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Daniel Lieberman, PhD: What we can Learn about Running from Barefoot Running

Daniel Lieberman at the Mass General Orthopaedic Surgery Grand Rounds Barefoot RunningWhat we can Learn about Running from Barefoot Running
Daniel E Lieberman, PhD
Department of Human Evolutionary Biology
Harvard University, Cambridge, MA
Grand Rounds presented on March 15, 2012 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA
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The Plank: Strengthening the Core

The core is commonly thought of as only your abs, but consists of multiple muscle groups in your abdomen, back and pelvis. Core muscles are engaged during all activities requiring a coordinated movement of the upper and lower body. They generate the force and power required for many activities, while simultaneously playing a foundational role in stabilizing the torso.

Our modern sedentary lifestyle does nothing to working these important core muscles and over time result in their weakening, and the consequent injuries from seemingly simple tasks.

There are various ways to strengthen these core muscles. The PLANK, for instance, is easy to perform, effective and appropriate for any age and fitness level. With no special equipment, the plank can be performed on a carpeted floor or mat in your living room, in the gym between sets of other exercises, or at the end of a workout. Also, the plank literally only takes a minute!

In performing the plank, you hold a steady position by isometrically contracting the deep stabilizing abdominal muscles (transverse abdominus), while keeping the lower back (erector spinae and multifidi) stable, fighting fatigue and simultaneously building endurance. This exercise is not appropriate if you have any shoulder weakness or injury.

Step by Step: How to perform and hold the Plank
Plank Strengthening the Core Aches & Joints

  • Have a wrist watch or clock nearby to track time
  • Place forearms on floor, shoulder distance apart (see above) and elbows directly below the shoulders as demonstrated below
  • Extend legs back, one at a time, straightening the knees and balancing on your toes
  • Keep your body straight as a plank (see below)
  • Relax your neck and look down at the floor
  • As you fatigue, there will be a tendency for your hips to sag. Squeeze your deep abdominal muscles and glutes, and hold your hips in line with the rest of the body
  • For starters, hold the position for 30 seconds and work up to 60 seconds or longer
  • Rest on your knees; when ready, repeat plank for two additional sets

Plank Strengthening the Core Aches & Joints

For a more challenging workout: In the plank position, alternately lift and move each leg outwards (see demonstration below)
Plank Strengthening the Core Aches & Joints

Julie Schlenkerman, Personal Trainer, Clubs at Charles River ParkThe Plank was demonstrated by Julie Schlenkerman, certified personal trainer at the Clubs at Charles River Park, Boston, MA. Julie is an avid runner and ran the 2009 Boston Marathon in 3:16:14!

From our Archives: Simple exercises & Related articles

Scapular Exercises for Stronger Shoulders

Exercises for Strong and Healthy Shoulders
Shoulders permit our arms to move in a wide arc and perform elaborate activities. This mobility is due to superb coordination of muscles and soft tissues around the shoulder and shoulder blades (scapula, SKA-pew-la), and is essential for performing activities in a pain- and injury-free manner. See related article on Rotator Cuff complications impairing shoulder movement.

Conventional shoulder exercises strengthen the larger muscles but tend to overlook the mid-back muscles that stabilize the scapulas. This can often result in muscle imbalance and consequently, bad posture. Even non-shoulder exercises like running on a treadmill with shoulders slouched can lead to stiffness and pain. These conditions increase injury potential and thus the need for corrective exercises.

Michael Bento, personal trainer at the Clubs at Charles River Park, Boston, demonstrates simple exercises you can do at home to develop shoulder strength and protect them from injury. As a bonus, these exercises also help tone the all important core muscles.

These exercises can be performed on a stability ball as shown, or on a work bench. Dumbbells or additional weights are not required. And as I surprisingly found out last week, you can do these scapular exercises while standing and starting with the arms in front! Yaay!

Common Starting Position for Shoulder-Scapula Exercises
scapular exercises

  • Anchor heels to a wall, toes on the floor and slowly roll out on a stability ball.
  • Rest upper abdomen on the ball and straighten body forming a line from ears to ankles.
  • Pull your shoulder blades down, tuck your chin and look at the floor.
  • Start with arms straight, hands in front of the ball (or bench), fingers lightly curled, palms facing each other and thumbs pointing forward.
  • In this position, your core muscles including abdominal and gluteus muscles are engaged in stabilizing your body.
  • For a challenging core-muscle workout, move your heels away from the wall as demonstrated above and use as starting position.

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Yoga for Arthritis

This piece accompanies the article Men are from Mars and Women get Arthritis.

Yoga can provide immense physical benefits for women with arthritis.

For arthritis patients, aerobic exercises, muscle conditioning and increased physical activity can keep you strong and agile, improve heart fitness and reduce your weight. Yoga provides an effective alternative to the traditional strengthening and aerobic exercises, and offers other benefits as well.

While yoga may bring visions of complex body contortions, most yoga classes provide simple, gentle movements that gradually build muscular strength, promote balance and improve flexibility. Its meditative nature soothes and relaxes the mind, and is associated with increased mental alertness and enthusiasm. Scientific studies have shown that practicing yoga is a safe and effective way to increase physical activity, which is strongly recommended for arthritis patients. Yoga does not increase pain or worsen arthritis.

Picture of Padmasana Yoga Pose
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Sprains and Strains

Sprains and strains are a result of minor trauma to muscles, ligaments, and/or tendons. These are recognized by pain, immediate swelling in the area, and may be accompanied by discoloration of the site.

Difference between Sprains and Strains
A sprain is a stretching or tearing injury to one or more ligaments. The severity depends upon the extent of injury or tear in the ligament. Is it partially or completely torn? How many ligaments are involved? Are other soft tissues around the site injured? The most frequently sprained ligaments are in the ankles, knees and wrists.

A strain is an injury to either a muscle or a tendon caused by overuse, force, or stretching. Depending on the severity of the injury, a strain may be a simple over-stretch of the muscle or tendon, or it can result in a partial or complete tear.

Two common sites for strains are the back and the hamstring (muscle located in the back of the thigh). Contact sports such as soccer, football, hockey, boxing, and wrestling, put people at a higher risk for strains. Long distance runners experience strains in multiple muscles in their legs. Tennis, rowing, golf, and other sports that require extensive gripping can increase the risk of hand and forearm strains. Elbow strains can occur in people who participate in racquet sports, throwing, and contact sports.

Stretching Calf Muscles – A Heel Drop

The Heel Drop is another great exercise to stretch the calf muscles, the Achilles tendon, as well as the fascia under the heel. You can do this where ever you see a set of stairs. And it only takes a couple of minutes.

Stretching Calf Muscles, Meg Vitter

  • Look for a set of stairs with railings.
  • Hold on to the railings for support.
  • Place the ball of your left foot on the edge of a step.
  • Place entire right foot on the step above for stability.
  • Gradually let the heel of your left foot drop while keeping your leg straight.
  • Feel the stretch in the sole of your left foot, Achilles tendon and calf muscles.
  • Hold this position for 30 seconds.
  • Repeat the stretch three to five times for each leg.

Demonstrated by Meg Vitter of Boston, MA.

Also read:
Treating Heel Pain or Plantar Fasciitis
Heel and Achilles Tendon Stretch
Foot & Toe Extension
Precautions to take before starting new exercises

Foot and Toe Extension

For most of the day, our feet are bound within stiff shoes and many of the soft tissues within the feet are infrequently used. This is a simple yet very effective exercise to stretch the heel, the plantar fascia and the toes.

If you have heel pain, perform this stretch as you wakeup and place your feet on the floor. This can also be performed while sitting in the office or on the couch.

  • Sit on a chair and place your ankle over the opposite knee.
  • Grip toes and gently pull them back towards the knee, while holding the ankle to prevent it from moving.
  • Feel the stretch in the sole of the foot all the way to the heel.
  • Hold the stretch for 30 seconds.
  • Repeat three times for each foot.

From our Archives: Try these exercises

Heel and Achilles Tendon Stretch

A warm-up exercise to perform before running or participating in sports. This stretches the Achilles tendon as well as calf muscles. If you have heel pain (plantar fasciitis), this stretch may help alleviate the pain. You don’t need to go to a health club or gym to do this exercise, it can be performed while sitting in your office or waiting in the coffee line, or even during a walk in the park.

Heel and Achilles Tendon Stretch

heel achilles tendon stretch, Meg Vitter

  • When out for a walk, find a wall to lean against. Even a tree will do.
  • Stand an arms length from the wall.
  • Place the leg to be stretched about 12-18 inches behind you.
  • Keep your toes pointed forward and slightly inward.
  • Bend your arms and gradually lean towards the wall.
  • Make sure your leg is straight and the heel of your back leg is pressed to the floor.
  • Feel the stretch in the calf and heel of the back leg.
  • Hold this position for 30 seconds and return to starting position.
  • Repeat three times for each leg.

Stretches demonstrated by Meg Vitter of Boston, MA.

From our Archives: Try these simple exercises at home

Treating Heel Pain or Plantar Fasciitis

What you can do to reduce heel pain.

Heel Pain Can Be Debilitating:
“Getting out of bed each morning was painful,” recalls a patient of her yearlong experience with heel pain. “As I place my foot on the floor, I could feel a sharp pain in my heel and could only shuffle about the room. It would loosen up after a few minutes, but my foot would continue to hurt as I went through the day.”

Heel pain with the first steps getting out of bed in the morning, or when standing from a seated position, are the most characteristic symptoms of plantar fasciitis (fashee-eye-tiss). Pain can also occur with prolonged standing and walking. The sharp pain is usually on the bottom inside part of the heel. While it most often occurs in only one foot, it can affect both feet.

Plantar Fasciitis Causes Heel Pain:
Plantar Fascia Anatomy

The plantar fascia is a tough, fibrous tissue band running under the soles of your feet, and connects the heel bone (calcaneus) to the base of the toes. It also helps support the arch of the foot in its role as a shock absorber. An injury or continuous irritation of this tissue causes plantar fasciitis and the resulting heel pain.

Multiple factors likely cause plantar fasciitis. It tends to affect people between 40 and 70 years of age, more likely in women, people who are overweight, or have jobs that require a lot of walking or standing on hard surfaces. Runners may be at a higher risk. People with flat feet or high arches are also more prone to plantar fasciitis.

Treatment Options:
The following self care measures may help reduce symptoms.

  • Stop all impact sports and rest the foot.
  • Stretching the plantar fascia and Achilles tendon is proven to be effective in reducing symptoms. (see some effective exercises at the end of this post)
  • Use shoes with better heel cushioning, or include a heel cup for pain relief.
  • Applying ice to the heel is very effective. Freeze a plastic bottle of water and roll your foot over it.
  • Limited use of nonsteroidal anti-inflammatory medications (e.g. ibuprofen or naproxen) is helpful.
  • Different types of day or night wear splints keep your plantar fascia stretched, and relieve pain. (see below)

Day Splint
Day wear splints can be worn with regular shoes. They keep the heel stretched and provide pain relief throughout the day.

Night Splint
Night splint worn to bed is effective in keeping the plantar fascia stretched while sleeping and can prevent early morning heel pain.

In the vast majority, plantar fasciitis will resolve itself within three to six months, but in some patients it can take a year or more. When symptoms fail to improve after 4 to 6 weeks of home treatment, see your doctor or foot specialist.

If heel pain is accompanied by unusual symptoms such as back pain, burning in the foot, or recent trauma, see a specialist. In case of severe and persistent pain that has not responded to conservative treatments, your doctor may prescribe a removable walking cast. This will keep your foot immobile for a few weeks, to allow it to rest and heal. Other treatments include ultrasound therapy directed at the area of heel pain, or even cortisone injections.

Surgery As Last Resort:
Only a tiny percentage of people undergo surgery, which includes detaching the plantar fascia from the heel bone. “Surgery should be the last resort when all other treatments have failed, and the pain remains severe for over a year,” insists Dr. Richard de Asla, Co-Director of the Foot and Ankle Service at the Massachusetts General Hospital and Instructor of Orthopaedic Surgery at Harvard Medical School, Boston, MA.

“We rarely operate on this condition because in most patients the pain resolves on its own with time. Furthermore, the surgical success rate is only about 70% with the potential for other complications,” reminds Dr. de Asla.

Exercises to treat heel pain:

Knee Exercises: Stationary Lunge

Continuing exercises to strengthen the knees.
Certified trainer, Janet Livingston from the Clubs at Charles River Park, demonstrates the Stationary Lunge. You can perform this exercise at home or in the office.

This exercise is more challenging, so please do it slowly and carefully

Stationary Lunge

  • Take a step forward. Make sure that your hips are facing forward and the back foot is straight and facing forward as well.
  • Start to bend both knees to lower the front thigh until it is parallel to the floor.
  • Make sure your front knee is in line with the ankle. The knee of your back leg should be nearly touching the floor.
  • Push through the front heel and return to the starting position.
  • Stand next to a wall if you need to balance yourself. If your knee hurts, pull back.
  • Do three sets of 10 each.

See also, Chair Squats in the previous entry.
Please read these Precautions to Take Before Starting New Exercises