'Moving' Through COVID-19

During the COVID-19 pandemic, with the stay at home orders in place and gyms closed, I have seen many more people walking and running when I’ve been out running or on our family walks. It’s great to see people out doing the same thing and spending time together. Here are some tips that may be helpful.

1. Choose an appropriate shoe. Thanks to Lori Thomsen, MPT, PRC at The Hruska Clinic (the PT clinic started by Ron Hruska, founder of The Postural Restoration Institute), we have a list of shoes that meet specific criteria. We recommend shoes that have a solid heel counter (to allow for heel stability and the foot to supinate and pronate as it should during the gait cycle) and bend at the toe box and not in the middle of the shoe (to support your arch and allow proper push off). Here’s the Recommended Shoe List link.

   As you will see the list is organized by what type of arch you have (low, average or high). When you try on a shoe, it should feel comfortable right away. If you feel like you have to “break it in” it’s not your shoe. When walking in the shoe, you should be able to “sense” your heel, arch and big toe. In the ideal scenario, I (or your PT) would perform objective tests on your neck, shoulders/ribcage and hips/pelvis to determine the best shoe for your body. However, currently we are limited with social distancing. The best way for you to pick a shoe right now is by feel and comfort. We are fortunate to have Big River Running in St Louis making home deliveries. My current clients are ordering 2-3 pairs from the appropriate column and determining the best shoe by comfort when walking in them and then returning the ones that don’t work. Perhaps you have a local running store in your area that would be happy to have your business. If you need assistance to determine your arch type, I can do this remotely; please contact me: nancy@integrate360pt.com.

2. Swing your arms. When you are walking or running, it is very important that you swing your arms. Forward motion of your arms allows your trunk (ribcage and thorax) and therefore your pelvis to rotate and move as it should. I encourage my clients to see their fingers in their peripheral vision as they are walking. This will help ensure that your arms are moving forward. This will necessitate that you take your hands out of your pockets when you are walking. In addition, if you are walking your dog, consider a waist leash to free your hands allowing for arm swing.

3. Increase your distance gradually. There’s a tried and true 10% rule in running. It states that you should increase your distance by 10% each week. For example, if you are running 10 miles/week, you should increase to 11 miles the following week. This is to avoid overuse injuries. It’s tempting with being cooped up in the house and then going for a walk or run in the nice spring weather to not push yourself to go further when you are feeling good and strong. But don’t give in. Be smart and remember slow and steady wins the race!

4. Stay nourished, rested and hydrated. Eating healthy, consistent meals, being well rested, and staying hydrated are all essential to keeping your immune system strong! These three may be common knowledge, but during this pandemic, it’s especially important to eat nutritious meals throughout the day and also get 7-8 hours of sleep at night. Maybe not as known is maintaining adequate hydration. You should drink 1/2 to one ounce of water for every pound you weigh. So, if you weigh 150 lbs, you should drink 75-150 ounces of water per day. Of course, you will need more water if you are exercising and sweating more.

   Please keep moving! If you are working from home or staying home more, it’s difficult to get in as many steps during the day when you are not walking around the office, walking to and from public transit or running errands. You will have to make a conscious effort to get up from your desk and go out for a walk or run. But once you keep moving, you will feel better!

Sandals - What You Need To Know

Anyone that has been through a PRI program knows that shoes are extremely important to the success of said program. The Hruska Clinic (the clinic that the creator of the Postural Restoration Institute, Ron Hruska, owns and works out of) puts out a biannual shoe list where they look at hundreds of different tennis shoes, breaks them into categories to help clinicians narrow down the options for our patients, then lists a few shoes in each category (see current shoe list HERE). Having proper footwear can make or break a program. For our patients who present in a pattern (or are not in neutral in one or multiple areas of their body), these shoes can kick start their program instantly getting them in to neutral and saving weeks of work! However, once our patients lift scores get to a 3 out of five or higher, they have some options in terms of footwear. Since spring has sprung and we know that our patients will be wearing sandals at some point regardless of lift score, we wanted to you know what to look for in a good sandal.

1) Avoid a heel. Having any height in your heel will push the weight of your body onto the ball of your foot. We are designed to bear our weight through our heels. When we are forced into an unnatural ankle and foot position, we must counterbalance our weight up the chain so that we do not fall forward. The most typical compensation for this is to lean back in the shoulders accentuating the curve in the lower back and possibly pushing the head forward. This can quickly cause lower back, shoulder, and neck pain. 

2) Choose a shoe that is attached to your foot. When we wear a shoe that hangs on our foot like a flip flip or a mule, we have to work harder to keep that shoe on our foot while we walk. This may include gripping the shoe with our toes, lifting our toes up excessively, or even rotating our hips so that our toes point slightly outward. All of these compensation patterns cause excessive and abnormal muscle use which can irritate many areas including our foot, ankle, knees, hips, and lower backs. Choosing a shoe that straps at or around the ankle will ensure that the shoe stays on your foot while walking and you don’t have to work as hard!

3) Try to find a shoe with heel support. Although this is quite a challenge, it can be done. Many people realize the importance of having good arch support in a shoe for good foot and ankle alignment. However, many do not realize that what really determines the arch’s position is the heel bone or calcaneus. If you are able to find a sandal that encompasses the heel and gives it some support via a more rigid material, your arch will be much more stable. 

4) Feel your arches. As mentioned above, managing your heel position is very important, but it’s still essential to have support under your arches. Try to find a pair of sandals that has enough arch support built into it that when you stand and walk you can feel the material of the shoe supporting your arch. There should not be a gap between your arch and the shoe. Additionally, there should there never be so much build up that it’s painful or you feel as though it’s pushing your weight to the outside of your foot. The ability to sense and feel your arches helps your body to utilize your glut max muscle. This helps to keep your lower back from overworking and can help to strengthen those very important gluts!

5) Go for comfort. Whatever sandal you chose needs to be comfortable. Think about the last time you wore a pair of shoes that gave you a blister. First of all, remember how much that hurt. Second, remember how strangely you walked to avoid rubbing the blister even more? It’s obvious that when you walk oddly to avoid pain, you’re not walking in a biomechanically correct way which can lead to form breakdown and pain.

6) Limit your use. No matter how many of the above boxes your selected sandals check, we all have a limit to what our bodies can handle with less than desirable shoes (aka not tennis shoes). Listen to your body when you wear your sandals. You’ll soon begin to notice how much time or activity you can tolerate in those shoes before your body starts to break down. Have a your tennis shoes at the ready for when you drive home after that wedding or only wear them when you’re going to a nice dinner and won’t be on your feet much. 

Written by Lesley Callaham, MPT, PRC      April 2, 2019

How to Shovel (Through a PRI Lens)

Image from www.thegentleplace.com

The snow is here! And there may be more snow on the way so it’s important to know how to shovel your drive and walkways without causing excessive pain or injure yourself. 

1) Wear good shoes - You’re about to lift a lot of weight so having appropriate footwear is important. A good foundation for your foot allows for proper weight bearing through your legs and overall alignment of your body. If you feel comfortable and the snow is not too thick, just wear your tennis shoes.  If the snow is deeper, wear snow boots with good, supportive or any custom orthotics you may wear. 

2) Choose a good shovel - We all know that tools can make or break a job so choose a shovel that won’t break your back! We like ergonomic designs where the handle is slightly bent so that the shovel blade is lower to the ground. This is useful so you don’t have to bend over so far to get your blade to the ground. It also makes scooping the blade under the snow easier.

3) Squat - Once your blade is under that snow, you’re going to have to lift it. Be sure to squat down BEFORE lifting the snow. Place one foot slightly ahead of the other and press through your heels, as if you’re pushing the ground away from you, while you straighten your knees and stand up. It’s similar to pushing the footboard away from you on a leg press machine. You may be able to rest your forearms on your thighs to help lift the heavy snow off the ground. 

4) Use your abs - Now that you have all that weight lifted you’re going to have to move it off to the side. Do this by using your abs! Their job is to tuck your ribs, round your back, and twist your body. As this post is through a PRI lens, we want you to use your left abs a lot more than your right. In order to do this, you’ll need to have your left foot ahead of your right with your left hand farther down the shaft of the shovel (closer to the blade). As you get ready to through your snow to the side, be sure that your left shoulder stays lower than your right (trunk slightly bent to the left) and sense and feel your left abs rotate your trunk to the left so that your breast bone ends up facing toward the left. Your abs should be the primary force rotating your trunk, not your arms! It’s important to switch your lead arm/leg while shoveling to avoid fatigue and overuse injury, but as mentioned before, shovel with your left arm and left foot forward most often. 

5) Pace yourself - shoveling is much more taxing to our musculoskeletal and cardiovascular systems than we like to admit. Realize it’s ok to take period breaks to avoid fatigue and give your system a rest!

6) Have realistic expectations - Lifting large amounts of weights for a long time is not something most people do on a regular basis. Be aware that you will feel muscular soreness after doing this. This is normal. Even soreness in muscles that PRI likes to inhibit (lower back muscles, pecs, biceps, etc.) will be sore and that is ok. Shoveling is not a specific, rehabilitative activity; It’s an activity that uses many, many muscles in the body in order to complete a difficult physical task. It’s even acceptable if the pain for which you are receiving treatment gets aggravated. We would like to keep that as minimal as possible using the above tips, but if your body cannot tolerating driving a car, making it through a work day, folding laundry, etc. without feeling pain, it is to be expected that shoveling will exacerbate it to some extent. 

7) DO YOUR EXERCISES! - Be sure to do at least one of your exercises immediately before and immediately after shoveling. The idea is that we want to begin this physically demanding activity with our bodies in the best possible position. It’s likely that we will lose our good position or begin using compensatory muscle groups as we fatigue with shoveling so ending with an exercise (or more) will help put our body back in the correct position and quiet down our overused muscles so avoid excessive pain. 



Written by Lesley Callaham, MPT, PRC January 15, 2019

Shoes: The Right Pair Can Make All the Difference

{image credit Greatist}

Typically when we shoe shop we typically limit selection criteria to fit. But considering size alone is only looking at a portion of the issue. There's balance, positioning, support and a wide number of factors at play here that combine to create the ideal shoe for you. Use this handy fit guide & list of recommended shoes to find the right pair for your needs: Download the guide.