'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!

PRI Sleeping Tips

Image from Huffingtonpost.com

We all know sleeping is essential to overall health, but did you know that poor sleep can rob you of producing certain hormones that are necessary for tissue healing? Whether you’ve never been a “good sleeper” or pain is waking you at night, your sleep quality is important to improving your pain and needs to be addressed. Our upcoming blog post will be about improving your sleep hygiene and the quality of your sleep, but this week we will be highlighting the environment and positioning involved with sleeping to minimize pain at night. 

1) The right mattress is important! The Postural Restoration Institute (PRI) recommends a regular, coiled spring mattress. As the mattress is made up of many springs that individually adjust to different areas of the body, it is a great tool for our patients to sense and feel how their body is lying on the mattress and make appropriate adjustments. Conversely, a foam or sleep number mattress is either made of one large piece of material or much larger sections of air/foam. These designs cannot give our patient’s brains/bodies very specific information as to how they are lying, where most of their weight is, etc. Just as important as the type of mattress, be sure you have a quality mattress or make sure it is relatively new. All mattresses pad down overtime which will limit the mattress’ effectiveness in supporting our bodies, helping us realize where we are in space, or cause us to “fall into the ditch” of where the mattress is the lowest. All of these will increase pain and can cause night-time waking.

-If getting a new mattress is cost-prohibitive for you, you can usually find a donated mattress that’s under 90 days old. Most mattress companies offer free 90 day trial mattresses that are rejected are donated to off-set the company’s loss of income. Call around to your local donation centers and you’ll be able to find where the mattress companies donate their almost-new products. 

2) How you support your body differs depending on the position in which you sleep.

- Back sleeping- This is a great position to sleep in, but definitely is the least popular. Be sure to keep a pillow under your knees. This slackens the muscles on the front of our hip and thigh which can pull our pelvis forward and arch our back when we sleep with our knees straight. Use a pillow that is relatively flat, but has enough structure that the arch in your neck is maintained. 

- Stomach sleeping- Unfortunately, this is a pretty bad position to sleep in. It allows your lower back to excessively arch and places your neck in a significantly rotated position. Even if you do not use a pillow, the TMJ (jaw joint) is placed under a lot of strain as the weight of your head is directly on this non-weight bearing joint. Many people will kick a leg out to the side in this position which places a lot of strain on your pelvis and sacroiliac joints. If you are having a lot of trouble breaking this habit, try sleeping with a pillow under your stomach. Make sure your belly button is directly in the center of the pillow. This will help to keep your lower back in a less-arched position. Keep your legs together and avoid kicking them to the side. Lastly, do not use a pillow.

- Side sleeping - This is a great position to sleep in, but you want to support your body differently depending on what side you are sleeping on. This is based on the fact that our body is not symmetrical; Our diaphragm (muscle that we breathe with) does not work as well on the left which causes our left abdominals to weaken (first) allowing our left lower ribs to flare, our pelvis tends to twist to the right, and our left hip tends to rotate outward while our right tends to rotate inward.

- Left side sleeping - Use a pillow that will allow your neck to stay parallel to the mattresses or causes your head to become elevated slightly (right ear should move closer to the right shoulder). Place a pillow under your left lower ribs. This helps to keep your ribs in a better position and let your diaphragm function better. A diaphragm that works efficiently will allows our neck/shoulder/back muscles to relax as they are no longer needed to help pull in air and can decrease apnic episodes! Place another pillow between your knees and try to push your right knee forward a bit forward compared to your left. This will keep your pelvis from twisting to the right and place your hip in a better position which can decrease lower back strain and irritation to the joint itself. 

- Right side sleeping - Use a pillow that keeps your neck parallel to the mattress. A small pillow can be used under your right lower ribs if you have a flare on that side or know you have abdominal weakness on both sides. The last pillow is placed between your ankles which places your left hip in a better position. Lastly, pull your left knee back a bit compared to your right in order to keep your pelvis from rotating toward the right. 

3) Doing your exercises immediately before bed can have a huge impact. Our PRI exercises are designed to inhibit overactive musculature that are holding your body in a bad position/posture and decrease pain. By performing your exercises immediately before getting into bed, you’ll be going to sleep in the most balanced, relaxed, and pain-free state you can achieve! It also helps to decrease your fight or flight nervous system and increase our REST and digest system. This can have a dramatic impact on your quality of sleep, decrease in pain, and progress in your program.

Sweet dreams! 

Written by Lesley Callaham September 18, 2018