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.

“What Not to Wear”…5 Tips for Keeping Safe and Choosing Appropriate Winter Gear!

As temperatures drop and snow begins to fall across the country, winter snow gear, sleds, skis, snowmobiles and ice fishing gear are being pulled from the closets. So, what is it that you need to know this winter about keeping your feet safe, warm and properly outfitted?

1. Safety: The most important thing to keep in mind is safety and not just regarding your feet, but also protecting your head. Make sure that when you head out to engage in winter fun, you dress warmly, wear your helmet and follow safety guidelines. Know the temperatures, mountain conditions, weather forecast and your abilities all before leaving the house. If you are new to the sport, it is also important that you take a lesson to ensure your safety and the safety of others.

2. Blended Wool not Cotton Socks: By design, cotton is a material that absorbs and retains moisture. With any activity, feet tend to sweat and those cotton socks you’ve been wearing won’t do anything to keep your feet dry. Wet socks lead to decreased foot temperatures and increased incidence of friction, blisters, and ulceration especially in the diabetic population. Wool has a tendency to wick away moisture, so that is a much better option over cotton. Polypropylene and other synthetic fibers also trump cotton in wicking away moisture.

3. Choosing the Right Boots: Whether your skiing, snowboarding or heading out to build a snowman with your family, you need to have boots that are designed and fitted for your sport. Make sure that when you try on a boot, it fits along the foot maintaining appropriate circulation but slightly snug so that when the boots “break-in” after several wears, they still fit. They should be properly padded around the ankle and they should never be too stiff. Finally, try boots on before you make the purchase!! It sounds ridiculous, but many patrons do not try on a pair of boots before they hand over their credit cards and are simply buying based on the style and color of the boots. This is a major no-no! Put them on, run around the store, kneel down and stress the boots as they will be stressed once you get them home. If they feel comfortable after all that, then its safe to add them to your closet.

4. Custom Foot-Beds: First and foremost, do not put custom orthotics, made for running and hiking into your ski and snowboarding boots. Your custom orthotics CAN be inserted into snow boots for shoveling and trekking to the convenient store and they CAN be transferred into your snowmobiling boots, and sledding gear. The reason they should not be inserted to skiing or snowboarding boots is that in those sports you are not moving through the traditional phases of the gait cycle. Skiing and snowboarding puts the body, legs and feet into mid-stance thus forces across the foot that occur with walking and running are completely different than those that occur during skiing. If you are having pains in the feet and/or knees with your winter activities, see your local podiatrist and bring your boots along with you. Custom orthotics can be fabricated to support your foot in mid-stance thus providing proper alignment while engaging in activity.

5. Keep in shape: Next week we will be discussing off-season and in-season strengthening exercises to keep you strong throughout the winter season. Staying in shape for the activities which you plan to engage in will keep you safe and allow you to engage up to your abilities without overshooting and injuring yourself.

Take Two: Common Winter Sports Injuries

1. Frostbite: Frostbite occurs when there is decreased blood flow and decreased heat delivery to the toes, but can also affect the fingers, nose and ears. Ice crystal formation takes place in the affected areas and depending on the severity of the injury can involved tendons, nerves, muscles or even bone. Symptoms include numbness, tingling, burning or loss of sensation to the area and color changes may be noted. Prognosis depends on the extent of the injury and determining this may takes weeks. In some cases amputation may be necessary or in less traumatic cases, increased prevention for reoccurrence is the only treatment. To prevent frostbite, make sure to take frequent hot-chocolate breaks from being out in the cold temperatures and investing in foot warmers to be placed between your socks and your boots will also be helpful!

2. Ankle Fractures: Ankle injuries, including sprains, strains and fractures are very common in the winter months as icy and snowy conditions lead to increased incidence of falls. According to Lauge-Hansen, an Ankle Fracture classification system, there are 4 main categories of ankle fractures classified by the position of the foot and the motion that takes place as the fracture occurs. The most common ankle fracture is classified as “Supination External Rotation” fracture (SER); meaning there is inward rotation of the ankle while the leg and body move in the opposite direction. In the most severe SER ankle fractures the tibia and fibula (bones of the leg) are broken and the ligaments surrounding the ankle are ruptured resulting in dislocation of the ankle joint. Patients suffering this type of injury will need surgical intervention to realign and stabilize the bones with internal hardware (pins and screws) in addition to repairing the ruptured ligaments. Be prepared for at least 6 to 8 weeks of complete immobilization. Preventing ankle fractures starts with wearing winter boots that have suitable traction on the bottom. Watch where you walk, and if it’s not necessary to leave the house during icy conditions, stay home and watch you’re favorite holiday movie!

3. Calcaneal (Heel) Fractures: Calcaneal fractures are less common than other type of the injury to the foot, but in the event that they do occur, they are severely debilitating. This type of injury is caused by a high impact vertical force that can occur after jumping out a window or more realistically, a fall from a ladder while hanging holiday decorations and lights! Calcaneal fractures present with severe pain and “Mondors Sign:” severe bruising of the heel that extends to both the medial (outside) and lateral (inside) areas of the foot. Due to mechanism of injury, patients often suffer associated injuries including spinal fractures. The treatment for Calcaneal fractures is much the same as that for Ankle fractures: surgical repair is necessary with the use of internal hardware and long periods of immobilization. Make sure that when you are hanging decorations this holiday season, you have a helper with you that can stabilize the ladder you’re climbing, preventing a fall.

As mentioned last week, taking preventative measures will decrease the incidence of injury, especially during the winter months. Consult your Podiatrist if you have any concerns or need suggestions for selecting appropriate “winter gear.” If you do experience a traumatic injury, get yourself to the Emergency Room as soon as possible, or call your Podiatrist for an emergency appointment.