Running: Knowing the Risks and Benefits!

As the warm weather approaches, runners who’ve been using indoor tracks and treadmills during the winter will be coming outdoors to exercise.  Here’s what you need to know before you begin an outdoor running regimen.

PREPARATION

Before you hit the pavement—cement, asphalt or track— see your primary care physician, says St. Joseph Mercy Oakland family medicine specialist Ricardo Cabrera, MD.  He or she will determine if you’re healthy enough to run.  “If you have medical discomfort, bring it to the attention of your physician,” Dr. Cabrera advises.

Secondly, you’ll need the proper equipment and clothing.  Dr. Cabrera recommends dressing appropriately for the weather.  Wear shoes that fit properly.  Then, prepare your body.  Do warm-ups, such as stretches.  Most importantly, start slowly and increase your distance as your stamina improves.  “The biggest mistake is doing too much too soon,” he warns.  “Ease into it and be patient.”

With running shoes, it’s not how much you spend; it’s the right fit that counts. Often, people think that the more expensive the shoe, the better it is.  Dr. Cabrera says that’s not the case.  The shoe should not be too big, too small or loose, and “you need a reasonably good arch support,” he suggests.  Socks should always be worn to prevent friction. Breathable cotton is best since it absorbs sweat.

Dr. Cabrera also recommends whenever possible picking a surface that will limit injury.  Tracks are best because “they are meant to run on.”  A track has a cushion to absorb shock and has some give, where hard surfaces can be tougher on knees or ankles.  At the same time, a soft surface, like the beach “can cause pain and discomfort because you don’t have the support” of a harder surface, he advises.

In inclement weather, runners may want to use a treadmill to keep up the momentum.  Dr. Cabrera says treadmills are “a good alternative to running outside,” but there is a downside.  Runners have been known to fall off treadmills because they are going so fast. If you use a treadmill, take the proper precautions.

And what about diet?  Dr. Cabrera says a balanced diet is best.

BENEFITS

According to Dr. Cabrera, running is good for your health. “Running has cardiovascular benefits that will enhance your overall well-being.  It makes the body run more efficiently, and can help fight illness, lower bad cholesterol (LDL) and increase good cholesterol (HDL).”

Ricardo Cabrera, MD, joined the medical staff of St. Joseph Mercy Oakland in Pontiac in August 2008.  A board-certified specialist in family medicine, Dr. Cabrera earned his medical degree at the Autonomous University of Guadalajara, Mexico, and did his residency at North Oakland Medical Centers (now Doctors Hospital), where he chaired the Department of Family Medicine.  His professional memberships include American Academy of Family Practice, American Board of Family Medicine, Michigan State Medical Society and Oakland County Medical Society.

Stretch Your Limits

It’s boring. It takes too long. I don’t know how/when/how much to do. It hurts. I don’t need it. All of these are common excuses for not stretching.

While it’s true that one cannot “see” flexibility, a lack of flexibility is one of the most commonly felt areas of fitness. Anyone who has experienced musculoskeletal pain anywhere throughout the body has likely had some level of corresponding muscular tightness. Dr. Vladimir Janda described predictable patterns of muscle imbalances which included tightness in one area of the body and weakness on the opposite side, referred to as Upper and Lower Crossed Syndromes.

Much research has been done regarding the frequency, duration, time, and intensity of stretching. As with most areas, all the contradictory opinions cause a “paralysis by analysis”, and give people one more excuse to not do it. Confusing terms are used like: Proprioceptive Neuromuscular Facilitation, Reciprocal Inhibition, and Myofascial Release. Let me try to simplify (perhaps over-simplify) things a bit.

WHY IS FLEXIBILITY IMPORTANT?

• Reduced risk of injury: A lack of flexibility causes muscle imbalances, which can cause injury, pain, and tension throughout the body. I also need to say that there can also be excessive flexibility, which can cause injuries as well.

• Improved performance: The same muscle imbalances can prevent opposing muscles from firing, thereby promoting weakness in those muscles. When there is tightness and weakness around a joint, one cannot produce optimum movement for work, sports, play, etc.

WHY DO WE LOSE FLEXIBILITY?

• Trauma/Injury and Immobilization: With trauma/injury, scar tissue forms within tissues to protect the injured area. If not addressed properly, the scar tissue continues to prevent proper movement after the protective phase has ended. The longer the scar tissue has been present, the more difficult it generally is to change.

Besides the actual trauma/injury, immobilization (a period of restricted/absent movement in a joint) causes a lack of flexibility. Common periods of immobilization occur with casting/bracing after an injury, and prolonged bed rest for various reasons. Immobilization also occurs to a lesser degree when daily activities include maintained positions for prolonged periods, i.e. sitting all day at work.

• Aging: We lose flexibility with age – you can’t change your age.

• Not doing it: People generally don’t like to stretch. Whether for the reasons previously mentioned or a multitude of others, if you don’t use it you lose it. It is never too late to start stretching – so get to it.

TYPES OF STRETCHING

• Static vs. Dynamic: Static stretching is the type most often thought about, where a stretch is held for an extended period of time. Dynamic stretching includes any stretching where movement is involved. One type of dynamic stretching is ballistic stretching which is often thought of as “bouncing” while stretching. People are often told that this type of stretching is bad and will cause injury. While uncontrolled ballistic stretching can promote injury, a more controlled version can often improve performance and prevent injury better than its static counterpart.

The point is, there is no bad stretching, only stretching performed badly. The need for flexibility depends on the activity and the person, and a combination of different types of stretching is usually the most effective.

• Passive vs. Active: Passive stretching is where an external object is holding the stretched body part, whether it’s another person, a chair, wall, etc. Active stretching is when the body part being stretched is brought into that position and held with its own force. An example is to lie on your back and raise your straight leg towards the ceiling and hold it there using just your leg to raise itself. The benefit of passive stretching is that the stretched body part can often be stretched further. Active stretching is beneficial because contracting the opposite muscle causes relaxation of the stretching muscle. Again, variety is a good thing.

• Flexibility vs. Joint Mobility: Flexibility refers to the muscles and tendons along a body part. Joint mobility is the ligaments and other connective tissues directly surrounding a joint. Oftentimes, a person’s feeling of “tightness” is due to a lack of joint mobility vs. muscle flexibility, but that is another article.

HOW LONG AND WHEN TO STRETCH?

There is research to show benefits from static stretching for 10 seconds and up. The general goal for people is 30-60 seconds. However, 30-60 seconds is often the goal only because people do not have the patience or the control to last longer; and they don’t go shorter than 10 seconds because “ballistic stretching is bad.”

Most sports require a certain amount of dynamic or ballistic flexibility. Think about it. What sports other than gymnastics or dance (and a few others) require you to maintain a stretched position for longer than a second? If quick flexibility is required, then quick flexibility has to be trained. Again, mix it up.

When to stretch is somewhat controversial, but it is fairly well agreed that an initial warmup, which includes movement to promote bloodflow, is beneficial prior to static stretching, and that the greatest gains in flexibility will occur if stretching is performed after the actual workout, sport, etc. For those who believe in dynamic stretching, there is more of a place for that at the beginning of the workout or prior to the sport/activity.

SAMPLE STRETCHES

1 Groin Stretch (butterfly): Sit up straight with the soles of the feet together. Hold your ankles with your hands and pull them towards your body as far as possible. Use your elbows to push your knees down as far as possible. Maintain a straight spine, lean forward as far as possible. Hold 30-60 seconds, 2-3 times.

2 Dynamic Calf Stretch: Stand in a lunging position against a wall with the back foot flat on the floor and knee straight, as in a typical calf stretch. Pick the front foot off the ground while maintaining a stretch in the back calf, and rock your hips side to side in a controlled way. Do 10-20 rocks with the hips. Repeat two times per leg.

3a-3b Flexband Hamstring: Lay on your back with a strong band wrapped around one foot. Keep both knees straight, use the band to lift the one leg (with the band on it) as high as you can while maintaining a straight knee. Lower the leg and repeat. Hold at the top for only 1 second, but make it a strong stretch. Repeat 10 times, then hold the last one up for 20-30 seconds. Do two times per leg.

4 Prone Piriformis: Face the ground on your hands and knees. Cross one leg over the other and slide the leg back so your front knee comes towards the opposite shoulder. A stretch should be felt in the butt/hip on the forward leg side. Hold 30-60 seconds, 2-3 times per leg.

5 Lunging Hip Flexor: Get into a lunging position, with the front foot pretty far forward. Lunge your hips and torso forward while maintaining a vertical torso and tight abdominals. A stretch should be felt in the front of the hip and/or thigh on the back leg. Rock into a stretch, hold 20-30 seconds, then rock back. Repeat three times per leg.

6a-6c Flexband Shoulder: Using a somewhat firm band – hold in front of your body and move behind your back while maintaining straight elbows the entire time. Hold at each point that you feel a stretch for 5-10 seconds and repeat 5-10 times.

A couple of final notes: a weak muscle often gets tight. So in addition to stretching those areas, don’t forget to strengthen them as well. And, stretching can be performed more often than strengthening – start 3-4 times per week, up to 6-7 days if no detrimental effects are observed.

Fitness: Reliving Our Youth

Run, climb up and down stairs multiple times, play basketball, run, bike ride, skip, cross monkey bars, climb trees, run, swim, martial arts, run, jump, tumble, throw, catch, hit, rope climb, swing, did I mention run?

No, I am not describing the record setting effort of the World’s Fittest Man (see Health and Leisure, May 2008), I am describing a typical day for a child. These days, we really can learn a lot from our children. Let’s think about the things children are taught (and often do follow):

1. Save money – I know many, many adults who should learn how to use a piggy bank instead of a credit card!

2. Play fair – apparently this rule changes when entering the professional worlds of business, sports, politics, etc.

3. Have good manners – do most grown ups even know the meaning of please and thank you?

4. Problem solving – kids keep it simple, adults make things far more confusing than necessary

And last but certainly not least;

5. Play – let’s talk about this one

In the world of health and fitness a lot of misconceptions are floating around. We often hear about how bad it is to do things like deep squats, pushups, the splits. And, we are told about how much exercise is “just right” to burn fat, build muscle, stay healthy, etc. The problem with most exercise regimes is that they are often too rigid (for no good reason), too confusing, and they are no fun. Not only that, but with all the gyms popping up, all the people supposedly working out, and all the money being spent on health, why is everyone so out of shape?

I cannot describe how many people I see who have completely forgotten some basic motor skills. Most of my patients have no idea which is their dominant leg. When I ask which leg they would use to kick a ball, they still have to think about it for a while. Ask a child which leg they kick a ball with and there is generally no hesitation.

Activities like skipping, hopping, galloping, etc. – things we all did in elementary school gym class, have all been lost. Now granted, elementary school gym is a bit different now than when I was in school. Thank goodness for “progress.” We are producing millions of book-smart, video game playing, couch potatoes, who probably won’t see their toes past their bellies past the age of 25. As a father of a 6 year old and a 3 year old, I have seen where the changes have started happening. It starts when children begin sitting more often in school. This is when some of that amazing “young child, rubber person” flexibility starts to decrease slightly – especially in the hips. Once flexibility goes, other areas often follow.

To compare children and adults, let’s first look at the fact that exercise for children – up to age 8 or 9 we’ll say – comes in the form of “play” whereas adult fitness comes from “working out.” So which is better?

Flexibility: although children may lose some from sitting, touching their toes is not even a remote challenge for most. As I said before, many adults don’t even know where their toes are. Winner – kids.

Endurance: It is true that a stairmaster can get the heart pumping. But I have not seen too many adults keep up with their kids for an afternoon of active “playing.” Adults are so bad that – while sitting on the couch – they tell their kids to go get them something from the refrigerator, upstairs, on the other side of the room, etc. I don’t think it would go over too well if a child said, “hey dad, go grab me the remote from on top of the TV, I’m too tired to get up!” Additionally, kids cannot drive. If they want to go somewhere close they will often walk, bike ride, etc. Heaven forbid an adult walk somewhere if a car is nearby. Winner – kids.

Strength: Yes, an adult can lift more absolute weight than most young kids. And research has shown that all things being equal, strength generally peaks between around 25-30 years old. However, if you look at relative strength – strength relative to body weight – kids will often blow adults away. I consider myself to be relatively strong, but my son can easily deadlift a 53 lb. kettlebell (equal to his bodyweight) and walk around with it. Yes, I can pick up 185 lbs, but probably not as easily as he lifts 53 lbs, and many adults are pretty pathetic when it comes to handling their own bodyweight. Another example is to watch kids on monkey bars, many can do them easily – at least better than adults. Go ahead mom and dad, give the monkey bars a whirl, the kids need a good laugh. Winner – tie (I’m being generous to the adults on this one).

Breathing: I have spoken before about proper breathing, and adults don’t do it. Breathing from the diaphragm is more efficient and just better than chest breathing. Young kids do it from the diaphragm, adults generally from the chest. Winner – kids.

Joint Pain: Accidents happen. However, kids rarely complain of the pain in knees, backs, and shoulders that adults do. If kids do complain, it is chalked up to “growing pains” and quickly subsides. Yes, kids have not had the time for their joints to go to pot, but seeing as how there is a correlation between consistent physical exercise and a lack of pain in adulthood, I don’t think age is the only reason kids don’t hurt as much. Winner – kids.

Agility/Balance: With the growing popularity of BOSU balls, balance boards, Airex pads, etc.; balance has become a much more recognized area to work on in gyms and health clubs across the country. Kids on the other hand are always standing, hopping, and playing on one foot; standing on balls, etc. – so this area may be close to equal between kids and adults. But when looking at agility, adults almost never practice this skill, whereas kids are always running and changing directions “on a dime,” as well as other activities to develop agility. Winner – kids.

Equipment Utilization: To a child, “the world is their oyster!” They can play anywhere, with anything, and hence, get a great “workout.” Adults spend millions of dollars on exercise equipment, gym memberships, personal trainers, etc. All they need is a good swingset, open space, and some imagination. Winner – kids.

So let’s review: kids just kicked the adults’ butts in fitness and they are having more fun. Now anyone who is reading this article may be saying that I am wrong, and “playing” is not the same if adults do it. Well then, let’s look at the fittest group of adults in the world: professional athletes. What are athletes – people who play for a living, baby! We can learn a lot from our kids, let’s start now.

“Truly wonderful, the mind of a child is.”

– Yoda (Star Wars Episode II, Attack of the Clones)

To learn more about youth and adult fitness, email Bob at bob@functional-strength-training.com

Or visit his website at www.functional-strength-training.com

GolfRx: December 2007

One of the components to building a solid golf swing that has been over looked is the physical condition of a golfer. In the past, a player’s physical condition was not looked at as a part of a players development. Ever since Tiger Woods has come along, physical conditioning has been a major part of a player’s development and performance.

Because of this, a physical evaluation of a golfer is becoming a part of the overall evaluation of golfers when assessing their needs for improvement. Not only is this important to golf-swing performance but also to injury prevention.

When I evaluate a player’s swing I see faults that are directly related to a lack of the player’s strength or mobility. Titleist Performance Institute (TPI), part of Titleist Golf, has put together a program that specifically addresses a player’s physical condition and its relationship to the swing. The workshop to become a TPI certified golf fitness instructor helped me with organizing and matching up swing faults to the player’s body and then prescribing exercises for the individual.

TPI has developed a physical screening that involves a series of tests to identify a player’s limitations that may lead to swing faults. So not only can you look at the swing and predict where a player may have strength or mobility problem, but also through a series of tests predict what swing faults a player may have. Once you determine a player’s limitations you can prescribe exercises for that particular player.

I have always looked at golf conditioning in two ways; golf-specific as well as golfer specific. General conditioning is great, golfspecific conditioning that targets a certain area related to the golf swing is great, but player-specific conditioning that is for that individual player is the BEST. For most of us our busy lifestyles do not afford us much time to spend on conditioning. However, if you have a few specific exercises that fit your swing faults, you will be able to find the time during the offseason to do them.

Taking a break in the offseason can be the start of bad swing habits when you pick up a club in the spring. When we take a swing our bodies tend to move into positions of least resistance and into positions of strength. After a long break the flexibility and strength we may have had from swinging a golf club all summer may be lost. The start of the season can mean the start of bad habits as the body compensates for the lack of mobility and or strength. Restriction in trunk rotation or tight hip flexors may be the cause of a sway or over use of the arms and hands in the swing.

Many of the exercises that the TPI use to correct a players limitations resemble many of the yoga postures that you find in any yoga class. There is no wonder why I have played my best golf during periods of time when I was able to make it to yoga class on a regular basis. Even when I am not able to get to a class I will do my four or five postures at home that are specific to helping my swing.

Here are three exercises that you can do at home and the related areas of the golf set-up or swing they will help.

Quadruped Pelvic Tilts (Cats and Dogs)

Start in the quadruped position (all-fours) with your arms and thighs perpendicular to the floor. Without bending your elbows, try to lower (swayback) your spine creating the dog position (Fig. 1); and then lift or arch your back up creating the cat position (Fig. 2). Repeat this back and forth and then find the middle or neutral position. Hold this position with the abdominal muscles engaged for two breaths. Repeat several times.

This will help a player’s ability to move and control the pelvis during the swing. This is important for optimal power transfer from the lower body to the upper body during the swing. The cat and dogs exercise will also help a player improve their posture in the set-up position by making it easier to tilt forward from the pelvis and keep a neutral spin position at the same time. This will help a player in making a proper rotation in the back swing as well as helping a player stay in posture during the forward swing. The player who feels that they can’t stay down on the ball in the follow-through will benefit from this exercise.

Two Hip Rotation Exercises

Hip Circles – Start by stabilizing your core in the quadruped (all-fours) position. Try to have a feeling of strength in the core to prevent any movement from the spine. Slowly start to make circles with your right hip, try to create the biggest range of motion possible without losing your stable spin. Repeat on the left side.

Pigeon – From an all-fours position bring your right knee forward just inside your right hand, move your right foot toward your left hand in a bent position and extend your left leg back (Fig. 3). Bring your torso down into a forward bend over your right leg. Let the weight of your body rest on your leg (Fig.4). Repeat on the left side.

These two hip exercises will help in internal and external hip rotation. This is important in both coiling and loading into the hips on the back swing and bracing into and rotating around the hips on the downswing. Anytime there are restrictions in the hips’ range of motion there will be the potential for excessive lateral motion (sway and slide) in the golf swing.

I hope these exercises get you started with your golf-conditioning program. Maybe that bad habit you have been fighting in your golf swing is due to the lack of mobility or strength more so than lack of practice. Find out what is important to improving your swing and just maybe your swing improvements will come from improved physical condition rather from hitting balls at the range.

Have a happy holiday season!

Any questions or suggestions for future article topics please contact me at: joep@carlsgolfland.com.

Fitness: Building the Foundation From the Ground Up

Finally, those of us living in Michigan can look forward to some nice weather! Hopefully, this means good times in the outdoors. For many though, those good times are limited to activities which do not involve standing on our feet. Although going for a walk may seem appealing, too many people are prevented from enjoying various activities due to foot and ankle pain.

Various conditions can cause pain anywhere in the foot and ankle, and can range from minor discomfort to debilitating pain. The good news is that many conditions can be prevented, or at least lessened, with proper “foot fitness.”

First, let’s go over some common conditions:

1. Plantar Fasciitis

This is one of the most common foot pain issues seen by podiatrists and physical therapists. Plantar Fasciitis (PF) commonly includes bone spurs in the bottom of the heel. Pain is generally present in the bottom of the heel and possibly in the arch of the foot. The worst times are with the initial step after a period of non-weight bearing – such as the first step out of bed in the morning. Often, the pain will decrease after you start walking and increases again after prolonged walking/standing. This cycle continues to repeat itself, causing misery for those with the condition.

2. Tendonitis

There are multiple tendons in the foot and ankle, and therefore, many places where tendonitis can occur. Two of the more common areas are in the Achilles tendon, which attaches from the calf muscle to the back of the heel, and the Posterior Tibialis tendon, which runs down the inside of the ankle behind the inside ankle bone and into the foot. Pain is present over the tendons with Achilles Tendonitis pain often on the back of the heel, and Posterior Tibialis Tendonitis pain often right behind the inside ankle bone and/or inside of the foot.

3. Metatarsalgia

Pain which occurs in the base of the toes under the “ball” of the foot is called metatarsalgia. It is commonly seen in people who participate in activities involving impact to the ball of the foot, i.e. running; but can afflict anyone.

4. Ankle sprains

Most commonly occurs when the foot is turned inwards, resulting in pain on the outside of the ankle along with bruising and swelling.

EXERCISE 1

Attach an elastic band to something secure in front of you, and the other end around the ball of your foot. Point your foot forward and pull back. Make sure there is enough band resistance to make it challenging. Do 3 sets of 12 repetitions.

EXERCISE 2

Attach an elastic band to something secure to the outside of your foot (if it is your left foot, the band should be tied to something to your left), and the other end around the ball of your foot. Turn your foot/ankle out, then, in. Make sure only your foot and ankle move. Do not rotate your entire leg. Do 3 sets of 12 repetitions.

EXERCISE 3

Attach an elastic band to something secure to the inside of your foot (if it is your left foot, the band should be tied to something to your right), and the other end around the ball of your foot. Turn your foot/ankle in, then, out. Make sure only your foot and ankle move. Do not rotate your entire leg. Do 3 sets of 12 repetitions.

EXERCISE 4

Stand on a step (a secure one) on the ball of your foot. Raise yourself up and down on your toes. Do 2 sets of 15-20 repetitions.

EXERCISE 5

Balance with your foot on a pillow. Try to keep the weight evenly distributed on your entire foot. Do not put the weight on your toes, heel, inside, or outside of foot. Balance for 1 minute, 2 times.

EXERCISE 6

Place a small towel on a hard, flat surface (tile, linoleum, etc). Start with your toes at one end of the towel. “Scrunch” your toes to pull the towel towards you. Keep going until you get to the end of the towel. As the towel gets bunched up under your foot, pull the excess back and keep going. Only use your toes. Do not pull with your foot or leg. Repeat for 3-5 minutes.

EXERCISE 7

Place your foot on a tennis ball, either while standing or sitting. Roll your foot on top of the ball to “massage” the bottom of your foot. It can also be performed with a cold can of soda instead of a tennis ball to help decrease swelling after being on your feet for a long time. Repeat for 5 minutes.

EXERCISE 8

Use your hand to pull the toes back. This can be done with your knee straight or bent. You should feel a stretch in the arch and/or calf muscles. Hold for 30-60 seconds, repeat 2-3 times.

EXERCISE 9

Calf stretch: Stand in a lunge position with the front leg bent and back leg straight (left picture). Keep toes facing forward and heels on the floor. Lunge forward, bringing your hips towards the wall until a stretch is felt in the back of the calf. Repeat the same procedure, but with the back leg slightly bent (right picture). Hold 30-60 seconds, repeat 2-3 times each.

Performing these exercises 1-3 times per week (or more in the case of the stretches) should help strengthen and stretch the foot and ankle, and help avoid some nasty pains. These are general ideas which should be combined with other preventative measures as stated earlier, as well as proper fitness for the rest of the body. By exercising the knees, hips, and low back; and maintaining proper weight control you can avoid excess stress on the feet. Try them so you can get out and enjoy yourself this summer!

Bob Budai is a board certified specialist in orthopedic physical therapy and a certified personal trainer. He can be reached for questions through email at: bob@functional-strength-training.com

The purpose of this article is not to diagnose, or treat current injuries/pain. If you suspect that you have any of these conditions, the first step should be to see a medical professional, generally a Podiatrist. There are many conditions of the foot and ankle which can appear as one thing, but actually be another. Further, some conditions can actually be a secondary problem which has arisen from something else.

The purpose of this article is to offer general information, as well as preventative exercises, to hopefully help avoid these conditions. The use of proper footwear, orthotics, and other preventative strategies cannot be overemphasized. But for our purposes, let’s look at some good exercises to address what is often the most abused and neglected part of our bodies – our feet.