplete these minerals during regular training. If, however, you find yourself exercising in extreme conditions or for long times (an Ironman or ultramarathon) consider adding a sports drink with electrolytes. Sports drinks are not usually for children. High sugar drinks have finally been recognized for their contribution to childhood obesity. If your child is playing outside, offer them water or low calorie drinks instead.

Enjoying the outdoors while using common sense and simple strategies will increase enjoyment and eliminate unnecessary risks.

Plantar Fasciitis

One of the most common causes of foot and heel pain is plantar fasciitis. It’s an inflammatory condition involving the thick band of tissue that runs along the bottom of the foot from your heel to your toes. Many people experience the pain in the morning with their first steps or with prolonged walking and standing.

Who gets plantar fasciitis and how does this happen? Plantar fasciitis can effect anyone if the risk factors are present. Take for example the upcoming warm weather that will hopefully be coming our way. Many of us will get out our sandals or flip flops, or perhaps be spending more time bare foot. This allows for an unsupported base for your foot that causes continual stress to this area. If you are a person with low arches or an overpronator this will also increase your risk. Other common causes include occupations with prolonged weight bearing on hard surfaces, rapid increase of an exercise program, improper or poor footwear and change in lifestyle from active to sedentary or vice/versa.

If addressed in the early stages with the appropriate treatment, plantar fasciitis can be easily alleviated. Physical therapy is a good option for intervention for most everyone. Treatment includes a thorough foot and ankle assessment, attention to footwear and possible needed support, education on night splints, as well as, specific exercises to address the inflamed tissue. Don’t wait for every step to hurt, take the time to address the root cause of the pain and get back on your feet.

Couch to 5k

Spring has sprung and the nice weather has arrived. What better way to enjoy it than to set a goal for the upcoming months and embrace the longer, warmer days? With some easy, no-pressure planning you too could sign up and complete your first 5K race. An added bonus are all the health benefits that come along with some minimal cost exercise. First things first, some may be wondering “How far is a 5K?” A 5K is 3.1 miles and is an extremely common race distance that is offered in many local areas. Too often people are quickly discouraged by running because they start too fast and push their bodies too hard. No sooner than you start do you want to quit because you resent the activity. The key to success is following a program that slowly transitions you to traversing the distance without injury.

There is a plethora of Couch to 5K programs available. Apps can even be downloaded to your smartphone! The key component to look for when starting the process is a plan that advises you on a walk/jog interchange which slowly and gradually increases your jog time intervals over the span of about 8-9 weeks. Another magic piece of advice to remember is pick a pace, the speed at which you are jogging, that you feel you could sustain for an hour, even if you are only maintaining it for a minute. Finding this speed allows you to build the base you will need to improve your overall endurance. Another key note when attempting any new exercise is to stretch at the completion of the activity. Stretching appropriately helps prevent injury and overall discomfort that could deter you from continuing. Basic stretches to include are those that target the hamstrings and quadriceps, those are the large muscles of the front and back of the thigh; the calf muscles, located in the back of our lower legs, and the gluteal/hip area. If you’re contemplating starting a program, have already begun, or battling an injury related to running, and could use some guidance then consider connecting with your local physical therapist. A brief consult or specific intervention could help you on your path to attaining that goal and crossing the finish line.

Golfer’s Elbow

Medial epicondylitis, also known as golfer’s or thrower’s elbow, is an overuse injury of the tendons located on the inside aspect of the forearm. This condition is characterized by inflammation and pain associated with repetitive use of the elbow, wrist and hand. It commonly occurs in those who perform repetitive motions such as swinging a golf club or tennis racket, or activities requiring gripping, twisting or throwing. Some people may also experience it with an abnormal amount of yardwork or activity such as painting over the course of a few days. The most common symptoms are pain along the inside of the forearm with hand, elbow, wrist activity; numbness or tingling along the forearm with gripping or squeezing movements; tenderness to touch and swelling; weakness in the hand/forearm and elbow stiffness. The sooner you identify the problem and begin resting it, the sooner you’ll be able to return to your usual activities. Rest means truly keeping the wrist, hand and forearm as inactive as possible. Stay away from the repetitive activities that have contributed to this injury. Ice it regularly for 15-20 minutes, 2-3 times per day for the first week to address the inflammation. Also, consider utilizing a counter force brace to assist in reducing tendon and muscle strain.

Once you have rested it for about 10 days, and if it’s feeling better, it’s time to start a gentle stretching and strengthening program. This is also an opportune time to see a physical therapist who can help guide and direct your care. Considerations to the activity and mechanics that precipitated the injury should be made. A physical therapist can give you instruction on proper mechanics and technique that can help prevent another exacerbation. Moving forward, the key is prevention because this is an overuse injury that quickly becomes chronic and painful. Consistently performing stretches before starting and after finishing the activity, focusing on good form and proper lifting and using the appropriate equipment are all examples of preventative care. Most importantly, listen to your body; if it hurts, take a break.