Shape Up! Your Guide to Lower Extremity Strengthening for Winter Activities

It’s no secret that your risk of injury decreases as your level of physical fitness increases. The older you get the less agile you become and the more important it is that you keep your body healthy, which includes eating right and exercising on a regular basis. Not only does a healthy lifestyle decrease your risk of injury with athletic activity, but also it decreases your risk of adult onset (Type II) diabetes, heart disease, high cholesterol…and the list goes on and on!

This guide will attempt to provide ideas for strengthening exercises to keep you going throughout the winter season. It will increase your ability to perform your best on the slopes and on the hiking trails while helping you to avoid injury. As always, it is important to consult your Primary Care Physician before engaging in any exercise routine in addition to staying hydrated and getting plenty of rest.

Cardiovascular Workout – Anything that can get your heart pumping and your body sweating constitutes as cardiovascular activity. “Cardio” workouts will increase your endurance and improve your overall strength, in addition to burning calories! Some easy and fun suggestions for this type of exercise include: walking with a friend around the neighborhood while catching up, taking your favorite “kick-boxing” class at the gym, or jogging with your dog after work. Twenty to thirty minutes, three times a week is an attainable goal.

Core Strengthening Exercises – Keeping a strong core will help increase you posture, place your center of gravity centrally in your body and improve your overall balance. Standard crunches on a mat and single or double leg-raises while lying on your back are great exercises for increasing core strength. Pikes and the use of an exercise ball for these core strengthening exercises increase the outcome, but are technically more difficult. Abdominal exercises have no minimum or maximum, so doing 3 sets of 25 in the morning and in the evening 6 days per week, will only make you stronger! For proper technique in performing the standard abdominal crunch and for other core strengthening exercises, click on the link below which will take you to a video from the MayoClinic.com (http://www.mayoclinic.com/health/abdominal-crunch/MM00725)

Thigh Strengthening Exercises – Step-ups, squats and lunges are all exercises that are great for strengthening your quadriceps, hamstrings and gluteal muscles and will help protect your knees from injury. It is important that you remember to stretch and strengthen both the anterior and the posterior muscle groups of the thigh equally. If one group overpowers the other it can lead to patello-femoral pain, which is pain in the anterior part of the knee or pain posteriorly located behind the knee. To see a video on how to properly perform these exercises, please click on the link, as it will redirect you back to the MayoClinic.com (http://www.mayoclinic.com/health/squat/MM00724)

Calf and Ankle Exercises – Increasing your calf strength and the strength of the muscles passing from the leg, across the ankle joint and into the foot will improve balance as well as decrease your risk of high-grade ankle injuries, plantar fasciitis and tendonitis among others. Simple exercises for the calf include jump-roping, single-limb heel raises with your heel hanging off the edge of a stair (3 sets of 15 reps each side), and a weighted toe raise. The weighted toe raise can be done with something as simple as a sack of potatoes hung from the mid-foot with the leg at 90 degrees and dangled over the edge of a table. Pull the toes up towards your head, hold for 3 seconds and then lower the toes back to neutral; repeat for 15 repetitions, 3 sets. Exercises for the ankle focus on stability and include a single-limb stance with the knee slightly bent held for 30-45 seconds. Balance boards, used under the instruction of a trainer can also be effective for increasing ankle stability and decreasing your risk of injury. For fun, lie on your back with one foot in the air and trace the alphabet with your foot. When you get to “z” switch to the other side.

The thigh and calf exercises can both be completed on the days in between your cardiovascular workouts, in sets of 3, 15 repetitions for each exercise. It is important that you give yourself at least one, if not two days a week for rest and recovery period so that you don’t fall victim to overuse injuries. Should you start to feel pains that feel out of proportion on one side of the body versus the other, consult your Podiatrist or Primary Care Physician for a referral and discontinue all exercise until further investigation can be completed.

Weekend Winter Warriors

Thanksgiving marks the beginning of many holiday traditions including pick-up football games, hanging holiday lights and family ski trips. It is during this time of year that injuries commonly see in athletes playing high impact sports are seen in the everyday business man or woman: the “weekend warrior” type of individual.

The injuries that make the newspapers are unfortunately the more life-threatening injuries, but those suffered in the lower extremity can also be quite detrimental to a person’s quality of life. Over the next two weeks, I will break down some of the common injuries experienced in the winter months, how they are treated, and what can be done to prevent them.

1. 5^th Metatarsal Fractures: This is a fracture of a long bone in the forefoot that connects to the 5^th toe. This type of fracture is typically associated with an inversion ankle sprain, which occurs when the foot flexes downward and the ankle rolls inward. Inversion ankle sprains can occur with normal activities such as walking, and are common in pick-up sports such as football and basketball. There are five types of 5^th metatarsal fractures, but the most commonly seen is an Avulsion Fracture. Avulsion fractures occur when the tendon (proneus brevis) attached to the base of the 5^th metatarsal bone, sharply contracts during an inversion sprain and avulses, or pulls off a piece of bone. Treatment includes RICE* and immobilization for 4-6 weeks in a below knee cast, where the patient should remain non-weight bearing. Prevention for this type of injury can include strength training with a physical therapist as well as strapping or bracing of injury prone ankles prior to athletic activities.

2. Boot-top Fractures – Fractures of the Tibia from Ski Boots: “Boot-top” injuries occur when skis do not release from the ski boots during collisions. The skiers body continues forward while the boots remain fixed to the snowy surface. The tibia and often times the fibula (the bones of the leg) will fracture when enough force is applied. This type of injury often requires reduction, meaning the bone pieces need to be realigned, and often times surgery is required in order to stabilize the bone. The patient will be immobilized for at least 6 weeks in a below knee cast, where the patient must remain non-weight bearing. Taking care to have properly fitted and adjusted ski boots can help decrease the risk of “Boot-top Factures,” along with ensuring that the boot release is appropriate for the level of skill of the skier. Ski lessons for beginners are also a must!

Although these types of injuries are relatively rare, you should be aware of them and take preventative measures to ensure your safety! If you do experience injury to the lower extremity make sure to seek medical attention immediately, whether that be by going to the Emergency Room or by calling your Podiatrist to make an immediate appointment.

Don’t forget to check back next week for more “Winter Warrior” injuries explained!

*RICE: Rest, Ice Compression and Elevation

Get A Move On!

Exercise regimens are important for any individual, but are of increased importance in the diabetic population. It has been shown that exercise lowers blood sugar levels and improves the body’s ability to use glucose.

During exercise in the non-diabetic individual the muscles of the body demand increased fuel sources, thus they turn to glycogen stores in the muscles themselves. If additional fuel sources are needed, the muscles will use glucose from the blood stream and eventually the liver, where glycogen is converted to glucose or stored proteins and fats will be used to supply energy.

In the diabetic patient this process isn’t as efficient. This by no means gives you a ticket out of exercising, but must increase your awareness in selecting exercises that are most appropriate.

Your exercise regime should be focused on increasing flexibility and maintaining proprioception. Proprioception is the body’s ability to feel that the ground is beneath your feet. When proprioception is lost, which occurs often in the diabetic patient, the risk and incidence of falls increases. Below are several exercises that will both increase flexibility to decrease deformity as well as increase proprioceptive reflexes to decrease risk of injury.

• Cardiovascular Exercise – this is exercise that makes you sweat and increases your heart rate, but should be low impact. Good options for “cardio” include walking, stationary bike, swimming or jumping rope. (20 minutes)
• Sit to Stand – Sitting in a chair with your knees bent at a 90-degree angle raise yourself from the chair without using your hands. Lower yourself down and repeat. If you feel unsteady, try to use just one hand for support. (3 sets of 10 repetitions)
• Seated Single Leg Raise – Sitting forward in a chair with your knees bent at a 90-degree angle, straighten the right leg at the knee elevating the foot off the floor, hold for 3 seconds and return to the start position. Repeat on the left leg. (3 sets of 10 repetitions)
• Calf Stretching – Facing the wall, place your hands onto the wall in front of you, place one foot forward with knee bent and one foot back with the heel touching the ground. Lean into the wall keeping the back leg straight and the heel on the ground. Hold for 10 seconds, relax and repeat. After 10 repetitions switch legs. (3 sets of 10 repetitions on each leg)
• Tandem Repeats – Standing close to a wall with feet shoulder width apart, place one foot in front of the other and hold for 5 seconds, return to start. Repeat on the other side to complete 1 repetition. For increased proprioception, close your eyes and try to complete this exercise. (3 sets of 10 repetitions)

The U.S. Government recommends a minimum of 5 days per week of appropriate exercise, but 3 days a week, or even 2 days a week are better than none. Remember to do as much as you can without overdoing yourself! If you experiencing calf pain, referred to as claudication pain, during exercise and you find yourself traveling shorter and shorter distances daily, you need to see your Podiatrist immediately. This could indicate decreased blood flow to your lower extremities and demands further vascular investigation.

So, get out there and get exercising!