Fast Fitness - Balance and Ankle Stability in the Dark

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.

1. Stand on one foot.
2. Balance on that foot with eyes closed. Switch feet.
3. 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.

Maintain the arch in your foot. Notice if you flatten it downward or teeter too far to the side edge. Use foot and ankle muscles to lift it back to neutral position. See Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches.

Click the label "balance" under this post for all Fitness Fixer posts on balance.

Labels: ankle, balance, fast fitness, feet, sprain

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Fast Fitness - Sprain Prevention and Rehab Training

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

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

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

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

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

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

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Fast Fitness - Leap for Balance on Leap Year

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

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

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

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

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Does Hyperbaric Treatment Help Muscle Injuries?

The previous post Does Hyperbaric Treatment Heal Sprains? covered research that looked into hyperbaric oxygen treatment for injuries like ankle and knee sprains, and muscle soreness.

Some professional sports teams have been using hyperbaric oxygen chambers hoping to speed recovery and enhance performance. Players spend time in a small pressurized enclosure, breathing high levels of oxygen. Other athletes and private citizens have purchased chambers, hoping for various gains. Like other helpful and specific medicines, hyperbaric oxygen helps some things and not others, and can have side effects. The post Does Hyperbaric Oxygen Help Exercise Ability? explains more of how it works.

Sprains and delayed onset soreness are not injuries where low oxygen prevents cells from doing their job to fight infection and rebuild. Elevating oxygen levels doesn't turn normal cells into super cells. It returns them to function. For non-geriatric athletes, sports injuries should not be hypoxic, which is an area of low oxygen. (Given the junk these athletes eat for "sports food" the state of their blood vessels should benefit by a closer look. See Is Your Health Food Unhealthful.)

A concern in hyperbaric medicine is that sensationalized use of hyperbarics for things that may not work will take the legitimate medicine of oxygen treatment and give it a sham image. Dr. Steve Thom, MD, PhD, past president of the Undersea and Hyperbaric Medical Society (UHMS) warns that some team physicians appear unaware of the risks of hyperbaric medicine. He stresses the need for proper medical clearance and supervision of the hyperbaric chamber. For certification and policy information, see the UHMS web site.

The idea that perhaps there are other effects of injury that are not from low oxygen has led to more research on sprains and muscle injury. A study presented here at the UHMS meeting this week by a group from the Tokyo Medical and Dental University in Japan was, "The effects of hyperbaric oxygen therapy on patients with muscle injury." They wondered if hyperbaric oxygen could reduce edema after muscle injury.

Dr. Kazuyoshi Yagishita and colleagues looked at twenty patients who sustained muscle injury during sports, who were admitted to the Tokyo hospital within seven days after injury. The patients received hour-long hyperbaric treatments for one to seven sessions. Patients were tested before and after each treatment for pain at rest and with motion, subjective evaluation of edema, muscle stiffness, and leg volume. All parameters slightly improved with treatment. They concluded that, in this study, in patients with muscle injury, hyperbaric treatment was effective. Dr. Yagishita told me he felt that further study is necessary to assess healing acceleration and intermediate and long-term results.

Labels: hyperbaric, injury, performance enhancing modality, sprain

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Does Hyperbaric Treatment Heal Sprains?

The Utah Deseret News reported on a game where teens scratched letters into their arms. In March, a 14-year-old girl playing the game became infected with necrotizing fasciitis, commonly called "flesh-eating bacteria."

The bacteria don't eat the skin as the name seems to say, but release toxic factors, which quickly destroy skin and muscle, causing pain, disfigurement, and a high death rate. Necrotizing fasciitis is a serious infection. The teen needed over 60 hyperbaric treatments and several surgeries. Hyperbaric oxygen treatment is done in a small room or chamber. The air pressure inside is increased so that the person can receive more oxygen. One or more people can get treatment in the chamber at once. The post Does Hyperbaric Oxygen Help Exercise Ability? explains more of how it works.

Hyperbaric oxygen treatment is effective against necrotizing fasciitis and infections like gangrene in several ways. The bacteria involved are susceptible to high oxygen pressure, the low oxygen area of the infection is raised to a level where the body's white cells can do their job to clear the bacteria, higher oxygen pressure prevents white cells from sticking to vessel lining, and a few other nice effects to be covered in future posts.

Given that hyperbaric oxygen speeds healing in certain infections, crush injuries, problem wounds, diabetic ulcers, thermal burns, ionizing radiation injury, refractory osteomyelitis, osteoradionecrosis, and compromised grafts, it has been hoped by some that it would also be useful for sprains and muscle injury.

One study by diving medicine pioneer Dr. Fred Bove (my advisor for one of my dissertations) and his colleagues, found no effect of hyperbaric oxygen treatment on time to recovery for ankle sprains (Am J Sports Med. 1997 Sep-Oct;25(5):619-25). Another study by Dr. Michael Bennett and colleagues reviewed known past studies using randomized trials of hyperbaric oxygen on soft tissue injury (ankle sprain and medial collateral knee ligament injury) and muscle soreness after exercise. They found there was was not enough evidence that hyperbaric treatment helped ankle sprain, acute knee ligament injury, or soreness (Cochrane Database Syst Rev. 2005 Oct 19;(4)). Dr. Brad Bailey of San Diego did a review of the utility of hyperbaric oxygen for sprains and sports injuries and found no benefit for soreness, but a few studies that showed benefit in acute sprains and strains. There may be aspects of injury, not previously looked at, that may be helped. These are being looked at in newer studies. The next post will cover them.

You can do much to rehab sprains on your own. Posts with helpful information to prevent and rehab sprains are:
How To Treat Ankle Sprains and Prevent Them
and
No More Ankle Sprains Part II.

Labels: hyperbaric, injury, performance enhancing modality, soreness, sprain

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Fixing Fitness Myths

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

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

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

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

Feet and Ankles

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

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

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

Dispelling Myths of Orthotics Use:

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

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

Do Breathing Exercises Work?

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

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

Dispelling Nutrition for Exercise Myths:

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

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

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

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

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

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

Myths that only gyms and weights can improve your strength:

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

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

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

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No More Ankle Sprains Part II

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

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

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

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

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

Coming Next - Using Abs Is Not Tightening.

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

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How To Treat Ankle Sprains and Prevent Them

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

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

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

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

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

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

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

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