Fast Fitness - BIPOD Reader Prescription for Healthier Feet
Friday, October 09, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - BIPOD is a way to happier feet that you can do yourself at home. Reader Paul J sent in this gem in July. Other great work from him and other readers are still in the piles of mail.
For background: A shoe insert is any pad of any size, shape or quality that you put in your shoe for various reasons. Hard shoes are a common course of joint pain. Many shoes benefit from better cushioning and even a cheap soft insert for cushioning purpose can help that. Orthotics are different. Orthotics are hard shapes, specially fitted by a trained orthotist or sometimes a physical therapist with orthotic training. Orthotics usually cost a few hundreds of dollars. Orthotics are rigid forms to hold your feet in a specific position. There are also hard inserts with molded arch or other area advertised to change your foot posture. Sometimes orthotics and hard inserts make more pain or don't change the source of the problem. Most of the time, for non-paralyzed people, if the orthotic can make your foot change to a healthy position, you can do the same using your own muscles and sense of positioning. Using your own feet and ankle muscles is often healthier, more comfortable, and more likely to yield long term results.
Now Paul J's intelligent prescription:
"Bookspan Invisible Pain-free Orthotic Drops - BIPOD. Now you can walk, run, or stand without the pain of traditional hard orthotic inserts. BIPOD will revolutionize the way you stand. Read and follow product instructions, failure to do so will render this product ineffective. Attempts to walk, run, or stand without BIPOD is not recommended by our accountants.
"In order to reduce the burden on landfills, please follow the directions below to make BIPOD at home. You must use your brain and following all directions in order to get DHMO and CS (see above).
Ingredients: one tablespoon of cold tap water one tablespoon of tap water from hot tap, before it gets hot.
Mix for 4 seconds in a container that can hold 2 _ tablespoons of liquid.
"The left over mixture maybe placed in the refrigerator for later use or discarded in most plants."
Remember - get the point of healthy practices. Don't get bogged down on purchasing exercise machines and expensive devices that reduce your own body's involvement in your life, or trivial details of exercise "form." Get the big picture of easy healthier ways and enjoy improving your life.
Many readers' great stories are in the piles. Remember to read the instructions and concepts in articles on fixing pain first before asking what to do. Gain the benefits and better health and send in that story. Then we can all enjoy more instead of taking time plodding through and answering reader comments of, "I read your work on how to fix neck pain, will your stretches work?" and similar instances of missing the point. Would anyone help Hannah (or Cheryl?). She left the 36th comment asking if the stretches work on Fixing Upper Back and Neck Pain, which had already explained, along with the 35 questions and replies already there. Thanks!
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
---
Image of helping feet with brains by "lapolab" via Flickr
Your Muscles Are Your Orthotics for Arches, Knock Knee, and Knee Pain
Thursday, January 22, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
David from Belgium has been a success story and valuable contributor. He frequently makes us photos and movies showing how to fix pain and unhealthful fitness using Fitness Fixer techniques. He first left a comment on a post in 2007:
"I'm training to be a yoga teacher and I'd love to teach the right things to my pupils such as good posture. Your insights are very inspirational. After struggling with minor but persistent knee pain for some years, I was diagnosed with seriously fallen arches recently. I'm not really flat-footed, but ankles that drop inwards too much. (I could clearly see that on the video my podiatrist made of me walking on bare feet). In a week I'll be getting new orthotics. Though, after reading a patient's testimony on your site I decided to try and use my feet differently. So now on my walks to and from my day job I'm trying to walk 'right'. Rolling on the entire foot, heel to toes, leaning more on the sides and using all five toes. It feels awkward though and I notice that I often forget it. I wonder if this will 'fix' my feet eventually? Anyway, thanks for sharing your knowledge!"
I replied that it "fixes" arch positioning as soon as you do it. It is natural to control how you stand and move - the whole intent of functioning in a healthy way in life, and the intent of yoga (supposedly). It seems at odds to say that yoga teaches body awareness, strength, or positioning, then let ankles slump without control, and purchase devices to do it for you. Once you understand the purpose, it will not be awkward. It is the same as any other good posture.
Since then, David has consistently made good use of these materials, and shared many success stories. He has fixed various pain producing habits for himself and his students, fixed his mother's herniated lumbar disc by showing her healthy bending around the house - Bending Right is Fitness as a Lifestyle, and developed a new yoga system of healthier movement - Getting the Right Yoga Medicine.
Orthotics are rigid shaped devices, fitted by prescription, that specifically move and hold your foot in a certain position.
Orthotics are different from over-the-counter shoe pads that can help by cushioning impact.
Orthotics do not do anything you cannot do yourself using your own muscles and sense of positioning (kinesthetics).
It is a myth that only a device can move your foot and leg leg. Click the label "myth" under this post for all Fitness Fixer posts on fitness myths.
Try these in relaxed way:
Stand and see that you can raise your own arches back to normal, taught in the post Arch Support Is Not From Shoes. It takes only seconds.
Make sure you are also not pronating from higher up - Healthy Knees.
Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints.
The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
During walking and running, a brief and small inward drop (slight pronation) occurs right after foot contact that creates part of the "spring" and propulsion. The idea is not to prevent all foot motion, but to not let the knee twist inward. You can do that with your own brain and muscles.
See if your answers are already here by clicking links, labels under posts, archives, and the Fitness Fixer Index. Read success stories of these methods and send your own. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer - Click "updates via e-mail" - (trumpet icon) upper right. Find fun topics on See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
There are still people around the world, by the millions, without basics.
Blake Mycoskie created TOMS footwear to, "Produce stylish, comfortable, and practical footwear while improving the lives of children around the world."
TOMS press kits states they adhere to "No Sweatshops…ensuring both fair labor practices and minimal impact on the environment."
Mycoskie writes, “Inspired by a traditional Argentine shoe and challenged by continent’s poverty and heath issues, I created TOMS with a singular mission: To make life more comfortable. TOMS accomplishes this through a unique shoe and commitment to match every pair purchased with a pair to a child in need…no complicated formulas, it’s simple…you buy a pair of TOMS and TOMS gives a pair to a child on your behalf.
Privileged Western children may benefit from, even enjoy, practicing this type of gift giving, over spending on junk food and indulgent status items for themselves.
--- Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column.
Fast Fitness - Balance and Ankle Stability in the Dark
Friday, August 22, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - quickly improve balance and ankle proprioception - the ability of the ankle and foot to correct positioning, reducing sprain and fall potential.
This one helps balance for daily life, and also helps footing in darkness, which can be encountered on stairs, curbs, and late hikes.
Stand on one foot.
Balance on that foot with eyes closed. Switch feet.
Extend length of balance time with frequent practice.
Balance and proprioception are key to preventing and fixing ankle, foot, and balance trouble.
Obviously, don't do this near the stairs or the breakables. Use common sense to get started safely.
Here is Friday Fast Fitness - Train children's balance and grip strength, use your legs, and have family fun.
Have young children sit on your feet, and hang on (sensibly, parent's permission, and all that). Babies are born with a grasping reflex and are stronger than you may expect.
Do any variety of walking, marching, dancing, and range of motion, while standing, or sitting, while they act as natural strength and endurance trainers and floor dusters.
Teach sharing, enjoyment, physical skills, personal interaction, and all the good you can think of.
Outside of all the debates of whether leg weights are helpful or not, fun activity with your family can develop many strengths.
Last year, reader Ted fixed back pain by learning to use neutral spine during running and daily life. This week he checked in to say the back is still fine, and that he went on to fix other painful sites.
Fixing pain and injuries by doing some exercises may temporarily ease symptoms. Instead, you can stop the source of injury by making movement habits healthy while exercising and moving through daily life, so that you can get exercise at the same time that the area can heal, and the pain not return.
Ted writes:
"Dr Bookspan, last summer, you helped me return to running, and did an article on me and how the neutral spine fixed my back problem with running.
"The back is a NON ISSUE. Thank you so much.
"Currently, I am working on hip/hammy/knee issues (probably due to over-training). Just thought I would share a thought on the ''Duck Foot'' issue you had talked about (I read the Fitness Fixer religiously). While running on the padded infield of the Stadium Football Field, I was still noticing pains in my hip (caught my foot on the ''upswing'' during a run, hip has hurt off and on since October).
"I focused on my feet, specifically, how I pushed off after the foot-strike (very soft, I often scare other runners because they can't hear me coming up on them). A straight push off after the foot-strike made the pain go away (probably because it aligned my foot/knee/hip during the movement). Also, when the knee pain flared, tensing my quads made it go away.
"I have enjoyed reading your ''Running Articles' please keep 'em coming. AND Thank you for fixing my Back. Much Appreciated, Ted H"
To fix the source of pain, it works best to understand healthful movement retraining and not just "do" a series of rules. One important example is keeping feet parallel or facing forward. The idea is to understand that a straight push-off comes from keeping all the joints in the kinetic chain from feet to hip and spine from twisting in unhealthful ways, not just straighten one segment by twisting another. Yanking or forcing the feet straight is not the point of good positioning.
Ted has more helpful stories to come in future posts. Click these posts for more:
Raina and several other readers asked about plantar fasciitis.
On a house, a fascia is a flat horizontal surface just under the roof. In your body, a fascia is flat fibrous tissue that wraps your muscles and soft structures. You have fascia in several places. One is across the bottom of your feet. "Plantar” means the bottom of your foot that you "plant" on the ground. Your plantar fascia is the fascia on the bottom of your foot. Plantar fasciitis is an inflammation (-itis) of the fascia on the bottom of your foot.
Normal Plantar Fascia Action When you walk or run with your feet facing straight ahead, the line of bending of the foot is straight from front to back. Each step gives you a nice, built-in small stretch across the bottom of your foot. As you walk, run, jump, and move, your plantar fascia transmits body weight across your foot. It is part of shock absorption for your entire leg.
How Bad Movement Mechanics Hurts Several things can make the fascia tighten and hurt. Here are three. More to come in future posts:
1. When you walk or run with feet facing outward, the fascia loses the normal stretch. Over years of not getting its normal stretch, it becomes tight. Walking with feet facing outward also puts sideways forces on the fascia with each step instead of the needed stretch. Walking with poor shock absorption, banging down heavily with each step can amplify strain forces on a tight fascia. Every step you take on a tight fascia yanks on the heel where it attaches. Eventually the heel and bottom of the foot get irritated from the yanking and start to hurt. Irritation can eventually cause the bone to thicken to protect itself - a heel spur.
The tighter your Achilles and foot fascia, the more "normal" it feels to walk toe-out. In a circular problem, walking toe-outward is a common fascial tightener. It may be "natural" with tightness, but can increase tightness over time.
2. Letting ankles constantly sag into pronation (flattened arches) is another fascial strain. Keeping body weight more evenly around the sole of your foot, not pressing and downward on your arches, lifts the weight off the arch. Reader David from Belgium made us a great short video of easily changing from rolling in on the arches to holding straight in Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches.
3. Hard sole shoes and some fasciitis braces stop the sole from getting the normal lengthening while walking, stopping the pain from the stretch, giving the false impression that the injury is lessening. A negative cycle continues of shortening and continuing the source of the injury. Injections briefly make the area more prone to injury. Pain pills allow you to continue the injury process without pain telling you that it is wrong. Several kinds of anti-inflammatory and pain medicines interfere with healing. Wearing high heeled shoes raises the heel, shortening the length of the Achilles tendon, putting less stretch on the tendon, the lower leg muscles, and the fascia of the foot.
Fasciitis can be quickly stopped. It does not have to be chronic. "Doing" a few stretches does not undo a lifestyle of shortening, tightening, and straining. Forcing tight, artificially straight position instead of creating the length and use of the area that allows healthful motion, can create more pain in other segments. Use your brain and learn good body movement to allow it to heal and be functional.
Helpful links to move in healthy ways to stop plantar fasciitis:
The book Fix Your Own Pain Without Drugs or Surgery has a section on fasciitis, the many unhealthful lifestyle contributors, and simple lifestyle fixes to build into daily life and your exercise classes.
Fast Fitness - Sprain Prevention and Rehab Training
Friday, April 18, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
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:
Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
Rise to toe and hold
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.
Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches
Friday, April 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
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:
Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
Pull outward (straighten) until your arches rise and restore to neutral position, and your ankles are straight.
Learn to feel neutral position. Don't hold rigidly or roll outward. You gain 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. 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 restores and holds healthy arch from second 13 onward. The "exercise" is not to roll back and forth. It is just to learn to feel what allowing sagging too much feels like, and how to restore neutral position.
During walking and running, there is a small natural inward drop (slight pronation) that is part of the spring and propulsion. Allowing exaggerated sagging is like rounding your shoulders too much. 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.
Some people with existing abnormality or growths in the ball of the foot will roll inward (or outward) to get the pressure off the deformed area because standing straight hurts. See your doctor first. Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy. ---
Not long after, I saw Dennis running by at a fast clip, with beautiful neutral spine, good leg and foot alignment, and a light landing with each foot-fall. I asked him why he had asked about running lightly. He said he changed to running lightly after I worked with him on it. I asked if it made a difference and he laughed, "Of course. It used to hurt."
Dennis is muscular and squarely built. He used to leave an impression on the floor when he walked, and had knee, neck, and lower back pain after running.
Landing without jarring reduced pain. Dennis also did several things to stop injuring his joints during movement:
Stopped letting his arches flatten downward. Using his own leg and ankle muscles, Dennis held neutral foot position maintaining a good arch without needing any inserts or special running shoe - Arch Support Is Not From Shoes.
Stopped letting the knees bend inward toward each other when running, and held neutral foot position - Healthy Knees.
Using the information in my classes, Dennis fixed recurring ankle injuries, and various back neck and other joint pain and went on to win medals in wrestling. His stories and photos will follow in posts to come.
Here is Friday Fast Fitness for the intercalary year (Leap Year) - Leap to develop ankle and knee stability, leg power, and balance.
Leap to a point in front of you. Then leap back again:
Leap forward, landing on the other foot with soft shock absorption. Don't land hard, which jars joints.
"Stick" your landing, without wobbling or setting the first foot down.
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.
This skill is good fall reduction training, and ankle sprain prevention for many terrains.
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.
Walk Lightly - Shock Absorption for Happier Joints
Thursday, January 24, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
"Your tread must be light and sure as though your path were upon rice paper
"This rice paper is the test Fragile as the wings of the dragonfly
"Clinging as the cocoon of the silkworm When you can walk its length and leave no trace You will have learned" - Master Khan to Grasshopper in the 70's TV series Kung Fu
Walk, run, jump, and move lightly.
Banging down with each step is not good for your body. It increases risk of joint pain and plantar fasciitis.
I tell my students to stop banging and stomping when they walk and move and jump. One day, a student asked me "How?" Here are some things to try:
1. I asked the student to stomp his foot. Then I asked him to place his foot down lightly. That is how.
2. Use an analog bathroom scale. Step on heavily and see the numbers go up high. Then step on again lightly and see that the last number reached is a lower number. In sports medicine, we use force plates to measure ground forces when an athlete jumps or runs by.
3. While walking, try not to make noise. It doesn't mean to tip-toe, but to walk with regular heel to toe gait, but lightly.
4. Try walking with a full-to-the-brim cup of hot coffee or any liquid. Don't tip-toe, just walk softly without spilling any.
5. Practice jumping in the air and landing softly. Bend your knees when landing. Increase the height of the jump, maintain soft landing. Work up to jumping down from increasing heights without making a sound, or much sound.
Photo by Jolie taken at a Malaysian backpackers hostel
To prevent knee pain when rowing any craft or machine that uses foot bracing, foot wells, or other foot counter-force, do not push off the ball of the foot, pictured above.
Keep your heels down. Push off the whole foot, feeling the push-off through the heel. You will feel the more muscular strong push in the thigh and hip muscles, and the effort will shift off the knees. You will also get better stretch for the bottom of the foot, called the fascia.
Keep heels on the floor when doing leg press exercise and half squats for weight lifting and daily bending. Get more leg and hip muscle use and built-in Achilles stretch.
The prayer of the farmer kneeling in his field to weed it, the prayer of the rower kneeling with the stroke of his oar, are true prayers heard throughout nature. - Ralph Waldo Emerson
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Diabetes causes such serious health problems that the risk of death is twice as high for someone with diabetes compared to someone of similar age without. More than 20 million people in the US have diabetes (colloquially called "the sugar" disease) with 2 million a year more cases diagnosed every year. Exercise has been found to be a top factor to prevent and treat diabetes.
Three main types of diabetes are type 1, type 2, and gestational.
Type 1 diabetes, where the body does not make enough insulin (in the body organ called the pancreas), is treated with injected or inhaled insulin, although nutrition and exercise changes are a fundamental part of management.
An estimated 90–95% of cases of diabetes in North American are type 2. Type 2 diabetes is also called non insulin-dependent diabetes and obesity-related diabetes. Type 2 was rare until modern sedentary habits combined with mass sales of unhealthful food.
Gestational diabetes is generally a form of type 2 during pregnancy.
In the recent past, type 2 diabetes developed only in adults as they gained weight, reduced activity, and increased packaged, commercial, unhealthful foods. An escalating phenomenon of type 2 diabetes in children is now occurring.
Approximately 85% percent of adults and children diagnosed with type 2 are overweight and less active than they could be. Type 2 is increasingly being found to be best treated with more fun movement and less bad food, a win-win situation.
Several studies have found that exercise and healthier diet are more effective than medicine for people with type 2 diabetes. A recent randomized controlled Canadian study published in the Annals of Internal Medicine found that people with type 2 diabetes who began exercising developed better blood sugar control, both from aerobic exercise and resistance training. Not exercising yielded no improvements in sugar control. People who combined aerobic exercise and also lifted weights had the biggest improvement. It is not known in this study if results occurred because of the type of exercise mattered, or because the duration of exercise was greater in the combined exercise training group. According to an editorial co-published with the study, "Doctors should prescribe exercise to all type 2 diabetes patients who are healthy enough to work out."
In the past people with diabetes and diabetes-related complications were discouraged from exercise. However, exercise has been known in the past, with recent substantiating studies, to be the top factor to prevent and reverse diabetic problems. According to William Kraus, MD, of Duke University Medical Center, "Failing to prescribe exercise to patients with diabetes is simply unacceptable practice."
Things To Help
You do not need a gym or special clothes or equipment to get aerobic or weight lifting exercise.
Go outdoors for a break every day that you can, for fresh air, sunshine, and fun movement.
For both active and resistance exercise indoors and out, remember that daily healthful movement easily accumulates from your healthy bending, balancing while dressing, taking the stairs, and other daily real life movement.
Have fun - skate, bowl, cycle, walk, go dancing, gardening, shoot hoops, take food to shut-ins and get them moving too, with improvised exercise of moving arms and legs, clapping, singing, and having fun.
For fun exercise-as-lifestyle ideas, check through lists of Fitness Fixer posts, linked at the right of each article.
My post Hyperbarics for Diabetic Foot Injury gives more information on preventing amputations from diabetic wounds, and lists some of the ways that exercise reverses the contributors and complications of diabetes.
There is great hope. Have fun making a new healthier life.
Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier
Wednesday, August 29, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
Ivy had serious sciatica with foot drop. She had knee and other injuries. She was in awful pain. In this kind of foot drop, the nerve cannot serve the muscles enough to lift the foot to walk normally. The toes drag. The foot hangs limply and slaps the ground with each step.
Commonly, someone with foot drop is put in a leg brace for life. One surgery done for foot-drop fuses the ankle so the foot is rigid and doesn't hang. Other problems come over years from changes in walking mechanics. For the terrible pain, patients are often directed to drugs and surgery. These are not healthy.
We changed that:
Monday's post Inspirational Ivy told the essentials of stopping the cause of the sciatic pain and nerve impingement, rather than treat the results with unhealthy means. Links to specific methods are there.
Sciatica, disc damage, facet pain, and impingement are results, not the cause of pain. They are not a diagnosis. When you have them, find what is causing them. Then you can reverse the cause: The Cause of Disc and Back Pain
Ivy followed my directions exactly and used her brain to understand how to get the intended results, not just "do a bunch of exercises." When she first began, she wrote,
"Over the past few days, I have been very conscious of my movements and, hey presto, I have not experienced any tingling or pain. I have to take total responsibility for every movement I make. I am constantly telling myself 'Think before you go to the fridge or need to pick up something off the floor - think lunges.'"
I gave her simple gait retraining. Ivy quickly discarded the cane she had used for nearly 7 months.
Ivy went on to teach several neighbors in her community how to fix their own pain. One story is posted in Each One Teach One.
In April 2006, Ivy wrote,
"It is nearly 5 months since I started your wonderful programme so I thought it was time that I gave you an update. I am fit and well, the sciatica has disappeared, if I get a little niggle in that area, I ask myself as to what have I done wrong, my left knee (IT Band) is no longer a problem, my balance has improved immensely and the "dropped" foot is great, in fact, when I go for my daily walk, I no longer hear the plop, plop of which I hated. I can also now wear "normal" shoes.
"Without your help and support and putting me on the right road so to speak, I would still be in constant pain plus making the chiropractor richer. Please note, I no longer go to him for treatment - I DON'T NEED HIM."
At age 70, Ivy is steadily improving strength and range of motion using healthy movement for daily life. She is eating healthful vegetarian food. January 2007 brought this note:
"The reason for this e-mail being that I feel somewhat excited re a remark made by the son of one of my fellow villagers. His very words being, "How did you become the woman that you are now. I have watched you over the past couple of years - when I first met you, you were obviously in a lot of pain, what is your secret?"
"I also sent the photos to my son and daughter-in-law who live in the US, they too, could see the improvement - they thought I looked great. Mind you, over that 2 year period, I gradually lost 20 lbs."
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
Tuesday, August 21, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
Reader Jill hasn't sent a photo yet, but her words are a beautiful picture. Her story can help many readers stop pain and improve strength and function for happier daily life.
In the post Lunges and Beans Jill commented on Celiac disorder, an immune reaction to foods with the gluten protein - principally wheat plus a few others. Symptoms can be baffling until identified as coming from gluten.
Jill writes: "I had bad and steadily worsening joint problems, especially in the knees, for ten years before I found out about my gluten sensitivity. By that time my legs were extremely weak from having been unable to put weight on a bent knee for so long.
"I let the knees heal without doing anything special for them until I hit a plateau, then started doing isometric exercise for the quads (the classic wall chair), then six months after that started running slowly on an elliptical trainer. Weightlifting exercises for quads, though, still left me hobbling.
"That's where I was when I found your blog, and since then I've been doing squats at every opportunity, which was very hard at first and got much easier. Along with the foot stretch you gave, the Achilles tendon stretch in the squats also caused tremendous improvement in my plantar fasciitis.
"After a few weeks of that you posted the stair climbing posts and now I'm having far less trouble on the large numbers of stairs I climb every day. I am shying away from lunges from long associating them with pain, but plan to get over that soon and try them (gently) according to your detailed suggestions.
"Your blog has given me an enormous number of ideas to help in rehabilitating my knees from the years of gluten, which has made an enormous improvement in my quality of life. Thank you for the care and skill you put into it."
Jill, thank you for your care and skill to write things that will help many, and to do empowered good work to shine again. I put the posts with their links. Everyone, add your favorites:
Strengthen Legs Without Knee Pain - Standing Lunge
Thursday, August 02, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
Many people know they need to bend "right" but don't because it hurts their knees.
Bending right will not hurt knees. It will help fix one of the things that has been injuring them - bad bending habits which pressure and grind the joint.
Good bending will also give your knees the exercise they (and you) need.
Some knee patients are told to never "bend right" with a half-squat or lunge because it is bad for the knee. There are specific things about bending and straightening the knee that can increase certain kinds of pain, to be covered in future posts. Use your brain and try the following gently and safely. Done right, it should reduce knee pressure, not increase it.
How To Lunge:
Stand with one foot far in front of the other. Both feet face forward. (Left photo.)
Feet remain normal width from side-to-side, not directly in line front-to-back.
Lift your back heel. Don't turn the back toes outward. Look at your back foot and check.
Tuck your hip under (click "neutral spine" label for posts explaining how). You will feel a far better stretch and strengthener.
Bend both knees to lower straight downward. Don't touch back knee to the floor. Use leg muscles. Watch your front knee and keep it over your front heel, not sliding forward. (Right photo.)
Don't let your front knee sway inward.
Keep upper body upright and straight. (Right photo.)
Lower and rise several times, then switch legs. Keep feet still, not stepping forward and back.
Tips:
To keep healthy knee positioning for the front knee, peek downward to see your front knee and foot.
You should be able to see your front toes all the way through the bend.
If your knee slides forward covering your toes, you are shifting weight to your knee joint and off your leg muscles. This is one of two common ways to increase knee pain while bending. Letting the front knee sway inward is another.
Keep front knee steady over your front ankle, not sliding forward or inward. You will strengthen and stabilize your knees and legs instead of hurt them. You will feel more muscle use when you keep healthful positioning.
Lunge is a Lifestyle, not an Exercise to "do" 10 Times:
No need to go to a gym to do lunges. Use the lunge for daily bending around the house. It will add up to many lunges every day, built-in as fitness as a lifestyle. The posts How Often Should You Be Healthy? and Bending Right is Fitness as a Lifestyle give ideas of how to use healthy bending for normal daily life.
Benefits of the Standing Lunge:
Strengthen leg muscles
Strengthen the knee
Stop harmful forces on the knees from bad bending
Stretch the front of the hip of the rear leg
Stretch the Achilles tendon and foot of the back leg
Learn knee stabilization
Practice balance
Retrain healthful bending for daily life - transferring to function instead of just being an arbitrary exercise - free exercise all day
Retrain straight upper body position for bending - more functional exercise
Provide beneficial general exercise, warming which makes further movement easier, and healthful body movement.
Have fun practicing this now. You will need the standing lunge for tomorrow's Fast Fitness - Quick Warm Up. Enjoy.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
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."
It is estimated that every 30 seconds someone in the world has their foot amputated because of a diabetic foot ulcer. Reduced blood supply to the feet and lower legs in people with diabetes delays wound healing and increases infection and chance of gangrene. Foot infection worsens the situation of inadequate blood supply by increasing the area's need for oxygen but decreasing blood supply. Poor blood supply further decreases ability to fight infection. Diabetic ulcers treated with antibiotics can become colonized with drug-resistant bugs.
I am at the annual meeting of the Undersea and Hyperbaric Medical Society (UHMS). Several interesting studies are being presented on diabetic wound healing. Enhancement of healing in selected problem wounds is one of the 13 approved indications for use of hyperbaric oxygen therapy as defined by the Hyperbaric Oxygen Therapy Committee. Hyperbaric treatments are done by putting the entire person in a small room or chamber and increasing the pressure inside so that the person breathes oxygen at higher pressure than what you are breathing now. The post Does Hyperbaric Oxygen Help Exercise Ability? explains more of how it works.
One of the studies presented here looked at 50 patients with severe diabetic foot ulcers. Half were treated with hyperbaric oxygen therapy (age and gender matched with the half who did not). Diabetic patients treated with hyperbaric oxygen had 56% chance of healing and 16% chance of amputation. Diabetic patients not receiving hyperbaric oxygen therapy had a 32% chance of healing and a 32% chance of amputation. Supplying oxygen to compromised areas, such as diabetic wounds, is important to restoring health. Hyperbaric oxygen is established to help that.
From the President's Competition came another study on hyperbaric oxygen therapy and stem cell mobilization in people with diabetes. This study was by researchers at the University of Pennsylvania's Institute for Environmental Medicine, where I did nine years of my research in diving medicine. Hyperbaric oxygen is already known to mobilize bone marrow stem cells in animals, healthy humans, and in patients with a history of radiation exposure. This study looked at diabetic patients with refractory foot ulcers or radiation necrosis who were receiving hyperbaric oxygen treatments. The study was small and results varied more than in previous trials. However, the researchers reported that overall, hyperbaric oxygen therapy increased circulating CD34+ stem cells three-fold in the patients with diabetics, and was shown to play a role in wound healing. Three patients of twelve in the study group did not increase stem cells. The researchers said that the reason for no increase should be investigated.
In the exhibit hall of the hyperbaric conference, various companies display their fun oximetry units. There are several kinds of oximeters. The most common ones painlessly assess oxygen levels through the skin. Oximetry is used to assess oxygen available to the injured and surrounding tissue, and to tell how well hyperbaric oxygen treatments are working to improve oxygenation and new blood vessel growth. I like to try them all on, on different parts of my body. I experiment with different exercises to see the different effects on oxygenating different areas. Movement makes rapid, effective increases in oxygen levels.
In the past, people with diabetes were cautioned not to exercise because it was felt that they would injure themselves. Now it's known that exercise is an important part of preventing injuries from diabetes, and preventing or curbing diabetes itself. Regular exercise:
Helps your body burn more sugar.
Increases the number of insulin receptors on your cells and increases the sensitivity of your body to insulin.
Helps your body grow new blood vessels and improve circulation.
Improves oxygen levels to areas to help them heal.
Reduces high blood fat levels (cholesterol and triglycerides) which leads to early aging of blood vessels.
Increases blood flow to the feet, which helps prevent diabetic foot problems.
Keep moving for many aspects of preventing disease, secondary effects from disease, and to improve your health.
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.
Here is a hamstring stretch that is relaxing to do, more effective than bending over to touch toes, and doesn't pressure the lower back or neck discs. The doorway hamstring stretch trains healthful positioning that makes straighter posture feel natural in daily life when standing up and gives a better stretch while lying down. Reader Ivy from New Zealand sent in the photo at right of doing this stretch so well. Thank you Ivy.
Lie face up in a doorway.
Lift one leg up to rest against the wall or doorjamb.
Keep your body, shoulders, head, and other leg relaxed comfortably flat on the floor.
Keep both hips flat on the floor. Don't let your hips round under you. Don't let the leg on the floor get lifted upward along with the leg you are stretching. If it raises, that often indicates a tight hip. Gently keeping the leg down on the floor stretches the hip, giving additional benefit.
Relax and breathe. Smile. Hold for a few seconds, then switch legs using the other side of the door or wall.
For more stretch, move your whole body further into the doorway.
To add stretch for the back of your calf and bottom of your foot, pull your toes back and downward, using your shin muscles, a towel, or your hand if you can reach.
It is not the case that you must bend the other knee to protect your back or prevent muscle strain. It is not harmful to keep the leg on the floor comfortably straight and stretched flat against the floor. Keeping the leg down makes the stretch more functional and transferable to daily life movement. Several Fitness Fixer articles cover why - here is one, Fast Fitness - Don't Shorten Hip When Stretching Hamstring. Relax and enjoy this stretch.
Readers, send me your photos and success stories showing healthy movement during real life. Don't be shy.
Read more success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
"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.
When you take your shoes off and stand up, do your toes turn upward by themselves, as in the photo at right? That is usually from tightness in the top of the foot. You can often see the tight, string-like tendons on the top of the foot pulling the toes back. Do your toes face outward (toward the little toes) when your foot is facing straight forward (same photo). A sideways -shift is common, not only from tight shoes, but can be produced from how you walk, step after step, year after year.
Toes deform into unhealthful positions in common ways:
Shoes: Tight shoes fold and shift toes out of place. Heeled shoes push toes upward. When toes are held in one position too much, the muscles tighten and don't go back to normal length.
How You Use Foot Muscles: Many people do not use muscles in their feet or toes when they walk. They just clomp. The muscles that normally work to pull toes and forefoot downward during the weight-bearing phase never engage properly. The toes stretch upward during push-off, but not downward.
Positioning: If you walk with feet facing outward, the "push-off" phase is on the side of the big toe instead of the bottom of the foot. After years of being pushed toward the other toes, the big toe eventually tightens into the new shifted position.
Good reasons to stretch toes:
Healthy spacing avoids fungus like Athlete's foot, calluses and other injuries from rubbing, and improves needed movement.
Toes need to move through a full range up and down, and independently from each other, for balance, preventing several causes of foot pain, and for quicker, healthier movement ability. Feet are not just blocks to clomp around on.
You can avoid toes that curl, hook, hammer, face different directions, or push sideways into bunions.
Try these easy stretches:
Take your toes in your hands and bend them all downward, to stretch the top of your foot.
Take your toes in your hands and bend them all upward, enough to feel a nice stretch in the bottom of your foot, not just the toes.
Pull each toe apart from the next.
Pull the little and big toes away from each other at once, restoring healthy width to the front of the foot.
Pull any toes that are bent-up until they are back downward. Pull bent-down areas gently straight, and pull curled toes straight out to restore straight length.
Stretch deformed, squashed toes with your hands several times every day, or at least at night and in the morning, or when exercising or stretching. Reduce the need to stretch them back to health in the first place. Walk with feet (and knees) facing straight ahead. Wear shoes with room in the toes. Tight shoes are not healthy. Unhealthy shoes are not beautiful.
Shoes worn snugly "for support" cause frequent problems. If your toes fit together like puzzle pieces or do not face straight ahead, as in the photo at left, it is likely that you frequently wear shoes that are too tight.
There should be space between each toe, and each toe should face straight forward, not turned toward either side (photo below right).
If you need toe separators (a soft foam device for separating toes) to paint your toenails, your toes are too tight and bunched together. Toes that are bunched together need regular stretching to separate them. Take your toes in your hands and gently pull them apart. Some of my patients use those toe separators to wear to bed. That is all right to start, but instead of only treating the result of a tightness problem, it is best to correct the problem with simple stretching before deformity progresses to the point where it is difficult to fix:
Pull your toes away from each other with your hands.
Straighten each toe gently.
Make sure all toes separate and can wiggle.
Practice wiggling your toes.
Don't wear shoes that push your toes together or keep them from moving.
Avoid tight socks and stockings - "tight" is anything that presses your toes together.
When standing, don't tighten or clench your toes against the floor or each other. Don't press toes into the ground to balance so much that they buckle and bend. Keep your weight distributed over your entire foot, including your heel. Notice if you rock forward to the ball of your foot when standing.
Take off shoes and all hosiery every day and let toes get sunlight and air.
When you exercise and walk, make sure you do not walk "toe-out." Turning the feet outward, sometimes called "duck-foot" used to be thought the normal direction of the fibers and muscles. Now it is known that both feet should be able to comfortably face straight ahead.
Toes do many wonderful things for balance, walking, ability to jump and move quickly, for the shock absorption important to your hip, and more. See the post Healthy Toe Stretches for foot stretches. The next post will give fun stretches specifically for tight toes.
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 a well known 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:
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.
Work up to rising to toe and lowering on just one foot (good for balance).
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.
Use the above stabilization technique each time you step up or down from anything, including stairs and curbs.
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.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
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?
Stand up. Keep both feet facing straight ahead, not turned out.
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.
Shift your body weight over your big toe and second toe. Don't let your ankles sag inward or outward. Hold your ankles straight.
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.
Next: More fun ankle proprioception retraining to rehab ankle sprains and learn to prevent future sprains - No More Ankle Sprains Part II.
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.
See if your your arch slumps downward, pressing your arches against the floor (left hand photo). In most cases, there is something wrong with your arches, but simply because you allowed it.
If you use the muscles on the outsides of your ankles and legs, you can gently shift your weight more evenly to get your body weight 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.
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.
Remember, don't force. If it hurts, it's wrong.
All you are doing is learning how to stand neutral, not tilted and compressing your joints. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
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.
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.
Which Shoes Help Exercise, Fall Prevention, and Ankles?
Tuesday, February 20, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
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.
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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.
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. To get started:
Practice standing on one foot without holding on to anything. If balance is poor stand near a wall for safety to get started and have a skilled friend help. Practice standing for 10 counts without holding on. Increase how long you can balance.
Stand on one foot and swing the other forward and back, side to side, without holding on or touching down. Safely.
If you use a cane, practice walking holding it off the ground. Use your brain to do this intelligently and safely to improve balance and reduce dependence on the cane.
Balance is "use or lose" and can be quickly improved with safe smart practice. You don't need to go to a gym or "do exercises." Use balance skills as part of your daily life.
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