Static and Dynamic stretches

Static and Dynamic stretches

In our previous article we discussed the importance of stretching. However, there were few benefits which didn’t complement  each other. The reason is different types of stretching techniques. Stretching in a specific way will provide you slightly different results compared to other stretching techniques. The two most popular techniques are static and dynamic stretches. People often get confused which one to use and when.

Static stretch

Fig.1 Forearm Static stretch

Since decades static stretches have been practiced around the world. It is a great way to stretch those tight muscles. Static stretches, as the name suggests involves holding a stretch for certain amount of time. There are no repetitive movements involved. For example, a static stretch is a simple forearm stretch (fig.1) where you hold the position for around 20 seconds. They have been used in the past and are still being used as part of warm-up routine. However research has shown that Dynamic stretches are more appropriate than static stretches when it comes to warm-ups. Implementations of dynamic stretches have been difficult as many athletes still prefer to stick to satic stretch routine.




Dynamic stretches aim to prepare athletes physically and mentally, to cope with the demands of the subsequent activities. They are sports specific, as it involves similar movements which will occur in the sport or training routine. They are believed to sensitize the neuromuscular system better than static stretches, considering the movements involved. Looking at variety of sports and exercise routines, there are plenty of options for dynamic stretches. Some examples for dynamic Stretches would be butt kicks (fig.2), inch worm, lunges, and kicks.



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Stretching – Your body needs it!!

Stretching

Stretching has always been an important part of an exercise routine. However, it is also a greatly ignored part of an exercise/lifestyle routine. Reason can wary from it being boring, painful, unfitting, time consuming, worthless and many more. People can give you plenty of reasons to avoid stretching and jump straight to their preferred physical activity or sports. However, there are equal number of reasons or even more to spend quality time in stretching. Stretching is not only limited to an exercise routine or sports, it has an important role in day to day activities as well.

ITB-stretch

 

Our muscles have a tendency to get tighter overtime either from their regular use or from any muscle imbalances. When we train or play sports the dominant muscles tend to get stiffer and tighter from their use. Similarly bad postures will lead to tightness of the shortened and overactive muscles. In order to maintain a good muscle balance and flexibility, stretching plays an important part. Many people will argue that they do nothing except sitting at their work desk, why should they be stretching. These people are at a higher risk of not only contracting general health problems but muscle imbalance and musculoskeletal issues. Reduced movement tends to make the muscle tighter than using it.



Stretching helps in

  • Maintaining good flexibility in muscles
  • Reducing fatigue/soreness in muscles
  • Injury prevention
  • Maintaining good muscle imbalance
  • More power generation
  • Improving blood flow
  • Maintaining good posture
  • Improving joint range of motion
  • Relaxation





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The Barefoot and Minimalist Running Shoe Debate

The Barefoot and Minimalist Running Shoe Debate

Article by Dorcas Sholanke

Dorcas

Senior Podiatrist

About the Author – Dorcas is a Senior Podiatrist practicing in Singapore. Dorcas is well practiced in the management of musculoskeletal conditions of the foot and ankle and has worked with many of Singapore’s most prominent Orthopedic and Sports Physicians.


I treat a wide range of runners in my clinic on a daily basis. From weekend warriors to ultra-marathoners, everyone has a preference when it comes to their running shoes and most have a theory on why their chosen shoes work for them. Often there is good logic involved in their reasoning but with so much available on the market, runners can get swayed by clever marketing gimmicks. Buying the wrong shoes can easily result in associated injuries down the line.
You may have noticed that more and more types of running shoes are available and wondered what brought about this influx of products.




In 1960, Ethiopian marathon runner Abebe Bikila ran the Olympic Marathon in Rome. He shocked the world when he broke the world record and won the Olympic Gold Medal barefoot. This is, undoubtedly, the most influential barefoot running victory of all time. Over the years other marathon runners such as Bruce Tulloh, Shivnath Singh and Zola Budd also received acclaim running barefoot. Professional runners were racing without traditional running shoes and the industry was starting to take note.
The Tarahumara Indians have also played their part in the running footwear revolution. This Native American population of Northwest Mexico is renowned for being able to run long distances barefoot or with very thin lightweight sandals. It was reported that the Tarahumara Indians ran without getting injuries and they were living long, healthy lives.



barefoot-1
Major players in the running footwear industry started to question previously-recognised theory that cushioned shoes were best for running and we soon started to see ‘Vibram Five Fingers’ and minimalist shoes on the market. While this seems like a market reaction to evolving logic, there are some inherent flaws in the logic presented.
In particular, much of the information often recited in the running shoes debate is anecdotal. For instance, Abebe Bikila only ran barefoot because he didn’t have his favoured running shoes on the day and later he beat his barefoot world record wearing running shoes. The Tarahumara Indians are a genetically isolated tribe who are very light and run from a young age into their senior life on varied terrain. While barefoot marathon runners and Tarahumara Indians may be experiencing great results, they are very different from the average runners that are shopping in the mall.




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Lunges – Let’s do it right

 Lunges  – are you doing them right?

In the first part of the article series “Let’s do it right” we discussed the right way to perform exercises. Now this article will talk about – Lunges, one of the most common functional exercises done to build up thigh and butt muscles. Lunge is a great exercise to maintain or improve lower body strength. Apart from improving strength it also helps in improving balance and control.  It is also a very functional and specific exercise for many sports such as tennis and squash. Good thing about lunges is that you don’t need any fancy machines. However, if done in an inappropriate manner, it can lead to muscle imbalance and pain around the knee joint.

Lunges

Lunges





Muscles targeted

Many confuse this exercise to purely a quadriceps exercise. The primary muscles which are targeted by doing lunges are quadriceps muscles (front of thigh) and gluteal muscles (buttock muscles).  Second common confusion happens in identifying which leg is being trained front or back. Front leg is the driver however it is possible to feel a stretch on the thigh of the same. People compensate by loading their back leg more which is one of the many mistakes while doing lunges. Let’s see the common mistakes.

Next page – Common mistakes done while doing lunges







Obesity product of Urban Lifestyle

Obesity product of Urban Lifestyle

The answer is ‘YES’. However, you may not realize it immediately but urban lifestyle is a threat to your health. The prevalence of obesity has increased remarkably the world over which includes India amongst the top three obese countries in the world. According to WHO’s world health report 2013, there are more than 300 million obese people in the world. There is higher number of over nourished population than undernourished population on earth.

Technology has provided us with many conveniences such as automobiles, escalators, washing machines to name a few. Result of which is that our need to exert physically has dropped down drastically. To top it up, we are surrounded by high energy tempting food which makes it more difficult to stay slim.




Obesity is not just an aesthetic issue but it also brings along whole range of medical conditions with it. A person with higher BMI >23kg-m2 (body mass index) will have higher chances of acquiring diseases than a person with lower BMI.

Obesity can lead to heart diseases, hypertension, stroke, fatty liver, osteoarthritis, varicose veins, obstructive sleep apnea, psychological issues (depression, low self-esteem), diabetes, hernia and many others.



So, do you want to wait, watch and get worse or act and eliminate obesity? There is a need to act early on obesity is to be able to avoid :

  • Greater number of health problems and complications that persist the longer you stay obese.
  • Difficulty in exercising the heavier you get.
  • Many of the above mentioned medical conditions can be reversed at least partially with lifestyle modification.
  • Lifestyle intervention like exercise and proper diet is easy to implement before onset of any complication.

If you suspect or you have been diagnosed with any health condition, it is advisable to get a health screening done before you indulge yourself in any kind of exercise. The exercise routine has to be tailor made to prevent any complications.

Rehab Mantra
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Running Shoe buying Guide

Running Shoe buying Guide

Nowadays buying the right running shoe is a complicated affair because of the variety in brands, technology, and aesthetics. Top reasons why people select a particular shoe are its aesthetic, brand and their favorite celebrity endorsing it. A good running shoe regardless of above criteria should be one which compliments your foot type and requirement. It doesn’t matter if the shoe which works wonders to your friend’s running will do the same for you. All foot types are different and all feet behave differently when placed in load bearing activities.




Foot and ankle make an important part in how your whole body mechanics will work. Foot is the first area which comes in contact with ground and decides how the gravitation forces will act on different joints of your body.

  • Know your foot type
  • Which time of the day you should buy your shoe
  • Selecting a brand of shoe
  • Particulars to carry with you to shop
  • How to check a shoe









Are your feet normal??

There’s no such thing as normal: variety in healthy feet

Article by Timothy Maiden

Tim photo

Senior Podiatrist at The Foot Practice (Singapore)


“Is it normal?” must be one of the most commonly asked questions in medical history.

There’s actually been surprisingly little research done on ‘normal’ feet in adults.  Because feet are hidden away in shoes most of the time, we don’t see the natural variation the way we do with facial features or body shape.  People only seek medical help if they’re in pain, so there’s lots of research done about conditions like bunions or hammer toes, but very little done about the range of different shapes which characterise healthy feet.

The rough estimate is that around 11% of adults have flat feet (https://www.researchgate.net/publication/266142136_Prevalence_of_flat_foot_among_18_-25_years_old_physiotherapy_students_cross_sectional_study), while high arches affect around 10-15% (http://www.acnr.co.uk/2013/01/pes-cavus-not-just-a-clinical-sign-diagnosis-aetiology-and-management/), and everyone else is ‘normal’.  The statistics indicate that children have higher rates of foot deformities – but perhaps this is just because attentive parents take their children to the doctor for fairly mild problems, whereas adults are less keen to seek help for themselves. (http://www2.cmu.edu.tw/~mtjm/full-text/14%281%29p1-9.PDF)




Feet are often divided into categories according to their appearance.  “Peasant” feet are square-looking with stubby toes all a similar length; “Greek” feet have a peaked appearance, with the second toe longer than the big toe; and “Egyptian” feet look tapered, with the big toe the longest and the others of decreasing sizes.  But these aren’t medical descriptions, just loose descriptions used by shoe manufacturers. (http://www.pointeshoesonline.com/foot-shape/)

The official description of a normal foot, as found in medical textbooks, is a list of features written by a long-dead podiatrist and never really tested by science (http://www.podiatrytoday.com/what-%E2%80%98normal%E2%80%99-foot).  Sydney University is currently conducting a “1000 Norms” project, collecting and analysing data on the anatomy of healthy people (http://sydney.edu.au/health-sciences/research/1000-norms.shtml), but it will be years until the project is completed and we have a clearer picture.




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The right running shoe

 

Article by Timothy Maiden

 

Tim photo

Senior Podiatrist at The Foot Practice (Singapore)

There’s something exciting about slipping on a new pair of running shoes for the first time.  It makes you feel more confident about achieving your fitness goals, whether you’re training for a four minute mile or just hoping to get around the block without wheezing.  What if your new trainers didn’t just make you feel enthusiastic, but actually made running easier for you?  There are a new breed of shoes on the market which claim to do just that.

The precise measure of how effectively you run is known as your running economy: it is the amount of oxygen you need to breathe in order to maintain a certain velocity, known as VO2.  The lower your VO2, the more effectively you are running.

Energy return shoes claim to improve running economy by harnessing energy which would otherwise be lost.  Every time your foot hits the ground, energy is transferred out through pressure on your shoes.  Energy return styles claim to store some of this energy and give it back to you, in the form of extra bounce to help you push off again for your next step.  Over the course of a whole run, and it could make you go further and faster.




It sounds too good to be true, but there’s science behind these claims.  Energy return soles have been shown to improve running economy significantly in athletes.  Even if you’re just an occasional jogger, you’ll probably find the springy soles more comfortable than basic trainers.  (http://scicurve.com/paper/26367197.)

Remember, though, that a statistical decrease in VO2 under laboratory conditions doesn’t necessarily mean a dramatic improvement in your performance on the road.  You will certainly lose less energy as heat in the sole, but this is still a tiny amount of energy saved compared to the amount transferred into the muscles and tendons of your feet.  And you can’t do anything about that.  (http://www.runnersworld.com/the-shoe-room/the-truth-about-energy-return-in-your-shoes)

In reality, it’s not just the sole which affects performance while running.  The shoe upper (http://www.tandfonline.com/doi/abs/10.1080/19424280.2015.1038620?journalCode=tfws20), the texture of the lining (http://www.tandfonline.com/doi/abs/10.1080/02640414.2015.1117120?journalCode=rjsp20#.VmLnZOISyJc), and even the way you lace them up (http://www.researchgate.net/publication/23804393_Effects_of_different_shoe-lacing_patterns_on_the_biomechanics_of_running_shoes) all have an effect on running economy or your risk of injury.




For a casual runner, the type of person who does two miles around the park every Sunday, injury is probably a bigger concern than efficiency.  Running economy is great, but there’s no point reducing your VO2 if you end up with shin splits.  And this is where energy return shoes may not be the best choice.

Controversial recent research has turned on its head what we thought we knew about running injuries.  It was long thought that high impact forces increased the risk of injury, so sports shoes were made thick and cushioned in order to protect the feet.  It’s now suggested that impact is actually a useful method of feedback, allowing the body to brace and adjust itself to road conditions.  This is why running on hard surfaces does not do more damage than running on soft.  (http://www.sciencedirect.com/science/article/pii/S2095254615000861)

Heavily cushioned shoes have been linked to higher rates of injury.  Researchers suggest this is because the squishy sole tricks your body into thinking it has landed on a soft surface – only to be unprepared for the jolt that comes a few milliseconds later, when the sole is fully compressed and your foot jars against the ground.  Thickly cushioned shoes also reduce running economy – think about how difficult it is to walk on soft sand, rather than firm concrete. (http://www.ncbi.nlm.nih.gov/pubmed/24725045?dopt=Abstract)  Energy return shoes give an extra boost, but it may not compensate for the disadvantages of a thick sole.

Research on the body’s adaptations to impact has led to a recent craze for ‘minimalist’ shoes: with paper-thin soles and flexible uppers, they feel more like rubbery socks than shoes.  (A few hardy souls have begun running totally barefoot – LINKS HERE – but it’s a pretty risky proposition in the city.)

The evidence for minimalist shoes is mixed.  Studies show that they offer better running economy than normal, cushioned shoes (http://www.tandfonline.com/doi/full/10.1080/19424280.2013.873487).  But a switch from cushioned to minimalist shoes can cause serious foot problems, unless carefully managed.  In one study, almost half of participants developed painful bone marrow edema in their feet after switching to minimalist shoes.  (https://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1559685)

Energy return shoes aim to improve running economy with advanced technology that lifts you off the road; minimalist shoes try to bring you as close as possible to running barefoot, allowing your body to move naturally.  Both have been shown to improve running economy, and both have been linked to increased risk of injury.  Energy return and minimalist shoes are both recent inventions and no studies have been done comparing them, so we have to draw conclusions from what evidence there is.  So how can you decide whether one of these new types of shoe is right for you?

If you’ve been to a large sports shop, you’ve probably been subjected to gait analysis – where someone sticks you on a treadmill and thoughtfully prescribes a shoe to make your run ‘properly’.  You’ve always suspected it was a scam (how come the best shoes for me are never the pair which are half price in the sale?), and now science is backing that up.

After decades of conflicting evidence, researchers have proposed that people instinctively know the right shoe for them.  We’ve gone full circle, and sports science now harks back to what your mum told you when buying school shoes.  Try them on, wiggle your toes, bounce up and down a bit, and whichever shoe feels best is the one you should buy.  Forcing yourself to wear a certain type of shoe because it’s good for you is likely to lead to injury in the long term.  (http://bjsm.bmj.com/content/early/2015/07/28/bjsports-2015-095054.short?rss=1)




Scientists say that “a runner intuitively selects a comfortable product based on their own comfort filter, which allows them to remain in their preferred movement path”.  In layman’s terms: the shoes which feel most comfortable to you will be the ones which allow your body to move naturally, and allowing your body to move naturally improves your running efficiency and reduces risk of injury.

Simple, really.  Whether you choose energy return, minimalist, or a $5 pair of second-hand Pumas, the shoes which feel most comfortable will probably be the right ones for you (http://www.ncbi.nlm.nih.gov/pubmed/11689747)

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How to Give Your Ankle Sprains the Perfect Rehabilitation and Reduce Risks of Recurrence

 

Article by Timothy Maiden

Tim photo
Senior Podiatrist at The Foot Practice (Singapore)

 

Untreated ankle sprains can lead to chronic problems such as pain, joint instability, and diminished range of motion. Yet many patients with acute ankle injuries never seek medical attention [1].

Not to scare you, but poor recovery from ankle injury and long-term ankle instability ­­is associated with the development of painful degenerative joint disease. This risk can be reduced or eliminated with proper ankle care and rehabilitation. Ankle sprains are among the most common injuries to the musculoskeletal system, accounting for approximately 2 million injuries per year [2].

It’s no surprise that the most important risk factor for ankle sprains is a history of previous ankle sprains! Therefore, it’s absolutely imperative to follow an up-to-date rehabilitation program. An ounce of prevention is worth a pound of cure, and prevention of ankle sprains is especially crucial during the seven-week period after acute injury. In this guide, we’ll discuss ankle injury severity, the four-step rehabilitation process and the application of an orthosis (brace for an ankle injury).

 




Ankle Injury Severity

Depending on injury severity, ankle sprains are graded from I to III. It’s helpful to familiarize yourself with the grades, since injury severity informs treatment.

Grade I ankle sprains exhibit minimal loss of functional ability, pain or swelling, and an intact ankle ligament. A grade II ankle sprain entails a partial ligament tear and moderate pain, swelling, and loss of function. Finally, grade III is characterized by a complete ligament tear, with severe loss of function, pain, and swelling, as well as marked difficulty bearing weight.

The Perfect Ankle Sprain Rehabilitation Regimen

What’s the goal of ankle rehabilitation? Isn’t it enough to relax on the couch and let the healing process occur by itself? Rest and relaxation are certainly an important part of rehabilitation, but there are a number of other steps you can take to hasten recovery and prevent future injuries.

The goal of ankle sprain rehab is to I) decrease inflammation, II) regain your full range of motion, III) increase muscle strength, power, and endurance, and IV) improve proprioception. Proprioception is just a fancy word for how you perceive different parts of your body. Amputees, for example, would have disturbed proprioception as a consequence of their injury.



Start Rehabilitation Early! 

Early rehabilitation hastens recovery after ankle sprains [3]. Recent evidence suggests that early movement by range-of-motion exercises and isometric/isotonic strength exercises improves healing. Or in medical jargon: a study that found early mobilization leads to a beneficial orientation of collagen fibers compared to an immobilized ligament [4].

Remember grade III ankle sprains? This was the most severe kind of ankle injury. Well, for grade III ankle sprains, 7-14 days of immobilization (using a brase or orthosis) assisted by crutches may be needed if you’re in constant pain. Oral NSAIDS are useful for pain relief and reduce inflammation. Remember, decreasing inflammation was goal #1 of ankle sprain rehabilitation.

There are four phases of ankle rehabilitation:

  1. Manage pain and swelling
  2. Restore range of motion
  3. Begin muscle strengthening
  4. Regain full strength, functional rehabilitation, and return to normal activity

 




Ankle Bracing and Orthotic Therapy

Orthotics is a medical specialty that designs and applies orthoses – devices used to modify the structure or function of the musculoskeletal system. An example of an orthosis is an ankle brace.  Ankle braces come in three flavors: I) lace-up, II) stirrup, or III) an elastic configuration.

What are ankle braces for? They provide mechanical stability to the injured area and facilitate the healing process. Orthosis has a number of advantages: cost-effectiveness, ease of use, and you can do it yourself at home (you don’t need assistance from a medical professional to apply it!)

Orthotic therapy has been shown to enhance joint position sense, provide added stabilization, support, and sensorimotor feedback during exercise, improve balance after injury, reduce postural sway, fatigue and pain perception and protect against future injuries without significantly affecting athletic performance.

 

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Low waist, tight pants and their health hazards!!

Health Hazards of Low Waist and Tight Pants

Low waist, tight pants are in fashion and they look good and trendy, but everything comes with a price. Price here is not money, it’s your health. Without being aware of the harmful effects of wearing low waist,tight pants on your body and health, we tend to follow the trend blindly. These type of  pants can be the main reason behind hip pain, low back pain, knee pain and even hernia.

Low back and knee pain

Our body needs certain amount of contribution from different joints to perform activities. For example, to bend down and pick up something, the hip joint should have enough mobility to reduce stress on knee and low back. The right way to bend down is to bend more at hip while keeping the spine neutral (straight) and knees behind toes. People often have to change the way they bend forward while wearing a low rise pant to avoid showing their butt line. In order to avoid slipping of pants while bending forward, people either tend to bend more at the knees or low back. Excessive bending at knees over and over again can lead to early wear and tear of the knee joint. Similarly increased bending at back can lead to low back problems.

To maintain a neutral spine while sitting, pelvis needs to be maintained in neutral position as well. Excessive anterior (forward) tilting or posterior (backward) tilting makes it difficult for the spine to maintain a neutral posture. Position of pelvis largely depends on hip joint mobility. When wearing a low rise or tight fit pants, the forces on the pelvis increases, thus making it tilt backwards. This posterior tilting of pelvis constrains the spine to maintain a neutral position and makes it curve backwards. When your spine is pushed into a backward curve position it increases pressure on the disc resulting in a bulge or prolapse.

Meralgia paraesthetica

In this condition there can be pain, numbness, hypersensitivity or pins and needles on the outer thigh because of nerve compression. The nerve affected is the lateral cutaneous nerve of thigh. It used to be seen in people with big belly wearing tight belts just above the groin area. Now, it can be seen in people wearing tight low waist jeans, as it just sits over the groin area.

Hernias and hydrocele

Because of reduced hip range and slouched posture, the abdominal muscle becomes lax and the support required from it is reduced. There is also no external support to the abdominal wall from the belt as it is worn too low. All these factors have increased chances of hernia and hydrocele.

 

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