Fast Fitness - Sprain Prevention and Rehab Training

Here is Fast Friday Fitness - feel how your own muscles work to hold ankle position, so that you can have stable ankles without artificial shoe supports or bracing, which weaken the supporting muscles from disuse:

1. Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
2. Rise to toe and hold
3. Keep body weight over big and second toe with straight ankle position as you remain on tip-toe. Don't let your weight shift over the small toes, allowing ankle to bend outward.

Click the arrow to see this short movie of my student Diana's feet, as she first allows rolling the ankle outward when rising to toe, then at second 3 in the movie, she uses ankle, foot and leg muscles to pull to straight neutral ankle position. She prevents outward rolling as she again rises to toes three more times.

Prevent rolling outward whenever you rise on toe or push off or land from a jump or step.

Developing positioning sense in the receptors of your ankles prevents the sprain-promoting position called inversion, and gains built-in foot and ankle muscle strength and stability. Nice foot stretch too. Practice balancing on tip-toe, and rising up and down without rolling outward every day.

Labels: ankle, balance, fast fitness, feet, fix pain, injury, sprain, toes, video/movie

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Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches

Here is Fast Friday Fitness - feel how your own muscles work to hold arch support, so that you can have healthy arches without artificial shoe arch supports or orthotics, which weaken the supporting muscles from disuse:

1. Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
2. Pull outward until your arches rise and restore, and your ankles are straight
3. Use this as your new natural position, gaining built-in muscle strength and arch stability with each step you take.

Click the arrow to see the short movie made for us by reader David from Belgium. First he allows his weight to shirt inward, pushing his arch flatter toward the floor. Then at seconds 3 to 4 in the movie, he uses the outer muscles to pull to straight neutral ankle position. At seconds 8 to 9 he allows the arch to sag again, then simply restores and holds a healthy arch from second 13 onward.

You can have healthful arch position too. Legs and feet have posture that you can control yourself. Use your own muscles and get free built-in exercise and arch support all day, and stop painful poor positioning.

Labels: ankle, arches, fast fitness, feet, fix pain, posture, pronation, video/movie

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Fast Fitness - Leap for Balance on Leap Year

Here is Friday Fast Fitness for the intercalary year (Leap Year) - Leap to develop ankle and knee stability, leg power, and balance.

1. Leap forward, landing on the other foot with soft shock absorption. Don't land hard, which jars joints.
2. "Stick" your landing, without wobbling or setting the first foot down.
3. Leap backward to the original foot and place. Hold your landing steady. Try several leaps forward and backward, then change the leading leg and repeat.

When landing, keep ankle stable by preventing your foot from rolling to the outside. Info in the post No More Ankle Sprains Part II.
Train knee and hip stability by preventing your knee from swaying inward upon landing - Healthy Knees.

Labels: ankle, balance, fast fitness, feet, hip, holiday, impact, knee, leg strength, sprain

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Fast Fitness - Strength, Abs, Balance, and Ankle and Leg Stabilization

Here is Friday Fast Fitness - quickly increase functional stabilization of the knee, leg, and ankle while increasing overall strength and balance.

Anyone can lift weights, but can you do it balancing on a basketball? Get started by standing on one foot:

1. Do your regular lifts, curls, presses while standing on one foot (and then the other). Breathe.


2. Notice the leg you stand on. Don't let the arch of your foot flatten toward the floor, or knee roll inward toward the other leg. Hold knee, ankle, arch inline, using your muscles. See Arch Support Is Not From Shoes.
   


3. Don't lean your upper body backward (increasing lower back arch) when lifting arms up - a hidden source of back pain. See Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.

It reduces exercise to sit, even on a fitness ball. It is more exercise, more functional, and better balance training to stand on one foot than to sit. You sit all day already.

Be safe, be excited about having fun doing functional movement, be happy.

Labels: abdominal muscles, ankle, arches, arm, balance, exercise ball, fast fitness, hip strength, knee, leg strength, neutral spine, pronation, sitting, strength

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The Coming Two Weeks

We leave in a few hours for Colorado and the Wilderness Medical Society Meeting.

For the next two weeks, I'll have uncertain access to Internet, mail, or messages, to read or answer comments. I stored some fun posts for you. New Healthline staffer Leigh is scheduled to put them online while we make our way 'out West' during the week before the meeting. Thank you Leigh.

With each trip out to this part of the US, we work to document and preserve various martial arts systems of Native American Indians, as much as they want us to have. Will also make our way through the Rocky Mountains.

For going off-trail, we don't carry a tent or sleeping bag, let alone a computer. Simpler. There are still things to carry. The post Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain explained the role of using abdominal muscles to prevent one kind of back pain from carrying backpacks. It is not by tightening the ab muscles, but using them to position the lower spine forward enough to reduce an overly large lower back arch, and stand with neutral spine. Strengthening exercises, whether for abdominal or back muscles do not make the spine attain neutral position in place of overarching. That is why strengthening core muscles does not stop this kind of pain. You get better and more functional core exercise by preventing overarching when carrying loads than by doing crunches or exercises for any specific back muscles. When you hold neutral spine, a small inward curve remains, just not the large one with the "backside-stuck-out-in-back" tilt that damages the lower back.

The post Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique gives a quick effective way to feel how to move your hip and lower spine using your abs away from arching to neutral. This Friday's post should cover preventing upper back and neck pain when carrying backpacks.

In pretty much any terrain, we don't wear hiking boots or fancy cross-training shoes. I wear roomy, cheap (ten or fifteen dollar range), discount store sneakers (usually in tatters). A shoe should not be what holds your foot in position - it is better when your own ankle, leg, and foot muscles do that. For me, shoes are more to avoid hookworm, other parasites, tetanus, and bites. The posts
Arch Support Is Not From Shoes
and
Which Shoes Help Exercise, Fall Prevention, and Ankles?
show how to hold healthy foot and arch position, and give ideas for better gait and balance. In technical climbs, tight shoes are often worn. I'm not much of a climber, but decline tight climbing shoes for bare feet, and enjoy feeling the rocks. For daily wear, tight shoes are not healthful: See, Are Your Shoes Too Tight? My near-seven-foot-tall husband Paul does the same, in his size 17 sneakers or flip-flops (approx size 52+ European).

We don't bring "sports food," commercial hydration drinks, or energy bars and drinks. Refined sugar is not health food. Unfermented soy in many of these products is increasingly documented to promote unhealthy over-estrogenic effects for both men and women. The post Is Your Health Food Unhealthful tells hidden dangers to avoid. The posts Healthy Mother's Day and Independence Day for Fitness give a few quick, good-tasting, healthy foods and drinks to try instead. If you don't have a blender, mash ingredients by hand for arm exercise. Dehydration is important to prevent, and can be done with healthy food and drink.

We hope to arrive in Snowmass by Saturday for the toxicology symposium before the meeting. Then interesting lectures, my two workshops (come take them) and other workshops. The WMS will present the first Fellows of the Academy of Wilderness Medicine. I have been advanced to Fellow, along with Wilderness expert and Medicine for the Outdoors blogger Paul Auerbach, and others in the field. Dr. Auerbach could have easily been "grandfathered" to Fellow status for his stack of achievements, but he went through the exacting point system along with the rest of us. You set the bar high Boss, wow, thank you.

I will try to get to the conference Internet café during the meeting. For the week after, will again be outback without access. If you comment or e-mail, I may not have access to reply. Check existing replies to posts for answers already there. Look for fun posts until then. Hope to see you at the meeting.

"Utility is when you have one telephone; luxury is when you have two, and paradise is when you have none."

Labels: ankle, education, feet, lower back, martial arts, nutrition, orthotics

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Forensic Anthropology and Bone Density

A few weeks ago, I attended a lecture on forensic anthropology. In general, this is the study of things you can tell from human bones in a crime setting. How old was the person? Were they male or female? How big were they? What was their probable race or ancestry?

Why was I there when my work is with the living? Two main reasons. I am the science officer for the Vidocq Society, an international forensic society. I might evaluate data, for example in an aviation disaster, whether someone might have been conscious at each point when undergoing G-forces or different temperatures and amounts of oxygen after a depressurization at various altitudes. In a scuba death, I might advise on physical changes that occur with different situations. The second reason was to learn more about bones. Bones are remarkable. Your bones know a lot about you. What was your health like? Were you active? What kind of activity did you do? When I was small, I read about an archaeological dig in ancient Rome. The bones of a girl were recovered. The account stated they could tell she carried loads too heavy for her, and was therefore (in conjunction with other evidence) probably a servant or slave. I was riveted. How could they know that? I spent years after that learning more about telling how someone moved from looking at their bones.

Throughout your entire life, when you exercise you stimulate growth of new bone cells. The physical pull of muscles thickens your bones where the muscles attach. Using your arm muscles thickens arm bones. Using your legs strengthens leg bones, and so on. This is a main mechanism of how exercise prevents osteoporosis. Without exercise, you don't stimulate enough new cells to counter the normal loss as old ones break down. Your bones thin no matter how much calcium you eat. The post Exercise is More Important Than Calcium Supplements for Bones tells more about this. Bone demineralization is rapid and serious in astronauts in microgravity (Collapsing Astronaut Gives Healthy Reminder).

How you use your muscles causes them to pull differently, giving evidence about the kind of habitual motion. More interesting is that when you are active, your bones grow and shape themselves to facilitate your motion. An example of interest to readers following the posts on squatting is that people who habitually sit for normal daily life in full squat grow "squatting facets" on their lower leg bones. These are small areas on the bone that quickly grow to make squatting more comfortable. At one point, it was a debate in anthropology that squatting facets were a marker of someone of Asian ancestry, until it was found that others who squat also grow them, and that squatting facets disappear when the person adopts a Western sitting habit of chairs and no longer squats. Babies of all races can have them.

Someone who habitually slouches can change the shape of their bones, eventually deforming them. This can occur in the spine, knees, hips, ankles, shoulders, feet, toes - everywhere you pressure your bones. Changing positioning habits to healthier ones can, in many cases, reshape the bones back to healthier shape. Think of braces on your teeth. It's human bonsai. In cases of extreme dystrophies of the muscles, someone who sits without function of their trunk muscles to hold the spine upright, can eventually deform their spine until their ribs sit on their hip bones. How are you sitting right now? The recent post What Does Stretching Do? explained a bit of why stretching isn't reducing injuries. People are stretching, then exercising and going about daily life in bent over positions that rub and grind the joints and soft tissue.

You literally shape your own health. Use the posts throughout this Fitness Fixer blog to do healthy exercise in healthful positioning so that your bones will only tell good tales about you.

Labels: achilles stretch, aerospace, ankle, arm, feet, forensic, injury, leg stretch, osteoporosis, posture, scuba, sitting, squat, toes

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Fixing Fitness Myths

"The public has an insatiable curiosity to know everything, except which is worth knowing." - Oscar Wild

April 1 seems to be a day to notice, more than usual, if things in the news are not facts but April Fool. On other days, urban legends and other stories are still popular, sometimes more popular than what is really going on.

The observation that the Earth is flat seemed obviously true at one time until we had more information. It used to be a taught as a medical fact that the cause of epilepsy was masturbation. When I was in school, one of my medical books stated that you don't need to eat calcium since you can "get all you need from your bones." It is true that you pull calcium from your bones when you don't eat enough, although with unhealthy results.

The post Forensic Science told of two crime-science myths, often still taught in forensic books and popularized in television shows, which were never true. Following are more posts hoping to replace myth with information, so that you can get stronger and do more, without the injuries or restrictions in activity that are part of many fitness or injury rehab practices.

Feet and Ankles

Myth - You need tight shoes for support. Fact - tight shoes can deform toes and prevent healthy muscle use:
Are Your Shoes Too Tight?
and Healthy Toe Stretches.

Myth - All ankle stretches prevent sprains. Fact - Some may enhance predisposition to ankle sprains:
Unhealthy Yoga Ankles.

Myth - Following an ankle sprain, bracing must be continuous since no exercise can restore the area. Here is another way -
How To Treat Ankle Sprains and Prevent Them
and
No More Ankle Sprains Part II.

Dispelling Myths of Orthotics Use:

Myth - Only orthotics can place your arches in neutral position. Fact - your own muscles can often do the same:
Arch Support Is Not From Shoes
and
Which Shoes Help Exercise, Fall Prevention, and Ankles?

Dispelling Aging Myths - That respiratory function only declines with age:

Do Breathing Exercises Work?

Dispelling Aging Myths - That you only get weaker with aging:

Getting Stronger is for Everyone
What I Learned at the Aging Conference
Better Balance by Christmas
Conference on Aging Dec 2, 2006 in Midtown New York.

Dispelling Nutrition for Exercise Myths:

That weight gain with aging is primarily lower metabolism: Metabolism - How to Lose Weight and Save Money

or that Healthy eating is difficult or expensive:
What Medical Students Told Me About Nutrition.

Myth that you must eat much protein to get muscles:
Get Muscles for Christmas

Myth that acid prevention drugs are harmless:
Stomach Acid Drugs May Increase Osteoporosis and Hip Fractures

Myth that food marked "Health Food" means it has to be healthy:
Is Your Health Food Unhealthy
and Exercise Common Sense Discipline - Turn Down Halloween Junk Food

and the myth that it's healthy for children to eat junk food:
A Little Good Exercise, a Lot of Bad Food - Overweight Still No Mystery.

Myths that only gyms and weights can improve your strength:

How to get natural exercise is in Rocky IV and Healthier Exercise,
Getting Stronger Without a Gym
Exercising With A Friend - Partner Leg Press
Don't Confuse Exercise With Real Fitness
Healthy Toe Stretches
Quick and Fun Arm and Body Strengthener
and Quick and Easy Strength and Balance Exercise.

More to come for smart, fun, healthier ways to get exercise.

Labels: aging, ankle, arches, arm, balance, breathing, feet, fix pain, forensic, holiday, leg stretch, myths, nutrition, osteoporosis, partner exercise, shoes, sprain, strength, toes, yoga

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No More Ankle Sprains Part II

The previous post How To Treat Ankle Sprains and Prevent Them promised another effective technique on the missing link in preventing and rehabbing ankle sprains in today's post. It follows below. First, it made news yesterday that the biggest name in spine research, Stuart McGill, found what I have been saying for nearly 30 years of my research career - that tightening the abs and "sucking them in" inhibits healthful movement, and using the popular "draw in the abs" technique is making yoga and Pilates classes the sources of more back pain and problems. The post What Abdominal Muscles Don't Do - The Missing Link shows why crunches and Pilates are not the best exercises for core muscles, and the comment replies to Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain give more links on how abs really work. The next post will cover the news from Dr. McGill and my years of research of what works the abdominal muscles in healthier ways instead.

So today you get two breakthrough fitness posts in one. Now the promised second fun thing to do for more stable ankles. Maybe you never sprained your ankle but wear supportive shoes thinking that will keep you from sprains. Maybe you've sprained your ankle in the past, and rested it and keep it braced during activity thinking that will help, and did ankle exercises, usually consisting of "spelling the alphabet" in the air with your foot or using resistance bands. The "exercises" often do not prevent repeat sprains, leading people to think that exercise will not help and only bracing will "support" an ankle. Rest and bracing often make things worse - the numbers show many repeat sprains in people following this method. Why?

The missing link is receptors in your ankle that sense if you are standing straight on your ankle or if your ankle is bending outward, a movement called inversion. In an inversion sprain, the bottom of your foot turns toward the other leg and your ankle bends too much, overstretching or tearing the connective ligaments. Inversion is the most common source of sprains. There are two common beliefs in medicine - that strengthening will help prevent sprains, and that strengthening will not help. Both points of view are missing that preventing sprains requires something else - training the receptors that tell you if you are about to invert. This sense is called proprioception. Without it, the ankle does not send signals to your leg muscles to prevent you from turning it. With proprioception training, you learn how to sense ankle position and balance to keep it from inverting. Allowing inversion when stepping up or down is surprisingly common, even in people who exercise frequently. No wonder they get sprains. The last post showed the interesting proprioception drill of rising to toes while not allowing your ankle to invert. Try that first, then try this next step:

1. Rise to tiptoe and lower to full foot, keeping your ankles straight without allowing your weight to shift over your small toes. Keep weight over your big and second toe. Repeat at least 10 times.
2. Work up to rising to toe and lowering on just one foot (good for balance).
3. Work up to careful jumps, first coming down on both feet, then on one foot. Each time, land with your weight centered over your big and second toe, not turning your ankle outward, then roll gently down until the whole foot is one the floor.
4. Use the above stabilization technique each time you step up or down from anything, including stairs and curbs.
5. With this practice, you can train your ankles to deliberately hold healthy position with each foot-fall, reducing your risk of sprains, instead of letting the ankle turn outward.

The posts
Unhealthy Yoga Ankles
and
Better Hip Stretch - Check Your Ankles
show a common way that people predispose themselves to sprains by overstretching ankle ligaments without knowing it, and how to prevent it.

Coming Next - Using Abs Is Not Tightening.

Labels: ankle, balance, feet, gait, injury, sprain, yoga

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How To Treat Ankle Sprains and Prevent Them

The post Which Shoes Help Exercise, Fall Prevention, and Ankles? showed why you don't need high top shoes, or arch supports, or orthotics to prevent your arches and ankles from sagging inward (pronation, arch flattening, or flat feet). You can quickly train your ankles and feet to hold straight stable position using your own sense of positioning that comes from receptors in the muscles and connective tissue around your ankle and foot. The post Arch Support Is Not From Shoes gives a simple retraining to restore healthy comfortable arches and prevent the pronation that can cause knee, hip, ankle and foot pain. It's easy, built-in exercise-as-a-lifestyle.

What about feet and ankles that turn the other way - bending outward, not inward, at the ankle so that you may turn your ankle causing a fall or sprain? What if you already have sprained your ankle and want to get back to activities and prevent future sprains? The same simple principle applies. Using easy positioning training, you can teach your ankles to sense when they are turning too much to the outside, and quickly send signals to your ankle, foot, and leg muscles to straighten your ankle and prevent a sprain. This works well, even with damaged and overstretched ankle ligaments, and is key to rehabbing a sprain.

Wearing supportive shoes, an air cast, splints, taping, and elastic bands to brace an injured ankles is a common practice that perpetuates weak, unstable ankles because these devices prevent sense of balance and positioning. Wearing these things to "support" non-injured ankles for hiking and walking is just as bad. Within only one day of wearing an ankle brace, whether you have a sprain or not, balance is quickly diminished. You can put a healthy person in an ankle brace and test their ability to stand on that foot without the brace at the end of one day and find they are less able to balance and more likely to tip over. This problem compounds each day a brace is worn.

The missing link in ankle rehab and the reason for so many repeat sprains is staying in the bracing and not doing enough balance and positioning retraining after the last sprain. This is why resting an ankle, bracing it, and reducing activity can make things worse. It is also the reason why the usual ankle strengthening exercises have not been working, and people keep spraining their ankles despite strengthening exercises. The issue in ankle sprains is not as much strength as sense of positioning, called proprioception. You need simple and easy-to-do proprioception exercises. Would you like to try one?

1. Stand up. Keep both feet facing straight ahead, not turned out.
2. Rise up on tiptoe. Notice if you allow your weight to teeter over the small toes, tipping your feet and ankles outward. That is the poor positioning and lack of the stabilization that allows your ankle to turn in the outward direction that allows sprains. You don't want this bad positioning to occur any time you are walking, hiking, jumping, dancing, or moving in any way. Not even when sitting.
3. Shift your body weight over your big toe and second toe. Don't let your ankles sag inward or outward. Hold your ankles straight.
4. Hold standing up on tiptoe with straight, good positioning as long as you can. You can practice this on the phone, or when doing dishes or laundry. Make sure you use it in real life activities whenever standing on your toes to reach and lift.

The next post will give more fun ankle proprioception retraining to rehab ankle sprains and learn to prevent future sprains.

Labels: ankle, balance, feet, fix pain, injury, orthotics, pronation, sprain

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Why So Many Aerobics Injuries?

A recent New York Times article quotes aerobics teachers and devotees saying they now have painful, chronic injuries from years of aerobics classes. Why did this happen?

I receive frequent e-mails from aerobics instructors, many only in their 20s and 30s, saying they are too old to continue teaching because of pain and injuries from teaching. I am older than their parents. At the schools and clubs where I teach classes, teachers and trainers are often absent, or replaced, because of herniated discs.

The Times article quotes major aerobics spokespeople, attributing the injuries to jumping on "concrete floors in bad tennis shoes," and related how former well-known-names in the aerobics industry now teach low impact classes. The article continued, "A lot of people doing aerobics back then can no longer do any jumping whatsoever. They have problems with their backs, feet and hips."

In the years I spent in the lab studying injuries, seeing patients, and teaching students, I have found that the problem is not that impact must be avoided. I see patients who are instructors of Pilates, stretch, yoga, rowing, martial arts, and Alexander technique for degenerating joints. It is simple misuse. It is not that people are doing the exercises "wrong" but the movements themselves. If you saw someone bend over at the waist or hips to hoist a suitcase or child, you know it is bad bending and it hurts the back. The same people will bend over the same way to lift weights in a gym or do yoga stretches. It is the same disc-injuring bending in all cases. The post Common Exercises Teach Bad Bending gives interesting examples from a class that is "low-impact." Wear occurs on the lower back and neck discs regardless of how expensive and engineered the aerobics shoes. The post Are You Making Your Exercise Unhealthy? shows you how to put the knowledge of bad positioning together in your mind with how people are exercising, to realize it is not rocket science when people have pain, even though they "do their exercises."

Impact activities are not the problem. Many people walk with higher impact than a good martial artist will kickbox. Many people are unnecessarily restricted from favorite sports and told to walk instead, based on the fallacy that running or tennis is necessarily higher impact, instead of looking at how heavily they clomp around letting spine, hips, knees, and ankles sag and grind. One story with helpful links is told in You Can Fix Your Own Knees.

Many of my obese patients with knee pain stand and walk with their knees in sagging positions. This is not a consequence of their body weight. When I show them to simply hold their knee from knocking inward (or outward) by using their own muscles to hold straight, the pain quickly goes away. They say that they can then, for the first time, *do* any real exercise to lose weight.

The post When Did Health Become Thinking Out of The Box? explains more of why you don't have to have pain from exercising or even long sitting while studying (or watching TV). I don't take people away from their favorite activities when injured. I even use their sport as rehab, showing them how to do it in healthier ways so that they can do more, lift more, and run more than before, not less. Health care should not be "Limit to the patient to limit the pain."

Read Inspiring Patient Stories on my web site - how patients fixed their own pain and could do more than before.

Labels: ankle, disc, fix pain, hip, injury, knee, martial arts, planter fasciitis, shoes, yoga

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Arch Support Is Not From Shoes

The previous post showed how the best ankle support comes from your own ankle, leg, and foot muscles. Pronation (flat, sagging arches) is rarely just the way your feet are made or something you can't prevent. You may allow ankles to bend inward and sag, or you can prevent sagging and easily hold your ankles in healthy position, no differently than not letting your posture sag anywhere else.

It is commonly taught in gyms, medical schools, aerobics certification programs, and footwear stores all over the US, that shoes or orthotics are necessary to hold up your arches. That is a fallacy. The needed support should come from your own foot muscles. How do you do this?

• Stand up with both feet parallel, pointing straight ahead.
• Allow your body weight to slump downward, pressing your arches against the floor (left hand photo). You will notice that your arches flatten, reducing the arch, not because there is something wrong with your arches, but simply because you allowed it.
• Next, use the muscles on the outsides of your ankles and legs to gently shift your weight more to the soles of your feet and off your arch (right hand photo). Don't tilt completely to the side or stand on the sides of your feet, just shift enough to lift your arches from the floor.
• Now you can see that having arch support is the same as having neck support by using your upper body muscles to stop slouching. Pull your chin inward gently right now to remind yourself of this.

Support your feet by holding position using your own muscles, not a shoe 'straight jacket' that lets ankles atrophy and doesn't let toes move, stretch, and straighten.

See fun posts on foot and ankle health:
Healthy Toe Stretches and Unhealthy Yoga Ankles and my web site page Inspiring Patient Stories for a first-hand account of someone who fixed a lifetime of pain and pronation by simply stopping the cause - letting ankles and feet sag. By simply holding healthy positions during your normal day, you can get free built in exercise for your feet and ankles, and better health. See the book, "Fix Your Own Pain Without Drugs or Surgery" for how to have healthy arches and foot support.

Labels: ankle, arches, feet, fix pain, myths, orthotics, pronation, shoes

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Which Shoes Help Exercise, Fall Prevention, and Ankles?

We are in the cold, damp Tennessee mountains for the rest of the week, teaching at a medical school program of wilderness medicine. It should be warmer than home in the Northeast US where it's snowing, and the Schuylkill River, and water bottle on my bicycle are frozen. I won't have Internet or phone access at the wilderness camp. Unflagging Healthline staffer Carrie Locke is posting the blogs for me all week. Thank you Carrie, once again.

For wilderness treks and hikes, and everyday walking, you need to walk on uneven surfaces without stumbling or spraining your ankles. Expensive shoes, inserts, arch supports, braces, ankle supports, and orthotics are sold on the belief that they are needed to hold your foot and ankle in position. However, this is an expensive fallacy.

You are the one who can hold your ankles in straight position or let them sag into foot pronation. You don't need, or even want, shoes that hold your ankles straight for you. Without use, your ankle muscles weaken. With shoe support, your ankle doesn't have to work to hold itself. It gets weaker. It forgets how. It is the opposite of what is needed.

It is not high top shoes or ace bandages or taping or orthotics that prevent falls and ankle sprains, or prevent ankles from sagging inward or "pronation." The most important thing you can do for healthy ankles and preventing sprains is to use your own leg muscles, and simply hold your ankles without sagging, the same as any other posture. Think of a beginning skater. At first, they let their ankles bend and sag inward. They do not know how to hold their legs using their own muscles. Eventually, they learn to hold straight, healthful positioning.

Letting your ankles sag inward can press the joints of your arches, ankles, knees, even hips. In most instances, supportive shoes and inserts are no more needed than putting your mouth in a sling to keep it from falling open when you walk around. Thinking that you need supportive shoes to brace uninjured ankles for hiking and walking is a common myth that perpetuates weak, unstable ankles. Many people who use arch supports never learn how to use their own muscles, and are told to never go barefoot. This is an unfortunate and unnecessary restriction to their health.

The post Healthy Knees shows what inward-sagging knee positioning looks like and how to fix it. It is easy to do and makes an immediate and important improvement to your joint health.

Often in wilderness settings, I see hikers in expensive boots. The native mountain guides and pack-bearers are wearing flip-flops. This is not just a salary inequality. It is not that the guides don't know ankle health. They know something crucial - the health of your ankles comes from your own muscles. You will save much money on footwear and products that prevent your foot and ankle muscles from working, and you will get free, built-in leg and foot exercise with every step.

Read more how to have healthy ankles and ankle support in the book Fix Your Own Pain Without Drugs or Surgery.

Labels: ankle, arches, feet, hip, orthotics, pronation, shoes

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Better Hip Stretch - Check Your Ankles

We are on the long trip south to Malaysia. The next posts will tell the interesting story of why. The previous post Unhealthy Yoga Ankles showed how you can reduce the good stretch on the hip and increase a bad stretch on the ankles by letting your ankle bend inward instead of keeping the ankle joint straight when sitting cross legged.

Look at the photo, at left, of the good positioning of the people, sitting to chat, in the morning of the overnight train ride. Besides their good upright sitting positioning, note the straight ankle position. Good positioning is common in people of all ages here in Asia. People of all ages, even aged people, sit easily this way to eat, travel, or read the paper. Fitness as a lifestyle is not difficult and does not require exercise machines or gyms or trainers.

Labels: ankle, hip, leg stretch, posture, sitting, stretch

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Unhealthy Yoga Ankles

Just as there are foods that are bad for you, and just as some common medicines have side effects to make you sicker instead of better, there are several yoga moves that injure directly or predispose you to later injury. This is true, not just for people who overdo the pose, or who are inexperienced, but because the move itself is inherently unhealthy.

When you sit cross-legged, don't let your ankles turn upward, as in the left-side photo, above left. By turning the ankle, you diminish the stretch on your hip and inner leg muscles, and put an unhealthy stretch force on the outside of your ankle. The outside of the ankle is not supposed to stretch much; it is supposed to hold your ankle straight so that it does not turn when you stumble. Overstretching the outside of your ankle is one of a few bad habits that predispose you to ankle sprains. Future posts will cover more on stopping ankle pain and sprains, and will give fun ways to strengthen your ankles. For now, try this when sitting cross legged:

• Straighten your ankles, as in the right-hand photo above. Preventing the bending will stop overstretching the outer ligaments and you will get more and better stretch in your hip. The hip stretch is better because the turning of the leg has to come from the hip, instead of keeping the hip raised and tight, but bending up from the ankle.
  
• Sit upright and straight. Don't round your back, not even a small amount.
• Lift your chest to sit straight instead of sitting rounded.
  
• If your hip is so tight that you cannot comfortably sit upright and straight, put both hands behind you to lean your weight on your hands and push yourself upright (right photo, above).
• You will feel more stretch, and practice better habits by sitting up straight than by leaning forward with your back and shoulders rounded.

If you get recurring ankle sprains, check to see if you are ensuring that your problem continues through the bad habit of overlengthening the outside of your ankle. Check if you sit poorly to do this stretch with your back rounded and hip curled under because you are too tight to sit in a healthful position. Sitting rounded puts huge herniating force on the lumbar (lower back) discs. Putting your hands behind you to straighten you takes weight off your lower back discs, and gives you a good hip stretch as you regain straight positioning.

As more people try to fix their health problems through medical exercise programs and yoga classes, it is good to make sure not to do things that make new health problems and perpetuate old ones.

Photos from the book Healthy Martial Arts

Labels: ankle, injury, sitting, stretch, yoga

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Healthy Toe Stretches

Don't forget to stretch your toes. You need mobile toes for balance, healthy walking mechanics, and foot health.

Every day, take your feet in your hands and stretch your toes apart side to side, easily and comfortably. Make sure all your toes can move apart from each other, and that each one moves up and down. It is not healthy for your toes to remain stuck together and not moving.

Sitting in various ways can be a built-in stretch for the toes. If you sit on your heels, as in the photo at left, or kneel on your hands and knees with toes curled under you, or when you are sitting in your chair right now, see if you can bend your foot behind you and still touch all your toes to the floor - even your little toes. Don't force toes to bend, just gently see if they all reach the floor. After stretching your toes back (toward the top of your foot) bend them all down toward the bottom of your foot. Many people, particularly people who wear heeled shoes wind up with toes that are bent upward all the time. The tendons on the top of the foot can shorten from keeping the toes bent up, and the toes can get stuck in a pulled-up position. Future posts will cover more on stretching your feet for mobility, pain control, and health.

When you sit, as in the photo above, see if you can rise to a stand without pushing off the floor with your hands or bracing your hands against your leg or knee. Just use your leg muscles and get a strength and balance exercise while you get a nice stretch on the bottom of your feet.

The photo was taken when I studied a medicine course in Cambodia. Before and after classes you practice respect, concentration, and self-discipline. While you do this, you get a lot of physical exercise - it is commonplace for people of any age to kneel without using hands for anything except to hold the candles, flowers, and incense, and to rise the same way. The photo was taken in the middle of bowing, so I am not fully straightened yet. The nun is laughing. My Cambodian is so bad that I made her laugh. I think that is good exercise and good medicine too.

Photo by Paul

Labels: ankle, arches, balance, feet, fix pain, gait, leg strength, orthotics, pronation, shoes, spirit, squat, strength, stretch, toes

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Better Balance by Christmas

I heard a radio program about yoga for senior citizens. The yoga program directors made the usual statements about yoga helping strength and balance. Then they said something that seemed at odds with their goal. They said, "If your balance is poor, do the moves sitting down or hold on to the wall." The very thing that you need to improve your balance is to practice standing and (safely) not holding the wall. If you sit and hold on, you prevent practicing balance.

Balance that helps your normal daily life is easy to improve at any age. All you need is to stand up and balance. Balance is quickly lost with sitting and disuse.

How does balance practice help you? You have receptors in all your joints that sense positioning. They can tell if you are about to fall. They tell your body to send signals to your muscles to steady you. If you don't use your balance sensors with balance practice, they become slow and unable to sense positioning well. You may tip over far enough to fall before your receptors sense it and can tell your muscles to pull you to upright position. Balance practice also improves your muscles. Without balance practice, your muscles become too slow and weak to prevent you from tipping over and falling. If you have let yourself become tight, brittle, and weak from lack of general exercise, you may strain, tear, or break something from a fall that would not have otherwise caused any harm.

Years ago when I left working in the hospital to go into private practice in sports medicine, I found that by making house calls you learn the reasons for people's pain and injuries that you will never see in a hospital or clinic exam setting. It was the first time I ever saw anyone have to sit to put on or take off their shoes. Here are a few quick, functional (real life) ways to improve balance:

• Stand up when you put on your socks or hosiery.
• Stand up to put on your pants. Lift one leg in front of you, keep your upper body comfortably straight and upright, and slide on each pant leg.
• Stand up to put on your shoes. Try two ways: holding the foot in the air front of you to place the shoe, and by crossing the ankle on the opposite knee.
• For more balance, after putting on one sock or shoe, remain standing on one foot and do a small squat on one leg to reach the other sock or shoe on the floor.

If you can't stand to dress yourself, and you have at least one working leg, you may be too tight and weak and unsteady for healthy normal life. You don't need to go to a gym or "do exercises." Use balance skills as part of your daily life.

Photo by Manamanah. For more fun and functional real life balance activities see the books Fix Your Own Pain Without Drugs or Surgery and Healthy Martial Arts.

Labels: achilles stretch, aging, ankle, balance, feet, fix pain, holiday, leg strength, leg stretch, side, spirit, squat, strength, stretch, upper back, yoga

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Healthy Knees

My Tuesday night martial arts students worked hard last night on sweeps, falls, tumbling, and quick recovery to their feet. Each week they also learn a new jump rope technique. They have been getting good at fast skipping, crossing the rope in multiple spins to the front, sides, and overhead, and varied footwork during jumps.

When landing from jumps, it is important not to let your knees knock inward under your body weight (photo at left). It is important for knee health not only when jumping, but descending the stairs, bending for all daily needs, and even getting in and out of your chair.

Letting your weight fall to the inside of your knee joint, instead of holding your weight evenly on your knees using your own leg muscles, adds load and wear to the cartilage on the inner surface of the knee bones, stresses the anterior cruciate ligament (ACL) in the middle, overstretches the ligament on the inner side of the knee, and can damage a meniscus. A menscus is one of two small cushions in each knee between the knee bones. Letting knees sway inward more commonly damages the medial meniscus (the inner one) although either or both can be stretched or twisted by bad knee positioning. Letting your knees sway inward is not a "condition," and not unavoidable or something you are born to have. It is a posture you can control using your own muscles to hold your legs from swaying inward.

A while back I took a box-aerobics class because I had a coupon for a free week at a local club. The woman in front of me was stomping up and down as she swatted the air. Her knees bumped together every time her feet landed. Her feet were at least ten inches apart yet her knees bashed together, over and over, bending inward at the knee joint. It was alarming.

Don't let your knees (or ankles) sway inward under your weight. Use your muscles to hold knees in position, over your feet:

• When landing, land lightly - softly. Don't pound. The only noise should be the whirring of the