A Whole Big Fix

This is the first part of a great reader story. Mike has been fixing many things. Pain started with a local radiating pain, then became much other pain. Mike looked for something to fix the first area, then ably used other techniques.

Mike writes,

"I'm sorry it's taken so long to write back. Along with teaching and family time I've been taking a graduate class and I've just finish my final project for the class. Now I have time. Here goes.

"Back in 1983 I developed a deep pain and spasms in my right buttock along with radiating pain down my leg. I had been running 40-90 miles per week as a high school and college cross-country/track/road runner. For the past 20+ years this pain has come and gone every week while lying down, walking, and mostly sitting, making it very difficult to work at a desk, sit at a class, and drive. I've assumed it was a type of sciatica and read and tried everything I could for relief.

"The only temporary relief I found was in cycling, which stopped the pain for up to 48 hrs after rides, so I ended up cycling for 20 years, including racing for a team for 2 years. All that cycling caused other problems including a slumped, impinged shoulder from a separated collarbone in a crash, tight hip flexors, allergies from all the car exhaust and desert riding, and too many close calls from SUVs with drivers calling, texting etc. in heavy traffic. I was eating far too many simple carbs for energy on these intense rides. I stopped cycling to improve my health, decrease my risks of collisions, and to save money on all that equipment.

"The pain and spasms in my rear and down my leg increased in frequency and duration. My shoulder was not improving despite a month of visits to a physical therapist. Through searching in the internet I came across Dr. Bookspan's Fitness Fixer and books in early 2007. The logical stretches and strengthening moves worked much better than anything I had tried before. One time during a long class my rear and leg were killing me, so I applied a stretch (I learned from one of the books) while sitting in the chair without anyone knowing. The pain went away for the rest of the class. (Since applying Dr. Bookspan's shoulder retraining) my shoulder rarely bothers me and I've gone months without any pain in my rear and down my leg.

"I've also been enjoying Jolie's books for the sections on nutrition, spirituality, mental focus and general health and exercise advice. Working on all the parts at once seems to help the individual parts even more. I'm now working on walking comfortably without orthotics (it's getting better) and figuring out why my left knee and right hip pop so much. I'm very fortunate that I'm without pain now though, thanks to Dr. Bookspan's advice.

"I've attached some photos of the (hip) moves and stretches that work for me. Thank you! Mike "

Just as I was uploading this post today, Mike wrote me:

"Just wanted to let you know that my wife had a lot of pain and tightness in her hip yesterday from squats without warming up enough and possibly poor technique. She was very uncomfortable in any position, even lying down. I showed her how to do the hip stretch that worked for me, from your book, and it IMMEDIATELY, stopped the pain and tightness and she still feels great the next day! Mike"

I asked Mike about his statement, "I stopped cycling to improve my health." His story will continue, I hope next week.

Labels: biking, computer, hip, orthotics, readers inspiring story, running, sciatica, shoulder, squat

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Your Fitness Fixer Requests in the Works

Thank you for the many e-mails. I am sorting through the piles. Readers are sending success stories, long and short, of improving their lives and fixing injuries and the moves that produced them. They changed their mindset so that exercise is not something you change clothes and go "do" - if you can make time - but all the ways you sit, bend, reach, lift, and move all day in real life, using muscles to hold the positioning that prevents body aches and joint wear and tear, and comfortable easy movement. They are now getting fresh air, sunshine, balance, and real exercise going to work or grocery shopping on a real bike or walking on real ground, instead of driving then rushing home or to the gym to "do" exercise, illogically spending money on an artificial machine, exercise cycle, or treadmill. Instead of thinking they have to lose weight first to try things, they are using daily movement to be able to exercise for the first time without injury. They are saving money and health, eating real food instead of processed unhealthful "sports food."

Yoga instructor David from Belgium first asked about fixing knee pain and fallen arches in the comments of the post Thank You Grand Rounds 3.51. Since then, he quickly applied the posts I recommended and fixed his pain, no longer needed shoe orthotics, sent photos of new progress, asked about other injuries from yoga, changed how he teaches yoga, given his students my techniques, started making short mpeg movies for us (see the first here), and is translating my work into Dutch for his web site and students. I look forward to more collaboration. Watch for wonderful posts to come.

There have been a small number of e-mails from readers applying techniques in ways so "unclear on the concept," that some posts may turn out to be Readers Inspiring Stories of What Not To Do. All for the greater good, learning, and health.

If I can't get to everything in the comments I will make posts for you, don't worry. I read and want to get to them all. The top number of requests for posts, so far, are how to stop shoulder injury from swimming, baseball and weight lifting; low back pain from swimming, baseball, and golf; separating truth from advertising in orthotics and shoe inserts; more healthy sports food; rowing; sports drugs; hamstring injuries (often from the usual bad stretches); plantar fasciitis; knee pain from rowing, yoga, and walking; wrist pain from pushups and handstands; healthy sitting; and many requests for martial arts and self defense for body and mind. If you have other requests, let me know. Until I post each specifically, start with:

• Shoulder - use for all overhead reaching and lifting
• Lower back - learn the concept and apply to all sports
• Orthotics
• Yoga ankles
• Drugs
• Sports Food, what is good and what is not
  
• Hamstring
• Plantar fasciitis - details in comments of Why So Many Aerobics Injuries?
  
• Wrists
  
• Sitting
• Knees
• Martial arts
• Spirit

Fitness has become unhealthy. Healthful natural, comfortable body movement has become foreign as more people think that exercise means artificial sets of repetitions on a machine or using equipment. How are you sitting right now reading this? Pull chin comfortably in, instead of jutting forward or down. Stand up, breathe a grateful breath, and walk away from the computer for a few minutes contemplating a new, healthy fun life of natural movement. Print out a post of something that will make your own situation happier. Lie face down on a comfortable surface, propped slightly on elbows to read it. If you can't lie comfortably that way, that signals tightness that makes daily movement unhealthy and uncomfortable. I will post about that too.

Labels: education, orthotics, readers inspiring story, weight loss

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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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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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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, 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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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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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 jump rope, not your feet slamming the ground, transmitting shock to your knees and hips, and up your spine.
• Bend your knees lightly when you land. Don't land straight-legged.
• When you bend your knees for landing, don't let them sway inward.
• Keep kneecaps facing the same direction as toes, not twisting inward.
• Land softly, on the ball of the foot first. Quickly bring heels down while bending knees to absorb impact.

Remember healthy knee positioning during all activities. Look at your own knees and other people's knees when they take the stairs, and when bending to reach or retrieve things for healthy bending at home and work. Notice knees when you get out of your chair and sit back down. Don't let knees sway inward. Hold them above your ankles, not inward.

It is easy to control leg positioning for healthy knee joints while you stand, bend, take stairs, exercise, and jump so that your daily life and exercise is healthy.


Photos and more on keeping knees healthy during exercise, in the book Healthy Martial Arts and Fix Your Own Pain Without Drugs or Surgery

Labels: aging, ankle, arches, fix pain, injury, knee, leg strength, martial arts, orthotics, posture, pronation, strength, stretch

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