Mindful Walking

Mindful Walking

Maybe you’ve heard of mindful meditation or mindful eating, but have you heard of mindful walking? When I say mindful walking, what I mean is the state of being present when you are walking. In other words, to focus on the activity you are doing while you are doing it. So instead of walking and thinking about everything else in the world, practice this exercise of walking and thinking about how you are walking.

 

Walking is a very repetitive movement that is performed everyday and can lead to overuse injuries if done incorrectly. It’s funny to think that walking can be done incorrectly when you’ve been doing it since you were 1 yr. old. But there are certain things you should think about and be mindful of if you have pain when you are walking or you want to prevent pain.

 

  1. ) Are you heel striking with every step? Or do you tend to shuffle around? One way to be aware of if you are heel striking is to listen. Do you hear a scuffle or just one solid tap with each step you take. You may think why is that important? If you fail to heel strike, meaning bringing your toes back with every step and letting your heel touch the ground first, you could literally trip over your toes. This could lead to a fall, especially in older adults. Some people are unable to pull their toes back due to weakness in their tibialis anterior. (See my post on strengthening your ankles especially the one where you pull your toes up)

IMG_1901

2.) Are you pushing off more with one foot than the other? Some people have a dominant side, but be aware that you are walking as evenly as possible in order to strengthen both sides equally.

 

3.) Are you leaning forward and looking down at the ground? Do your shoulders fall forward? Or are your shoulders back and head up? Your mom was right–mind your posture! When you are walking, too much leaning forward and you could develop a stooped over posture. Your psoas (hip flexors), pects., and cervical extensors will shorten. Your glutes might become inactive and that muscle imbalance can lead to all sorts of hip and knee injuries.

 

4.)  Are your feet rolling in when you walk? Check out the bottom of your shoes to see where the wear pattern is? Do you pronate? Most people tend to pronate or roll their foot in when they walk. Often people that have collapsed arches tend to pronate. If this is the case, you can try to strengthen your foot intrinsic muscles and potentially wear arch support in your shoes.

towelscrunch

5. ) Think about how you walk up/down stairs. When you go up, are you pushing through your heel? Is your foot halfway off the step? When you are coming down the stairs, are your toes leading or your heel?

 

When you are walking up the stairs, think about getting the whole foot on the step and pushing up through your heel so you are activating your large muscle groups including your glutes and hamstrings. Give your poor gastroc muscles a break and let the bigger muscle groups take over. When walking down the stairs think of leading with your toes like you are stepping into cold water and rolling through your foot.

 

6.) Did you have a recent injury and now you are limping around? Stop that limp! If you don’t, your body could memorize this new gait pattern, and that could lead to all sorts of secondary compensatory injuries. If you are still healing from an injury, you should still try and walk as normally as possible. If that means you need to use a brace, CAM boot, or cane to get around for a bit, then use it until your pain improves and you can walk more normally.

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What To Do If You Have Foot Pain?

Foot Pain Got You Down?

feetfeet2

feet 3

 

 

 

 

 

 

Living and working in NYC, many people come in with foot pain because NY is a walking city. People walk everyday to get to where they need to go, and there is nothing short of foot traffic on the streets. Couple that with subway stairs, snow/ice weather conditions, poorly paved streets, and poor shoe choices, injuries are bound to happen. And then what do you do when you can’t walk without pain?

pain image

So with most kind of repetitive injuries, when an area is weak, tight, and overused, it starts giving you pain. And with all the steps you take a day, is it any wonder you wake up with pain?

 

Here are a few things you can try if you are having foot pain.

 

  1. Look at the shoes you are wearing on a daily basis. Are they old, worn down? Do they have any support in them? Do they have a wedge or a heel attached to them? Do you wear flip flops or shoes without a back to them? These are all questions you should ask yourself when your feet begin to hurt.

feet 6   feet 5

Your shoes are supporting your full body weight every day, and they work hard on the pavement of the streets. If you are a runner, even a good pair of running shoes typically don’t last longer than 6 months. So make sure your shoes aren’t worn out. Not sure? Look at the soles of your shoes –how is the traction? Look at the insoles of your shoes? Are they torn and worn or still give some cushion. Also check to make sure they have some form of arch support. Totally flat shoes i.e. ballet flats don’t offer any support. Especially if you have pronated feet or high arches.

 

When wearing heels, every inch higher the heel is can increase the % of pressure placed on the ball of your foot, not to mention the % of pressure on your knees. I’ve seen articles that said a 3 inch heel can increase the pressure on the ball of your foot by 76%! Yikes! This can cause all types of foot pain. It also shortens your Achilles and could lead to tendinitis.

Do you wear shoes without a back to them? Even slippers in your home without a back aren’t the best idea. People tend to grip and curl their toes a little to keep their shoes on. In doing so, you are overworking the muscles on the bottom of your foot and over time this tightens the muscles. This can lead to foot pain and spasms.

feet 7

  1. Stretch out! This includes the muscles along the front and back of your lower leg as well as the bottom of your foot. If your arch is cramping or you get cramps along the back of your leg, make sure you are stretching your plantar fascia, gastroc, and soleus. (see below)

 

Plantar Fascia Stretch 

PFstretch   3x for 30 sec. hold

Use a towel to go up and over the toes as you pull the towel back towards you. Make sure your toes are extending back so you feel the stretch along the bottom of your foot.

Gastroc Stretch

GSS   3x for 30 sec. hold

Place the towel just around the ball of your foot as you pull the whole ankle/foot back towards you.

Soleus Stretch

soleuss  3x of 30 sec. hold

Similar to gastroc stretch but with knees bent. Lean forward from the hips and keep your heels on the ground. Slightly bend your knees so you release the gastroc and effectively stretch the muscle behind it –the soleus.

Tib. Ant. Stretch 

tibants  Pointing your foot and apply gentle overpressure

If you get shin splints, make sure you are stretching the front of your leg (tib. anterior)

You can also apply an ice massage to the front of your leg with an ice cube for 5-10 min.

Peroneal Stretch

peroneals Pull more with the inside hand so your foot tilts

Another area that tends to get tight are the peroneal muscles which can pull on a bone in your foot called the cuboid and actually spin that bone so it causes lateral foot pain. Sometimes that peroneal muscle will spasm –make sure to roll out that muscle if it feels tight or you have lateral foot/leg pain.

3.) Strengthen your foot and ankle –Do you have a history of ankle sprains? Can you spread your toes out? Can you wiggle your toes? All of them? Since we are a little kid, our feet are shoved into these leather mittens (i.e. shoes) and over time this limits the mobility in your feet and toes. It’s important to let your toes move and strengthen your foot intrinsic muscles. See below for some exercises to help strengthen your foot.

 

Toe Waves

toe wave 1  toe wave 2

3 sets of 10 – Let toes come up and push them down (note – don’t move the hand that is holding the t-band; let the toes do all the work).

Towel Scrunch

towelscrunch1  towelscrunch

2 sets of 10 reps – Think of trying to pick up the towel with your toes.

Ankle Pumps/ Ankle Alphabet

ankle pump 1  ankle pump 2

If you get pain upon your first couple of steps in the morning, try to ankle pump sitting at the side of the bed before getting up. This gets the blood pumping and loosens your ankle joints up. Do 2 sets of 10 reps.

Ankle alphabet is similar but this time try to write the alphabet with your toes.

Theraband Ankle 4-way

IMG_1901 IMG_1897 IMG_1896 IMG_1892

Good ankle strengthening exercise which is great if you have a history of unstable ankles or balance issues. Try 10x each direction first and progress to 20x in each direction.

 

Heel Raises

heel raises 3 sets of 10

Go up and down on your toes holding for about 2 sec. at a time. Make sure your heels come all the way down every time.

Single Leg Balance

balance pic  3 sets of 20 sec. hold

Try to balance on 1 foot without holding on if you can.

4.) Roll out your plantar fascia. The thick fascia on the bottom of your foot covers 5 layers of muscle! Your feet have to support your body weight all day–that’s a lot of pressure. Therefore, you need to roll out those poor muscles and fascia. For 3-5 min. per foot. Don’t forget your gastroc. You can help get trigger points out as well by using a golf ball or tennis ball. If you are in a lot of pain, try freezing a water bottle and rolling the bottom of your foot out with that instead.

footroll

5.) If you’ve been having foot pain for 6 weeks or longer, time to see your doctor or podiatrist. Especially if the pain gets worse the more you walk. They will need to take X-rays to rule out stress fractures or bone spurs that may be contributing to your foot pain.

DISCLAIMER – Although I am a physical therapist, I am not your physical therapist. Always consult with your PT or health care provider for specifics about exercises and modalities that may be best suited for you.

11 Common Exercise Mistakes (that drive me crazy)

11 Common Exercise Mistakes (that drive me crazy)

1.) When stretching, make sure you are warm first. Don’t come into the gym when you are cold, and go straight into a static stretch. Your muscles aren’t warmed up yet and you could pull something. Work up a light sweat first, either by doing some light cardio or just trying to ‘lubricate’ your joints up with arm swings or hip swings. You can do your nice long stretches that you are holding at the end of your work-out.

cardio pic r

 

2.) Hamstring stretch – Don’t stretch with a stretchy strap! Stretchy straps such as thera-bands and other elastic bands are used to provide resistance in order to strengthen your muscles, not stretch. If you are stretching with the help of a strap, that is fine, but make sure it’s not working against you. It should be a material that doesn’t stretch too easily like a towel, belt, or dog leash. That way when you pull on it, it doesn’t serve as a counter force, but rather an extension of your hand.

stretch pic 1 revised  WRONG- Don’t use stretchy strap to stretch

hss 2 r CORRECT – Use a towel or strap for stretching

 

3.) Upper trap stretch – When stretching your neck, side-bend away from the side of the neck you want to stretch– just make sure you keep that shoulder down. Otherwise, you are not effectively stretching your neck muscles. It may help to use a strap or towel to keep your shoulder down if you are having difficulty with this, or use a mirror for visual feedback.

UT stretch 2 revised WRONG -Opposing shoulder is elevated

UT stretch 1 revised CORRECT -Keep the shoulder down

 

4.) Gastroc stretching on a stretch board – I always notice people leaning forward from their hips. You will get a better stretch if you keep your body in a straight line, so you are just hinging from your ankles, not your hips. Think of your belt buckle coming forward as you stretch.

gastroc stretch 1 R WRONG – Don’t lean forward from the hips

gastroc stretch 2 R CORRECT – Hips stay in a straight line

 

5.) Squat -When performing a squat, there are several things to remember. 1.) I hate seeing someone squat with their knees coming past their toes –bad!! Make sure your knees stay over your foot/ankle when you squat down. 2.) Also make sure your knee is tracking over your feet. Don’t let your knees roll-in. When I see this, I know there is some hip/glut weakness going on. 3.) Make sure you are sticking your butt out when you squat down. I know if feels funny, but doing a squat correctly isn’t about feeling proper here, it’s about protecting your back. You should have a small arch in your low back. Stick your butt out like you are going to sit in a chair.

squat pic 1 revised     WRONG – Knees are tracking too far over toes

squat 2 w2  WRONG – Don’t let your knees fall in

squat 3 rCORRECT – Keep knees over toes/ Stick your butt out

 

6.) Ankle thera-band exercise – When performing a thera-band exercise for your ankle, especially when you are moving in ankle inversion/everison (toes in and toes out), make sure just your knee isn’t moving. I often see people moving their knee and rotating their whole lower leg in and out, but it’s important to isolate the ankle movement.

ankle pic 1 revised   WRONG – The knee is rolling in

ankle pic 2 revised  CORRECT – Keep your knee straight

 

7.) Pelvic tilts – Often a difficult exercise to understand if you are not used to engaging your deep abdominal muscles. I instruct people to think of pulling their belly button in and pressing their low back into the floor. Remember to breathe! I always teach this by telling patients to exhale as you go into your pelvic tilt. You are less likely to hold your breath this way. Also, make sure your ribcage is dropped down, sometimes people like to splay their ribcage out.

Same thing applies when doing a plank–which you should be performing your pelvic tilt in. I thought it would be easier to see this with a plank than simply a pelvic tilt.

plank 2 r WRONG -Hips up in the air

plank 1 r CORRECT -Pelvic tilt engaged

 

8.) Tabletop Abdominal Exercise – Any time you are performing an exercise on your back with your legs at 90/90 or tabletop position, in order to effectively work your deep abdominals, make sure your knees aren’t pulled too closely into your chest. When your knees are too far into your chest, your abdominals are not engaged.

tabletop position 2 revised WRONG -Knees are drawn too far in toward chest

tabletop position 1 revised CORRECT – Hips are at a 90* angle; abdominals on!

 

9.) Heel raises – Make sure your weight is between your big toe and the second toe and your ankles are straight. I often see people shifting their weight to the little toes and this makes the outside of  your ankles stressed.

heel rise 2 r WRONG -Ankles rolled outwards

heel raise 1R CORRECT – Ankles stay in a straight line

 

10.) Lat Pull Down or any shoulder exercise – The first step should be to make sure you shoulders are down and scapulas engaged. If not, you are not effectively working your shoulder stabilizers. When working on good posture or any shoulder pain or injury, this step is really important. Make sure your shoulder blades are set in place first –you will feel this in your upper back!

lat pull down 2 WRONG – shoulder are up, back is not engaged

lat pull down 1 revised CORRECT -scapulas are set and shoulders are down

 

11.) Straight leg raise – As the name indicates, keep the working knee straight. This is true whether you are performing this exercise to the front, side, or back.

A common mistake I always notice when doing your straight leg raises to the side, (or as I call them, my Jane Fonda exercise) make sure you are not flexing in the hip. Your leg will be further behind you then you think. It should form a straight line all the way down your leg. Otherwise you are overworking your psoas (hip flexor) and tensor fasciae latae (the muscle part of your IT-band). Instead, you should be targeting your gluteus maximus, medius, and minimus.

slr 2 r WRONG – Hip is flexed

SLR 1 r CORRECT – Hip is in neutral

 

How to Help Your Neck Pain

Are you a slave to your i-device?

neck pain

http://cbsminnesota.files.wordpress.com/2014/11/spine-study.pdf

Are you constantly looking down at your smart phone, tablet, laptop during the day? Do you have neck pain? Ever get headaches? Any numbness/tingling down your arms? If so, these tips could help you.

Nowadays, we are constantly plugged in and looking at electronic devices during the day –one of the consequences of this could be a tight painful neck. If ignored, it could lead to nerve impingement, herniated discs, and migraines. So what to do? I’ve listed out a couple of tips that could help alleviate some of the problem and also described some activity modification that will be necessary if you want to prevent the pain from coming back!

1.)    Lifestyle modifications –I’ve listed this as number 1.) for a reason. It’s because if you make no modifications to overuse activities that bring on this pain, you can stretch til you’re blue in the face, but don’t expect lasting results. If your job includes long hours in front of your computer make sure you bring your screen up! Whether it be a smart-phone, tablet, or looking down at your computer screen, all these activities encourage you to look down. Instead of looking down constantly, try to bring the device up to eye level so your neck isn’t in a hyper-flexed position for a prolonged period of time. This tip is important in order to prevent the reoccurrence of neck pain. Look at your own activities and try to identify what movement patterns are causing this pain. This is where physical therapy can really help. They can help you modify and work on muscle/movement imbalances that may relate specifically to you. (see below for a few general exercises)

 

2.)    Mind the position of your neck when you sleep. Do you use multiple pillows at night under your neck? You could be perpetuating this forward head posture, pushing your head up while you sleep. Use just 1 medium-sized pillow to cradle the back of your neck, or a small towel roll under the crook of your neck to support it. Personally, I’m not a big fan of contoured pillows because if you don’t fall asleep in the same position every night, or you move around a lot while you sleep those pillows don’t move with you. Your neck could end up in a worse position before morning, and then you wake up with a terribly stiff neck! Therefore, don’t waste your money. The best positions to sleep in for your neck is either on your back or side with pillows for support. Sorry stomach sleepers, this is the worst position for your neck because you are forcing your neck to be rotated to one side the entire night. Ideally, you want your neck in a neutral position. See example below.

sleep position 2

 

3.)    Postural exercises! Yay! Over time, if you keep your head in a forward head posture you could actually change the length of your neck muscles. Usually with forward head posture comes rounded shoulders as well. This is perpetuated by tight pect. muscles. The muscles along the suboccipitals (back of the neck, where your skull meets your cervical spine) become stretched out and lengthen so it’s hard for you to contract them and therefore bring your neck back. Therefore, we need to strengthen them –here comes the chin tucks! See some postural strengthening exercises below.

Rows – with theraband, strengthen in between your shoulder blades to help you keep your shoulders back.  3 sets of 10 with squeezing shoulder blades together.

exercise rows pic

Chin tuck – 10x with 10 sec. hold (or work your way up to holding for 10 sec.)

chintuck 1   Step 1.) normal head posture -note forward head

chin tuck 2  Step 2.) think of making a double chin (glamorous I know 😉

4.) Neck Stretches – Your strengthening exercises mean nothing if tight muscles keep pulling your neck back to the position it was in. Below are 3 stretches that will help.

Upper trap stretch  – 3x for 30 sec. hold (each side) -Ear to shoulder on each side, with slight over-pressure with your hand. Make sure you are keeping the opposite shoulder down.

UT stretch

Levator scap. stretch, – 3x for 30 sec. hold (each side) – Nose to armpit with slight over-pressure with your hand on the top of your head.

LS stretch

Pect. stretch  -3x for 30 sec. hold – the one shown below is on a foam roller in what I call a ‘touch-down’ position. This is just one way to do a pect. stretch. You can also perform a stretch in a door-way. See below.

foam roller stretch

 

5.)    Modalities to help with pain/stiffness

  • Moist heat as mentioned in an earlier post, helps relax muscles and promotes blood flow to the area. Apply to neck and upper back for 15 -20 min.

hot pack

  • Biofreeze (Biofreeze) – pretty good topical analgesic used to help you with pain in your muscles. You’ll only need a dime sized amount and rub in until it’s absorbed. A little goes a long way. Also, be sure to wash your hands after use!

biofreeze

  •  Kinesiology Tape (Rocktape Kinesiology Tape) – everyone has their own opinion on this kind of tape, but in my experience it helps patients feel better. The thought is that is helps the fascia crinkle and move blood blow to the area. Kinesiology tape is taping for movement, NOT to stabilize or prevent you from moving. It’s supposed to help you move easier. It pretty much feels like a hand is on the back of your neck. See picture below for one type of taping technique for posterior neck pain. Keep tape on for 2-3 days, but not much longer because it can eventually irritate your skin. Make sure skin is clean when you put it on. Careful when taking it off, ideally after you shower, or with the use of baby oil to protect your skin.

neck tape

Rocktape Kinesiology Tape (click to purchase)

– Thera Cane Massager – Self torture device. A way for you to work out some of the adhesions/knots in your upper shoulder and back. You can use this for many areas of your body to work out the ‘kinks.’

theracane pic
t-cane exercise

Thera Cane Massager (click to purchase)

  • Manual therapy – whether that be a massage or if you are going to a physical therapist this can definitely aid in decreasing your pain and improving your ROM in the neck and shoulders. Research is varied on various manual techniques, but from personal experience I can tell you it helps.

massage pic

Word of note: none of these listed above modalities will do a lick of good if you aren’t making activity/lifestyle modifications because the tightness and pain will just come back!

DISCLAIMER – Although I am a physical therapist I am not your physical therapist. Always consult with your PT or health care provider for specifics about exercises and modalities that may be best suited for you. Also, if you have neck pain with any kind of numbness/tingling down your arms, I would suggest a visit to your doctor to rule out nerve related pathology.