Part II: Hips Don't Lie

Last week I shared with you this piece highlighting the benefits of standing with your feet pointed straight ahead. This week we bring movement into the equation and discuss the merits of moving with those feet pointed straight ahead.

IMAGE COURTESY OF RUNNERSWORLD.COM

Let’s start at the ground and work our way up. When we walk, the foot has a characteristic pattern in which it’s supposed to contact the ground. If you look at the bottom of someone’s shoe who has an ‘ideal’ stride, you’ll notice a wear pattern that goes from the outside (lateral) portion of the heel area, travels forward, then appears under the 1st and 2nd toe. This wear pattern indicates an “ideal’ interaction of the foot with the ground, which allows the foot to perform its duties of shock absorption and propulsion. When this foot positioning gets altered by turning the foot out, the muscles, bones, and ligaments of the foot are put into positions that decrease the functionality of the foot.

The foot is one of my favorite body parts because of its incredible architecture that allows for both stability and shock absorption. Without getting too technical, the foot has an intricate arch system that is supported not only by muscles and ligaments, but also by the alignment of the bones of the foot. Turning the foot outward causes this alignment to change, decreasing the boney support and thereby placing excessive stress on the ligaments and muscles that act as slings to support the arch of the foot. When we walk with our feet pointed outwards, we take a structure that is supposed to be rigidly supported by the strength of our foot bones and turn it into something that would make the Viagra reps drool. The layman calls this being flat-footed, the runner knows this as over-pronation, and the podiatrist associates this with the sweet sound of a credit card being swiped to pay for yet another pair of custom orthotics.

Walking with our feet turned out forces our bodies to compensate to get the job of forward movement done. We begin pushing off through the side of our big toe, instead of the bottom, creating a bunion. We attempt to use only our tendons to support our arch and develop posterior tibialis tendonitis and shin splints. The collapsed arch places an uneven load at the achilles and we see achilles tendonitis. Running and jumping serves to expedite the appearance of these injuries as more force is transmitted through these structures and our bodies are required to figure out a way deal with it.

PROPER HIP-KNEE-FOOT ALIGNMENT ON THE LEFT VS IMPROPER ALIGNMENT WITH THE FOOT TURNED OUT AND SUBSEQUENT COLLAPSE OF THE ARCH AND KNEE ON THE RIGHT

If one was to attempt more functional activities such as going up and down the stairs or squatting with the feet in this outwardly rotated position, the result would be a collapse of that arch, followed by a buckling inward of the knees, with excessive stress being placed at the inside (medial) aspect of the knee. Cue MCL sprains, meniscus tears, and runner’s knee”, aka patellofemoral syndrome or chondromalacia patella (big words that basically mean your knee hurts). One notable exception to the rule is that squatting with the feet slightly turned out is permissible at times, depending on the experience of the lifter and the anatomical variations present at the hip and lower extremity; but that’s a topic for another time.

At this point you may be thinking, ‘where do Shakira and her ‘hips don’t lie’ mantra play into all of this?’ Well, in reality perhaps I should have referenced Beyoncé and those glutes, but that “hips” song is just so darn catchy. As I discussed in part one of this article, the glutes stabilize the pelvis and femur (thigh bone) and promote proper alignment at the knee, lower leg, and foot. When we point our feet straight ahead, we are able to generate more tension through the glutes, and subsequently greater stability and power at legs and pelvis. This allows for improved performance in all functional activities, from walking to power lifting, and decreased rates of injury.

Check yo’self: For the next week I challenge you to walk, go up and down the stairs, and stand up from/sit down in your chair with your feet pointed straight ahead. Bonus points if you’re able to incorporate this challenge into your exercise routine and higher-level activities during the week. Be sure to keep your knees tracking in line with your feet, preferably in-line with your 2nd and 3rd toe. By pointing your feet straight ahead and gently contracting your glutes you should notice your arches slightly elevating, while your toes and heels remain in contact with the ground. Be sure to avoid over-squeezing your glutes and walking around looking like you’ve got a stick up your derrière. Just like standing with your feet pointed straight ahead, this is going to feel strange, and new, and weird. Suck it up. Your body will thank you.

C. Shante Cofield, PT, DPT, OCS, CSCS

Shante@duffyandbracken.com

Part I: Putting Your Best Foot Foward

One of the easiest postural corrections I think we as humans can make is standing with our feet pointed straight ahead. Living in NYC I am privy to seemingly an endless number of opportunities to watch people walk and stand. Let me tell you folks, we have an epidemic on our hands. The dreaded turned-out foot has become adopted by so many people it's no wonder Dr. Scholl's and Icy Hot patches have their own sections in the drug store. 

                               MUSCLES OF THE HIP

When we stand with our feet turned out, the hips follow, in a movement known as external rotation. In this position, the hip muscles are shortened and become tight, which leads to decreased hip strength and range of motion.

A muscle can only contract optimally if it can fully relax. Tight muscles are weak muscles, in that they are unable to fully lengthen and shorten as is required for generating maximum tension and strength. The role of the hip muscles, in addition to moving and stabilizing the femur (leg), is to stabilize the pelvis. As demonstrated in the picture below, the pelvis acts as a base on which the spine rests. When the glutes are tight and weak, they can no longer do their job of stabilizing the pelvis. If you've ever played Jenga, you understand the importance of having a sturdy base. When the glutes don’t stabilize the pelvis, it’s like playing Jenga in an earthquake. The pelvic instability caused by hip weakness creates excessive motion at the low back, which leads to, you guessed it, back pain.

From a movement perspective, the low back and hip are best friends with complementary roles. The hips, with their ball-and-socket design, allow for multidirectional movement (just ask Shakira), while the facet joints of the lumbar spine are designed for flexion and extension (forward and backward bending).

   THE BALL-AND-SOCKET CONFIGURATION OF THE HIP JOINT

           THE LUMBAR SPINE AS VIEWED FROM THE RIGHT

When those hips get tight and lose motion, they also lose their function, and suddenly the low back is left to pick up the slack. The low back, structurally suited for flexion-extension movement now has a job for which it is neither designed nor prepared. Enter again: low back pain! 

Check yo'self: Let your hips and back do what they were designed to do. Stand with your toes pointed forward, weight distributed equally between both feet, not leaning too far forward or backward. For those of you with a tendency to turn your feet outwards, standing with your feet pointing straight ahead will feel strange, and you may even feel like you’re pigeon-toed (toes pointed in). Suck it up. Look down and make sure that your knees are in line with your toes, and both are pointing straight ahead. If your knees are pointing inwards, gently contract your glutes (squeeze your butt) and notice how this causes your knees to rotate slightly outward and into a neutral position. This is proper standing position (from the hips down, anyway), and this is what I want you to focus on for the next week. Whenever you find yourself standing and waiting for the train or in line at Duane Reade waiting to buy your third pack of Icy Hot patches, make sure those feet are pointed straight ahead. Your body will thank you. 

 Tune in next week for Part II: Hips Don't Lie

C. Shante Cofield, PT, DPT, OCS, CSCS

shante@duffyandbracken.com

Physical Fitness For Your Business

Exercises, stretches and shoe selection tips to keep you and your business going strong.

I treat hundreds of businesswomen every year at our physical therapy clinic in downtown Manhattan. Regardless of industry, age, or fitness level, the questions I get tend to be very similar. If you’ve ever wondered “how can I fit a few exercises into my crazy day?” or “how do I pick great shoes that won’t hurt my feet?” – here are some answers just for you.

BUSY BEE EXERCISES

What are exercises I can do at my desk, on my commute or just to jumpstart to my day? I work over 60 hours a week, have kids at home and a household to manage: there just isn’t enough time!

Start from the moment you get out of bed. In one smooth motion, sweep your arms overhead, lift up to your toes, and take a deep breath in. Voila! You’ve just stretched your nerves, muscles and chest wall, elongated your spine, and invigorated your day. Brushing your teeth or taking a shower are both opportunities to squeeze your glutes or fit in a few squats. We already multitask in every other part of life, so feel free to get creative with your morning exercise routine!

But let’s fast-forward a few hours, when you’re stuck at your desk. Simply getting up every 20 minutes and moving for several minutes is enough to improve your health by increasing your glucose metabolism and circulation. I have patients who set phone alarms to remind them to regularly take a break from staring at their computer screens like zombies. Here’s just a few easy ways to do exercises using your office space and furniture:

Strengthening

1. Tricep dips – get the toned arms most women lust after by doing dips on your desk or on a low filing cabinet. Start with just 10 and try to get in 3 sets a day.

2. Walking lunges – if your office space permits, do a few lunges back and forth: they are a triple whammy of balance, core stability and leg strengthening. Add 5 or 8 pound dumbbells for more of a challenge.

3. Seated ab workout – while sitting at your desk, tighten your abs. Don’t forget to breathe! Hold it for 30 seconds, then rest and repeat. If you twist and hold onto your armrest while doing this, you’ll access your obliques. Option to lift your legs while holding onto the edges of chair – lift for 5 seconds, lower for 10-20 seconds.

4. Kegels – our clinic treats both orthopedic and pelvic floor conditions, and I can’t stress enough how important kegels are to do on a regular basis. Strengthening the pelvic floor prevents incontinence in old age. Just use your next boring meeting or long commute to sneak in a secret workout! Do several sets of 15 repetitions throughout the day, holding for 5-10 seconds each time.

Stretching

1. Wall angels – the perfect way to open up the rounded shoulders and forward head posture that plague every computer user. Remember to keep your spine touching the wall.

2. Forward bends – do them in sitting or standing, reaching forward towards your ankles to stretch out the spine and surrounding muscles. Reach towards one ankle and then the other to stretch out both sides.

3. Calf stretches – our footwear does us no favors, so kick off those heels when you can and stretch out the soles of your feet (plantar fascia) and your calves.

4. Wing pinching – stress and computers make our shoulders creep up towards our ears. Squeezing your shoulder blades by together and down activates those rhomboids and middle/lower traps to help relieve some of that tension.

5. Hip stretch – make your hips and rear happy by crossing one ankle over the other knee, sitting up straight, and then gently leaning forward. Keep the back straight as you begin to feel a stretch in the glutes and hip. You can press down on the knee to deepen the stretch.

PAIN IN THE NECK

My neck aches from looking at my phone, iPad or computer for too long. How do I position myself so this doesn’t happen?

Awareness of your posture is more than half the battle. Most of us sit stooped forward with our necks craned out and down as we look at our devices. Imagine a string on the top of your head that pulls you up, bringing your head to float squarely above your shoulders. Don’t let that string go slack as you start tapping out your next text message, just look down with your eyes or bring your phone up to eye level.

Many of us use our bodies to accommodate to our workspace instead of the other way around. If your computer is off to your left and you spend every day half-turned to the screen, is it any wonder why your back and neck ache on that side? Getting a thorough ergonomic assessment of your workspace by a physical therapist is a simple way to resolve many of those workplace aches.

HUNGRY FOR HEALTH

There’s so much advice out there about what to eat – what are some good foods I should stick to so I can avoid ‘grazing’ or eating on the go?

I spent years of my career working with professional athletes who needed to keep their bodies and minds in top shape for game day. Life in NYC, between the subway stairs, the crowded streets, and the stress of work, also demands a constantly high level of performance from our bodies and our brains. Foods that give your brain the glucose it needs to function will keep you from feeling fatigued and will make you more productive. Most of my clients just mix up a bag to snack on guilt-free throughout the workday. Some brain-food favorites include: walnuts, almonds, grapes, flax seeds, sunflower seeds, sesame seeds, dates, dried cranberries and dark chocolate chips. I also recommend investing in a water bottle that suits your personality and making it a point to drink at least two full bottles every day. Most of us are chronically dehydrated, and though coffee and soft drinks might quench our thirst, they don’t give our cells what they need to function properly. Headaches, fatigue, confusion, dry mouth and dark colored urine can all be signs of dehydration.

THESE SHOES WERE MADE FOR WALKIN’

I love my shoes, but I hate my feet: they hurt so much! How do I change that?

Feet anchor your body to the ground; think of them as your roots. Over time, anything that bothers your feet will have repercussions higher up – in the past decade, I’ve treated many patients with knee, hip, and back problems that stemmed simply from their footwear. It’s only when fashion meets function that you and your body will stay safe. Our feet are unique to the experiences we’ve put them through, and a one-size-fits-all approach to shoes is just asking for trouble. These are some quick tips for buying fashionable shoes:

1. Know your shoe size and width. If you haven’t had it checked in a while, remember that those numbers can change over time! Weight gain, pregnancy, even sports can and will change the structure and size of your foot. Next time you’re at the shoe store, ask the salesperson to properly size your foot.

2. Find out your foot type and mobility. Is your foot rigid? Do you have collapsed arches? Do you claw your toes? Are your ankles wobbly? If you’re in doubt, see a foot specialist to learn more about your foot type.

3. Earn those high heels. Stilettos and narrow wedges might be eye-catching, but they’re also very tough on the tendons and ligaments that surround your ankle, and can result in chronically shortened calf muscles. The stronger your core muscles and your Achilles tendon, the higher of a heel you’ll be able to wear safely. But if they aren’t strong, expect calluses, corns and bunions to follow.

4. If you’re choosing a “do-it-all” shoe – one that you can wear for your commute and during your work day – pick one that has heel support, a spring in the toe box, and a cushion or soft sole to absorb stress.

With improved posture, exercise, increased energy, and shoes that will keep you moving, there’s no excuse not to end summer with a spring in your step. Look out for my talk at WomanCon2014 for a total head-to-toe makeover – physical therapy style!

Renuka Pinto, MPT, PGDR, CSCS, CES

Pick The Right Stroller Without Obsessing!

For a new mom picking the right stroller can be overwhelming not to mention expensive. The sales pitch will have you deliberating between strollers of all shapes and sizes.

How do you choose between all the bells and whistles from smart phone to latte holders and various pockets that organize all your needs?

And of course, the price will leave you wondering if you have just been bamboozled. In the process of wanting the very best for our new bundles of joy, our real needs go out the window right along with our money. We forget that the practical aspects of our lifestyles and city living in particular, goes far beyond the new must have stroller or dream accessories.

To help you navigate through the wonderful world of strollers, here are 5 important things to remember when picking the right stroller.

 

1. Usage: are you going to use the stroller on public transportation (subway or bus). If so, can you carry the stroller and baby up a flight of subway or bus stairs? Case in point: as much as we would love them to say small, babies get heavier over time and are unable to negotiate stairs until 18 months old.
2. Ease of folding: can the stroller fold easily with baby in one hand. Remember as women we carry not just the stroller and baby but our pocketbook and/or diaper bag as well. 
3. Height: if you and your partner have more than 6 inches in height difference does the stroller have adjustable handles.
4. Footprint: how much space does a folded stroller occupy in closed quarters?
5.  Maneuverability: can the stroller lock, unlock and make tight turns? Can wheels transition from pavement to grass?

When it comes to picking the right stroller use your heart as well as your head, you can always personalize your stroller to meet your unique style after making the smart functional choice! Need help picking the right products for you? Schedule an appointment for my P3 Method Pregnancy Program and we can do some custom shopping together.

Renuka Pinto, MPT, PGDR, CSCS, CES
Physical Therapist & P3 Pregnancy Program Creator
Duffy & Bracken Physical Therapy

Movement Fundamentals

As a physical therapy aide I have witnessed many amazing recoveries and learned more exercises than ever imagined. Manual therapy is only half the battle toward eliminating weaknesses and rebuilding strength. Individualized exercise programs allow patients to be involved in their recovery, by not only re-gaining their range of motion but also their confidence. Patients discover their limits through exercise; and with assurance begin to push those limits. They also learn the importance of self-motivation, which can make for a gradual, yet positive recovery. It is especially important to your overall recovery that your individualized exercise program is followed because it helps your therapist to see your progress. This plays a role in whether your program is modified or kept the same.

For me, these exercise programs have served as a platform for learning. There is no one exercise that serves one purpose; they can be used for the affected area directly and indirectly. I can have two charts in my hand with the same exercises but chances are they will be for two different body parts. My job doesn’t just involve watching, it also includes engaging, correcting, explaining and reassuring the patient that it will be beneficial to their recovery.

Since being at Duffy & Bracken I have been given the opportunity to extend my dance knowledge. During my studies as a dance major I learned invaluable techniques for maintaining my flexibility and strength. No, I can’t twist into a pretzel or lift my leg all the way to my face, but who wants that anyway! The lessons I learned have helped me maintain a healthy balance of strength and flexibility. Here are a few dance techniques that I have been able to incorporate into some of our patients exercise plan.

These are considered basic foundations of movement, yet it can be difficult for some to execute.

X-Roll: Begin lying down on a flat and firm surface in an X shape. KEY 1: Everything is relaxed! Next, allow the right (or left) fingertips to lead the arm across the front of the body diagonally up to the left side, allowing the back to spiral. KEY 2: Nothing else except the arm and back should be moving at this point! Continuing this path, you engage the abdominal muscles, which will assist you in rolling over onto your stomach. KEY 3: Your legs are just coming along for the ride, leave them be! THINK: I’m Melting! You want your body to “melt” into the floor as you roll all the way onto your stomach, circling the opposite arm above the head so that you may create another X shape. To go back, refer to KEY 1, except you are leading with right (or left) toes! This time everything above the legs follows behind. 

Body Half: Again begin in a relaxed X shape. In this position we want to initiate movement from the head, elbow and knee of the same side. Head and elbow moves down as the knee moves up, creating a side bend. KEY 1: The opposite side is completely relaxed! To return to the X shape we simply initiate with the fingers, top of the head and toes to stretch back out. Simple enough right? Now give it a try on the other side!

Exercises from Bartenieff Fundamentals an extension of Laban Movement Analysis

Head Tail: Begin in a seated position on the floor with the legs outstretched in front of you. Legs and arms are relaxed, but the back is straight. Initiating from the top of the head, allow the head to drop to the side (Think: ear to shoulder). KEY 1: Do not control the head drop! Allow the full weight of the head to bring the torso along for the ride. Before hitting the mat, quickly catch yourself with your hands and push back up, creating a rebound. Now repeat on the left.  The goal of this exercise is to increase spinal mobility as well as learning to weight shift. By relaxing the head and spine you allow for more range of motion to be met while doing this exercise. 

These movements are as effortless as rolling out of bed (literally), but with limitations it can be taxing on the body. It is for that reason we stress the importance of exercise during AND after recovery. Listen to your body! An exercise program loses its effectiveness if you fly through it. Understand and continue to internalize the “kinks” that you may notice. If you are still in PT let your therapist know and together changes can be made. If you’re a past patient call us to schedule a Functional Movement Screen (FMS) so we can prescribe an exercise plan for you to keep you active and pain free.  

Brittany Wilson
Duffy & Bracken PT Aide

Pregnancy Aches & Pains

Every pregnant woman dreads being a victim to pain! You can't pop any medications and if you really need some relief you can ONLY take Tylenol.

Why do we have to experience pain & discomfort during such a wonderful experience? 

So let's understand pain and pregnancy. During pregnancy our bodies change shape, that's because of a hormone called Relaxin that allows our joints and muscles to loosen up to accommodate the weight gain. Our breasts become larger, waists widen and hips become round. This increase in SIZE makes our muscles work harder.

In a nutshell, the pain and discomfort we feel just points to the structures and areas of our body that are being overloaded! Rather than getting alarmed or accepting pain, speak out and seek help. Your best bet is a physical therapist that can help you to alleviate pain through joint techniques and teach you stability exercises so your weak areas become strong.

At Duffy & Bracken we see at least six pregnant women per week with pain....with successful outcomes. We explain why that particular area hurts and then offer solutions to avoid undue stress.

Stay tuned for later blogs were I will cover how pregnancy affects individual areas like your spine, feet and pelvis in more detail.

Renuka Pinto, MPT, PGDR, CSCS, CES