Exercise Prescription for Healthy Living

I came across a great blog post from Bret Contreras, which gives reasons for exercising and gives you a blueprint for it!  This is a great guide for anybody who wants to start exercising or maintain their fitness levels.

  http://bretcontreras.com/2012/01/ten-minute-a-day-keeps-the-doctor-away-a-5-set-full-bodyprogram/

No excuses!  Just do it!

Health and happiness

Lift for Flexibility!

Staying healthy by lifting

As you probably have read some of my previous blogs and twitter posts extolling the virtues of resistance training, i.e., dumbbells, barbells, resistance bands, etc.. But one more advantage of a good resistance training program would be its ability to increase flexibility.  I have found this out personally throughout my years of weight training when I feel much more loose and flexible after a weightroom workout.  Various studies have shown this, especially in nonathletic, middle-aged individuals (Monteiro et al., 2008, Santos et al, 2010).

Keep in mind in order for this flexibility to be achieved, the resistance exercises should be performed in the full range of motion, and there should be a hindrance to the full range.  Both requirements should be able to be assessed by a good personal trainer/strength coach and sent to the appropriate health professional if full range of motion can not be achieved.

Full range of motion?

I have recently started to prescribe more robust exercise routines for my patient for a dual purpose of strengthening and gaining flexibility.  I still prescribe stretching protocols as I also do them personally, but I feel resistance training gives busy patients a bigger “bang for their buck”!

Please contact me if you have any questions!
Health and happiness!

Interview with Dr. Jeff McBride

Jeffrey M. McBride, Ph.D.

I have had the pleasure of listening to Dr. McBride lecture at Appalachian State University in Boone, North Carolina twice now and I have always come away more informed and enlightened enough to change my practicing and coaching ideas. His journal articles are always fascinating and defend/refute old ideas about how the body works.  So it was only natural that I did a blog interview with Dr. McBride.

Dr. Jeffrey McBride is a Professor in Biomechanics at Appalachian State University in the Department of Health, Leisure & Exercise Science, along with the Director of the Neuromuscular & Biomechanics Laboratory and Director of Graduate Studies in Exercise Science.  He has published 65 research studies in scientific journals and has 100 conference abstracts presentations.

(Q): What led you to become a scientist specializing in biomechanics?

(A): I have always participated in sports and exercise.  So my undergraduate major in exercise science was a perfect fit.  During my undergraduate degree, I started to become interested in resistance training research.  I was a competitive powerlifter for many years and started to focus on athletic performance, in particular the stretch-shortening cycle.  I met a scientist, Dr. Robert Newton, from Australia when I was at Penn State, completing my Masters Degree with Dr. William Kraemer.  Dr. Newton had similar interests in studying strength and power training.  I decided to go to Australia to complete my Ph.D. with him in the Biomechanics Laboratory at Southern Cross University.  There we were examining power output with different loads in the jump squat.  This involved biomechanical measurement techniques using a force plate, videography and EMG.

(Q): Your Neuromuscular & Biomechanics Laboratory always seem to turn out impressive work.  Tell us about your lab.

(A):  It has taken a long time and a lot of hard work to develop my laboratory.  Since we are always trying to do measurements and study topics in a new and unique way, we have pretty much had to make everything ourselves, from platforms to pulley systems, electrical systems, etc.. My father was a drag racer, so I was always working on engines and building various things by hand when I was younger.  I love to build new devices for making different kinds of measurements in the lab.  A very important component of my research is the assistance I receive from my graduate students.  They run the day-to-day operation of the lab and I could not perform my research without them.

(Q): You also do some track and field coaching.  Do you find your knowledge a hindrance (“paralysis by analysis”) or helpful when working with an athlete?

(A):  Because of my busy schedule with research, I really have very little time to work with specific athletes.  I recently, though, have had the opportunity to work with a very gifted weightlifter from Japan and also a great 800 meter runner here at ASU.  I find it interesting that a lot of practitioners actually have this problem (“paralysis by analysis”) and make training athletes much more complicated than necessary. My workouts are relatively simple, by some people’s standards, in that I simply use a couple of simple exercises like squats, power cleans and plyometric exercises like drop jumps.  Strength and conditioning is simply a supplement to an athlete’s overall training program.  Most of their training takes place on the field.  The most difficult part of training is regulating volume and intensity of training, not picking which exercises they will use.  When I do train an athlete, I have spreadsheets mapping out volume and intensity variation over time.  If you are not monitoring volume and intensity very closely, then you are missing the whole point of training.  I hate to say this, but training to improve athletic performance is not really rocket science.  When the athlete is tired, they rest, when they feel good, you train.

(Q): Do you believe that everyone should get stronger?  If so, what would be the best exercises to elicit overall strength gains?

(A):  The most important factor as a strength and conditioning coach is to make the athlete stronger, that’s why it’s called strength and conditioning.  Strength training takes place in the weight room and most conditioning actually takes place on the field.  The exercise that you use are mostly irrelevant.  The reason you use a squat to strength train the legs is that it is an easy exercise to use to get the needed loading to cause adaptation, meaning placing a lot of weight on your back. The concept of trying to mimic any on-field movement patterns in the weight room seems like an odd concept to me. From a biomechanical research standpoint, nothing you do in the weight room is anything like what an athlete does on the field.  Weight room training requires high levels of loading which causes adaptation of the neuromuscular system.  By that I mean muscles hypertrophy and the peripheral nervous system changes firing rates and neuromuscular junction capabilities.  Neither of these things are movement pattern specific.  If a muscle gets bigger or the peripheral nervous system activating this muscle can fire at a higher rate than the muscle can generate more force; it seems like some people are saying that these systems have a brain and know when they are performing a contracting during a golf swing versus a tennis serve versus the shot put, etc.

(Q): I have long held the belief that “core training” does little for the core musculature and it is refreshing to see that proven in scientific studies.  Does “core training”, i.e., stability ball, BOSU balls, have any place in a training program?

(A):  “Core training” is just a layman’s term. The term “core” is not used in the discipline of anatomy.  What I think they mean is “trunk” or “torso”.  The trunk is divided into the thorax, abdomen and pelvic region.  These muscles are a component of overall physical performance, but to indicate that they play some major role in athletic performance more than any other body part, I think seems a little odd.  The trunk has been a major area of focus in rehabilitation settings because of low back pain issues in patients, which is the number one reason for missed days at work in the country.  Most of the concepts in training the trunk have come from rehabilitation-related professions. I am not dismissing the very important aspect of trunk function.  Low pain back is a very difficult disability to deal with and can lead to a very low quality of life.  Unfortunately in rehabilitation, a lot of research has shown very few programs with long-term effectiveness for recovery from this debilitating condition.  Acute recovery has been achieved, but in the long-term, people with this condition continue to have lasting problems, even the rest of their life.  Permanent and continued focus on strengthening all parts of the body (legs, thorax, abdomen, pelvic region, etc.), I believe is the key to success.  The best way to do this is with structural exercises, not isolating one region or the other.  This is not my opinion, it is based on data.  A general exercise program (sit and stand [squats], push ups, medicine ball lifts, jogging on a bouncer, skipping rope) has been shown to be just as effective as motor control exercises (instruction and training by recruiting deep muscles of the spine and reduce activity of other muscles) and spinal manipulative therapy (joint mobilization or manipulation) in improving patient-specific functional scores and global perceived effect scores (typical measurements used in low back pain studies) after a 6 to 12 month time frame (Ferreira et al., 2007).

(Q): I recently heard you talk about FMS (Functional Movement Screening) and its usefulness in sports performance.  Tell us what studies have shown about this.

(A): There are many studies I could mention, but one in particular, showed no or actually an inverse relationship between FMS scores and athletic performance (Okada et al., 2011).  Our recent study just coming out in the Journal of Strength & Conditioning Research showed the same thing.  Absolutely no relationship between FMS score and jumping, running, etc.. I think the primary factor is that FMS does not have a measure of strength or power.

(Q): What exciting new projects are you are working on?

(A):  Our most recent studies have been focusing on mechanical efficiency in jumping and running.  This comes back to my interest in stretch-shortening cycle function.  This is of importance to especially repeated event athletes.  Like repeated jumping (basketball, volleyball, etc.) or long distance runners (1500m, 3000m,  marathon, etc.).  We have been attempting to use ultrasound to visualize muscle length changes and optic fibers to perform in vivo measurement of patellar tendon forces.  These are very difficult techniques and I have actually been working on them for the past 10 years trying to get them to work.  This information would show us how and why plyometric exercise improve performance by allowing athletes to maintain muscle length and maximize tendon length changes during jumping, thus improving jump height and mechanical efficiency during repeated jumping.  We have also had the opportunity to work with NASCAR pit crews in terms of testing them for strength and power capabilities for the development of training programs.  Next year we will be back to working on determining what loads maximize power output during human movements using loading and unloading.  The last topic is something I have been working on for quite some time.  This has implications for training loads for power training programs.  We also are working some more on examining instability training in the weight room and its effect on athletic performance.  I wanted to finish up by saying that I have “no dog in this race”.  I don’t want to sound indifferent but I actually care very little about what training programs practitioners use, it’s up to them.  My goal is simply to publish data concerning the findings of our studies on these topics. I would be happy to accept one form of training over any other.  It doesn’t matter to me what type of training works and what type of training doesn’t work. That’s not my job.  I just come up with scientific experiments to address hypotheses of interest of us.  But of course I always hope that the date eventually assists practitioners in making decisions about their training programs. Practitioners have the difficult job in trying to determine how they are actually going to train their athletes.  Thanks.

An incredible amount of information with implications for not only the athlete, but the active individual.  Please fee free to contact me if there is any questions.

Health and happiness!

Cute and Comfortable

Shoe party at Armstrong Podiatry & Sports Health, PLLC

I am proud to present our office’s first shoe party/information session. Aerosoles will be at the office on Friday November 11th from 6-8 pm to present their fall line of shoegear. You will only see shoes with some support and adequate for everyday usage (not the best, mind you!). Take this opportunity to buy some quality shoes with direction from a podiatrist! E-mail the office at ap4feet@gmail.com if you are interested.

Health and happiness!

Strong hips=Healthy life

Work those hip muscles!

I came across a cutting-edge, top-notch facility located in Calgary, Canada called the Running Injury Clinic (http://www.runninginjuryclinic.com/).   They have truly grasped the concept of the entire body contributing to health or injury of the individual.  They offer a lot of hip strengthening exercises, in which their studies reveals helps with knee pain. Furthermore, strong hip muscles direct the entire lower extremity and limit excessive motion which could cause injury, i.e., ankle or foot motion.  These types of exercises can be done by anyone, young and old, athletic or nonathletic. I am starting to incorporate these exercises as part of my protocol for anyone with stability issues or running-related overuse injuries.  Check them out at: http://www.runninginjuryclinic.com/Resources/hip-muscle-strengthening.html

Health and happiness!

NFL and Achilles tendon injuries

As an outsider looking in, I have noticed an inordinate number of Achilles tendon injuries at NFL camps (nine the last time I looked) this year.  As many try to explain them away as not related to the lockout, I would contend it is precisely due to the lockout that these injuries are occurring.

The Achilles tendon is the longest and thickest tendon in your body.  It is made up of two muscles, the gastrocnemius (which is more easily seen and referred to some as the “calf muscle” with its two heads) and the soleus muscle (which is deeper in the body and makes up most of the tendon).  They join together to form the Achilles tendon and occupies the bottom quarter of the leg. It inserts at the back of the heel bone (calcaneus).  This anatomy makes the tendon a powerful force during accelerations, sudden stops and sprinting activity.

Jumping to Achilles tendon readiness

Massaging the tendon after intense activity

 

 

Even though the Achilles tendon is not a muscle, studies have shown that it has contractile properties, so it should be treated as such.  Sensible, progressive training principles should be done to help strengthen the Achilles tendon and give it adequate viscoelasticity.  Typical training methods, such as resistance exercises, plyometric training and sprint training all provide strength to the tendon, and recovery activities, such as stretching and massage therapy, provide pliability to the tendon (so it will be useful for the next training session).  These methods such be put into place for months before full game day activity is attempted.

Struggling to get into game shape with limited training time is certainly a dilemma.  If someone asked me (and no one will!) how I would solve this, I would tell them to do less volume daily, but increase the restorative activities.  This will do two things, allow the athletes to do more intense work on a more regular basis, because they are recovered fully and also give the athletes a fitness base with the restorative activities such as circuit training or stationary biking.  Then, like any fitness program, slowly increase the volume of intense work as the weeks progress.  As a podiatrist, I would add two measures in regards to the Achilles tendon:  add in some eccentric heel drops, made famous by Alfredson;  and of course, to wear some shoes with no heel lift, i.e., Altra,  during the day (not during exercise) to provide increased Achilles tendon activity.

Always back to shoegear!

Hopefully all the players get into game shape and are able to play the beloved sport of football! Please contact me if you have any questions.

Health and happiness!

Ways to stay away from the doctor.

 

Here is a talk (audio only) I gave recently to a local company about prevention and wellness.  I believe it encapsulates the complete picture needed to achieve not only healthy feet, but a healthy lifestyle. 

https://cisco.webex.com/ciscosales/lsr.php?AT=pb&SP=MC&rID=52423137&rKey=1bf1bdb7ab6a6e74

(The link uses a program WebEx, which has to be installed on your computer to make it work.)

Of course, feel free to ask questions as I go through lots of topics.

Happiness and good health!

 

Running and Shoegear

 

http://www.scienceofrunning.com/2010/01/why-running-shoes-do-not-work-looking.html

This is the best article I have ever seen that explains the nature of running shoegear and its interaction with the human foot and the running motion. The author, Steve Magness, is now a coach for the Nike Oregon Project. 

Take note of the ability of the body to adapt to the environment.  If you give your body a chance, it can do wonderful or even superhuman things!

Health and happiness!

Interview with Dr. McClanahan

Ray McClanahan, D.P.M.

I had the great fortune and honor to do an interview with a fellow colleague of mine, Dr. Ray McClanahan.  Dr. McClanahan practices in Portland, Oregon at Northwest Foot & Ankle, and will nicely help summarize and bring my previous blog articles about shoegear to a conclusion.

(Q) Thanks for the interview.  Tell us why you chose the podiatrist profession?

(RM): I chose podiatry because I had a lot of foot problems while running track and field in college.  Shortly after college, I met a podiatrist at a road race, who became my friend and invited me to visit his practice to see what a podiatrist does to help people achieve healthy feet.  It felt like my calling.

(Q) Does your experience as a runner help or hinder your treatment plans with your patients?

(RM): I believe runners come to see me because they know that as a runner, I understand their need to run, and their love of our sport.  I have often had runners tell me that non-running medical professionals have told them to give up running, or find a different sport.  Many of those runners keep looking for a way to keep running, because running provides something for them personally that they do not receive from other types of exercise.  I believe that being a runner allows me to experience empathy for the suffering of my running patients.  I have felt what they are going through when they get injured.

And I feel their passion to continue to seek out ways of healing their bodies so that they can continue to receive all of the healthful benefits of running.

(Q) What is your definition of “healthy feet”?

(RM): Healthy feet are feet that can stand, walk and run without injury.  Healthy feet have toes that are spread wider than the ball of the foot.  This is natural foot anatomy that we are all born with, which begins to become deformed in early childhood due to the fact that most footwear for children are designed to mold the child’s foot to be shaped like a shoe, instead of allowing the toes to spread as nature intended. 

Healthy feet balance the task of bearing the body’s weight evenly, on the heel and all of the toes,  spread out and flat on the supporting surface.  This healthy position can rarely be achieved while wearing shoes.

Natural feet

(Q) I have been doing a blog series about shoegear and their unhealthy consequences.  What can be done to limit their destructive tendencies?

(RM): I believe footwear can be improved if the goal of the design is to maximize natural foot biomechanics.  Being barefoot is the model of natural biomechanics, and it is observed in the barefoot state, that the heel is level with all of the toes.  Most athletic footwear has the heel part of the shoe elevated above the front part (heel elevation).  The toebox of athletic shoes also artificially elevates the ends of the toes above the ball of the foot, which does not allow for natural foot biomechanics (toespring).  Athletic footwear does not allow the ends of the toes to be the widest part of the foot, but rather confines the toes to the conventional tapering shape, thus compromising balance and function (tapered toeboxes). 

An optimal shoe for running activities would allow the heel (calcaneus) to be level with the entire forefoot complex (metatarsalphalangeal joints and interphalangeal joints).  The toes would be allowed to spread wider than the ball of the foot, which is natural foot anatomy

Ideal shoe:  1. Flat    a) no heel elevation      b) no toespring

                            2. Wide at the ends of the toes

                            3. Flexible, so as to allow for strengthening of intrinsic arch flexor muscles needed for natural arch integrity

                            4. Lightweight

(Q) Tell me about your product, “Correct Toes”?  It sounds so simple, but so practice and fundamentally essential for shoe-wearing people.

(RM): “Correct Toes” is a conservative/natural product that encourages slowly and gradually changing the anatomy of your forefoot to resemble a more natural forefoot. More like what we are born with, before our feet get changed by shoes. This is accomplished by widening the space between the first and second toes and the 4th and 5th toes.  The goal is for the ends of your toes to be able to spread wider than the balls of your feet.  If this can be achieved, balance is enhanced and your brain can receive helpful proprioceptive information and respond more naturally.

 

 

Correct Toes-therapy for the feet

 

(Q) Do you have any specific shoes that you recommend to your patients?

(RM): We encourage our athletic patients to envision purchasing footwear that is as close to the position of their natural foot as possible.  We discourage them from identifying with brands or shoe sizes, but rather recommend that they look for footwear that is flat, wide at the ends of the toes and flexible.  When they find this type of shoe, we recommend they remove the sock liner and stand on it, to see if it allows their toes to spread wider than the ball of their feet.  Depending upon the patient’s foot:  Terra Plana, Crocs, Vibram  Five Fingers, ALTRA, Stem Footwear.

(Q) Your practice has a large focus on prevention.  Prevention seems to be a “buzzword” in healthcare today.  How do you think we can integrate prevention into the U.S Healthcare system?

(RM): I wish prevention was more of an action word, than a buzzword.  Unfortunately, it seems as if healthcare dollars are allocated for treatment and healthcare intervention, rather than for prevention and education.  I would like to see podiatry serve our patients on a model similar to the dental model, where Americans have their feet evaluated and preventive strategies are encouraged before problems occur.  Our patients would need to be willing to wear better footwear, like agreeing to flossing and brushing.  This can be a problem, in that fashion footwear is part of our conditioning.  I believe runners and people concerned for their health may be wise enough to choose healthful footwear.

The current model of podiatric healthcare delivery does not honor or reimburse podiatric physicians for educating patients or preventing disease.  Podiatric, and most other types of physicians, are reimbursed for treating illness, not preventing it.

I have personally dropped out of all insurance company plans to focus on wellness and prevention and many Americans are wise enough to seek education and prevention, even when it is not covered by their insurance plan.

Feel free to digest all the information in this blog interview and contact me if you have any questions.  Correct Toes will be available in my office for purchase also!

Happiness and good health!

The misshapen shoe

The typical last of a shoe

 

The past two installments of this blog series talked about some disruptive characteristics of shoegear on the feet, the heel lift and the toe spring.  This installment will focus on the curved last of shoegear.  The shape of the last of the shoe will have a profound effect upon the position of the joints of the feet, along with a change in the gait cycle.

The last of a shoe is the three-dimensional shape in which the shoe is based on.  The last differs in terms of heel height and the shape of the toebox.  The differences are related to the type of shoe, not really according to the shape of the human foot.  The human foot is naturally straight from the heel to toe with no curves (a great example of this would be a young child’s foot before walking).  Unfortunately, most (if not all) lasts have a curve to it, which causes a mismatch between the foot and the shoe with form-altering consequences. This mismatch usually places pressure on the digits and metatarsals, forcing them towards the center of the body; this is usually accompanied by a narrow toebox (common in most shoegear).  This combination can be considered a major force in the creation of bunion deformities on either side of the foot.

Natural foot

Not a natural foot

The curve of the last of a shoe can affect the position of the foot during walking and running.  When an individual walks without shoes, the initial foot contact with the ground is at the center of the heel.  Contrast that to when an individual walks with shoegear and the initial heel contact is on the outside heel of the shoe.  It is very common for individuals to notice a significant wear on the outside corner of the heel area over time.  The only logical explanation for such a phenomenon would be a change of the position of the feet, which could be due to the curved last of the shoe.

All too familiar for shoes

This concludes my blog series about shoegear and their unnatural characteristics in relation to the feet.  In my next blog post, I will try to be more constructive and explore how you can combat shoegear and make your feet and body healthier.

Happiness and good health!