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foot-pain

Plantar Fasciitis: Heel to Toe Pain

/26 November 2024/ All MFN blog/

Overly stretched, tiny tears can lead to inflammation and pain in the arch of the foot. This condition, called plantar fasciitis, accounts for nearly one million doctor visits per year. Our foot has a thick band of tissue called fascia that runs from our heel to our toe. This troublesome foot issue is actually more common in women than men. We need to spend time on our feet moving, so this foot problem, if left untreated, can cause excessive pain and greatly limit our mobility.

Contributing Factors

Plantar fasciitis is more common as we age (specifically between ages 40 and 60), but is also more likely to occur in someone who is overweight or constantly on their feet. It is very common in runners. Activities that are known for high rates of plantar fasciitis include ballet, dance, long-distance running, and ballistic jumping. There are a few other contributing factors which include wearing shoes that are worn out and have thin soles or wearing high-heels. The mechanics of how you walk (your stride) involves your foot position. If you have flat feet or a tight Achilles, the body will compensate for these dysfunctions which can lead to injury of the fascia.

Pain

Pain starts to occur near the heel towards the bottom of the foot. Most people feel the pain in the morning right when they get out of bed. This is known as “first-step pain”. This can also occur if you have been sitting for a long period of time and then stand up. The plantar fascia acts like an absorbing shock spring in our foot. Repetitive stretching and tearing of this area results in a stabbing pain.

Treatment

If pain persists, seeing a doctor can help detect this condition. He or she will check the tender areas of the foot. The good news is that plantar fasciitis does normally go away on its own. There are several treatment options. A doctor might prescribe anti-inflammatory medication or a steroid injection. Physical therapy and massage can help as well as shock wave therapy to stimulate blood flow. A Tenex procedure can remove scar tissue in the area or surgery can be done to remove the plantar fascia off of the heel bone. Wearing the right shoes or using shoe inserts oftentimes does the trick, so be sure to try these simple fixes first. Ice and soaking the heel can also help alleviate pain .

A good home remedy is freezing a foam cup of water then rubbing the top of the cup on the heel for 10 or so minutes. Stretching the calves and Achilles tendon can help over time and there are ways to tape the area of the foot to position the heel correctly with each step. Night splints worn to hold the foot at a 90 degree angle help when stretching the fascia.

There’s no doubt that we use and abuse our feet, bearing vast amounts of weight on them while performing all of our daily functions. As we walk from point A to point B, getting those 10,000 steps in, we must practice self-care from head to toe to heel. Sometimes foregoing that cute pair of shoes even at the gym is worth the fashion sacrifice to walk without pain.

Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

 

References

https://journals.lww.com/jaapa/Fulltext/2018/01000/Plantar_fasciitis__A_review_of_treatments.4.aspx
https://journals.sagepub.com/doi/full/10.1177/2473011419896763
https://academic.oup.com/occmed/article/65/2/97/1488760

Pregnant-woman-at-gym

Building Strength is an Important Component in a Prenatal Fitness Routine

/20 November 2024/ All MFN blog/

You may have heard people warn that pregnant women shouldn’t raise anything over their heads or lift objects that are heavier than ten pounds when pregnant. These are warnings that still make the fitness trainer rounds when working with pregnant clients, yet these warnings aren’t based on science.  In fact, there’s no evidence for warning pregnant women to avoid lifting over their head unless it causes discomfort or balance issues, and the ten-pound limit is even more questionable, as ten pounds would be too heavy for some women and as easy as a feather for others.

It’s important to always remember that each pregnant woman has a specific fitness level and ability, so setting arbitrary limits is an ineffective way to provide guidelines for this population. In addition, when confronted with statements such as these, always review the research that supports the claim before implementing the information into your training guidelines.

Many women choose to continue their pre-pregnancy strength training program while they are pregnant, and most women may safely start strength training during their pregnancy as long as they are cleared for exercise by their healthcare provider. When developing a pregnant woman’s fitness program, you should take into account her current level of fitness and strength and pay close attention to how she feels during and after exercise. The key to maintaining a safe and effective routine is through consistent modification of the exercises for comfort as pregnancy progresses.

Strength training is an essential prenatal fitness component, providing the muscle power needed to compensate for posture adjustments and weight gain that occurs with pregnancy. Women who continue or even start a strength training routine during pregnancy can help prepare her body for all the lifting done with a new baby and reduce the risk of low back pain. Strength training has not been shown to pose any harm to either the fetus or the mother as long as these general guidelines are followed:

  • A gradual reduction in weight loads from pre-pregnancy will likely occur as the pregnancy progresses.
  • Women may continue their pre-pregnancy strength training routine (wt/reps/set) as long as they modify the exercises for comfort as pregnancy progresses.
  • If training causes muscle soreness during the pregnancy, it is recommended that overload be progressed by increasing the number of repetitions versus the resistance/wt.
  • Monitor exercise techniques carefully by mirror observation or supervision in order to correct for progressive postural changes that occur with advancing pregnancy. Improper lifting techniques may aggravate back problems and increase soft tissue injuries.
  • Avoid maximal static lifts. They may cause a sudden increase in cardiac output and blood pressure and employ the Valsalva maneuver. During the Valsalva maneuver, there is a significant diversion of blood from the internal organs (such as the uterus) to the working muscles.
  • Maximal lifts may also place extreme stress on the lumbar spine and other joint areas. Never overload an unstable or weakened joint.
  • Modify supine positions after the first trimester of pregnancy by using an incline board or wedge.
  • A strength-training workout involving all the major muscle groups should be performed three times per week, with a rest day between each muscle group training bout.
  • Machines, free weights, resistance bands, and body weight
  • are all options for building a strength training routine.
  • Remind client that she should exhale with the lift and avoid holding her breath or bearing down and straining as she lifts.
  • If a particular exercise continues to produces pain or discomfort are modification, it should be discontinued. If pain persists, the client should consult with her healthcare provider.

As always, all pregnant women should check with her healthcare provider before starting or continuing an exercise program during pregnancy.

Catherine Cram, MS started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, “Women’s Health in Physical Therapy” and co-authored the revision of “Exercising Through Your Pregnancy” with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.

walking mindful

Can Mindfulness Improve your Balance?

/1 October 2024/ All MFN blog/

Short answer: Absolutely.

Focused attention has the power to improve your health, mood and cognition. When it comes to moving steadier, research shows that practicing mindfulness while walking can improve balance in older adults. This is a simple practice that anyone can do to move more freely and live more fully with more confidence.

What is Mindfulness?

Being mindful means to simply focus on the present moment. Its roots stem from ancient eastern and Buddhist philosophy. It includes being aware of your thoughts, feelings, sensations and the surrounding environment through a gentle, nurturing lens. This way you can tune into what you are sensing in the present moment rather than living in and rehashing the past or projecting into the future. 

Mindfulness Elevates Health

Do a PubMed search on “mindfulness and health” and 14,955 studies pop up in the National Library of Medicine! These research studies show there are numerous well-being benefits that can help people of any age with any health condition including:

  • Reducing stress and pain
  • Improving physical health and chronic conditions like arthritis, diabetes and cancer
  • Promoting cognitive function, attention and memory
  • Elevating emotional well-being and mood
  • Healthier aging and resilience
  • Improving balance!

One foundational way that mindfulness and meditation improve health is by calming your nervous system. Moving out of the sympathetic stress response and into the parasympathetic relaxation response is where health happens. It’s where the body can rest, digest, heal and repair itself. 

Constantly living in “stress mode” where you always feel overwhelmed, fearful or tense puts your body into a chronic state of inflammation that damages cells, tissues and organs. This damage accumulates and can lead to impaired bodily systems from your nervous system, respiratory, cardiovascular, musculoskeletal, and immune system. This can result in inflammaging where the body is under constant stress and strain and breaks down more than it can repair itself. It is a major reason for the age-related decline in physical and cognitive function that makes it more difficult to move and think smoothly and easily. 

Mindfulness for Better Balance

It’s well-accepted that practicing Tai Chi improves ankle proprioception and balance. Now studies are showing that walking meditation can do the same for elderly women and older adults with history of falling (1, 2). Walking meditation has even been shown to improve ankle proprioception and balance performance in people with chronic ankle instability! (3)

Walking meditation is a mindfulness practice where you walk slowly while focusing your attention on your leg and foot movements (2). Researchers saw improved ankle proprioception and balance improvements with older adults being able to stand on one leg for a longer time as well as increased neuromuscular control. When focusing your attention on your movement, researchers think that this improves the brain processes related to body awareness and balance adjustments (1). 

Stronger neural and muscular connections mean you can be faster to sense and respond to your everyday environment, as well as recover from the loss of balance to effectively prevent a life changing injury or fall.  

Practice Mindful Movement

For the happiest, healthiest and safest holiday season, before engaging in activity, focus on “BEAM” to relieve stress, boost mood, build a sharper brain, taller posture and better balance. BEAM is an acronym that stands for Breathe, Elongate, Align and Move Mindfully. 

You can imagine being as long, strong and sturdy as a “beam.” Another meaning of “beam” is to be happy, smiling and radiating a line of bright light or energy. Visualizations can enhance physical and emotional well-being and help bring your attention into the present moment.

BEAM for Better Brain, Body and Balance

Breathe: take 3-4 deep breaths into the front, back and sides of your belly, up into your ribs and then chest; exhale in the opposite direction from your chest, ribs and then squeeze your belly button towards your spine. 

Elongate: lengthen your spine on each inhalation lifting from the crown of your head

Align your body: feel light with body parts lined up; ears over shoulders, shoulders over hips, hips over knees and ankles. Practice standing with feet hip distance apart, toes pointing forward and knees softly bending over your second and third toes; pelvis is in neutral, your sternum lifts up and out with ribs aligned over pelvis, shoulders are back and down away from the ears, line up ears over shoulders that are over hips, knees and ankles. 

Move Mindfully: think about where you are and what you are about to do; whether you are cooking, cleaning, going up or down stairs or walking inside or outside focus on your leg and foot movements

Practice BEAMing throughout your day so you can move mindfully and enjoy feeling sharper, steadier, lighter and more confident with each step you take throughout the holiday season.  

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Cate Reade, MS, RD is a Registered Dietitian and Exercise Physiologist on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

References

  1. https://pubmed.ncbi.nlm.nih.gov/31563384/. Walking meditation promotes ankle proprioception and balance performance among elderly women.” Jour Bodywork & Movement Therapies 2019
  2. https://pubmed.ncbi.nlm.nih.gov/34931904/. “Walking meditation versus balance training for improving balance abilities among older adults with history of fall: A randomized controlled trial.” Clin Rehabil. 2022 
  3. https://europepmc.org/article/med/35093512. Comparative effect of walking meditation and rubber-band exercise on ankle proprioception and balance performance among persons with chronic ankle instability: A randomized controlled trial. Europe PMC 2022
lunch-food

Reverse Dieting: The Diet After the Diet

/26 September 2024/ All MFN blog/

A popular form of eating in the bodybuilding/fitness community is called reverse dieting. This type of eating follows the period after sticking to a low-calorie diet for a period for a period. The reason to eat this way is to avoid regaining a large amount of weight quickly after reintroducing higher calorie eating again. Low calorie diets are unsustainable, but when more calories are brought back, regulating how this is done can be important. Other people do reverse dieting when they feel like they have reached a weight loss plateau. 

The key principle behind reverse dieting is called adaptive thermogenesis. Another term for this is metabolic adaptation. The body is telling its metabolism that energy intake is increasing but energy output needs to decrease to slow down weight loss from happening too fast. To effectively do this, the body can try a few mechanisms. The body is not meant to keep these changes ongoing, rather, they are temporary measures during the caloric restriction. Hormonal changes can take place. These are the hormones related to hunger cues which include ghrelin, leptin, insulin, and peptide YY. These hormones will either be suppressed or released to tell you to eat. Another approach is called EAT which means exercise activity thermogenesis. Overall, the body feels like it doesn’t have enough energy to exercise so you don’t burn as many calories when exercising. There can also be a decrease in NEAT which means non-exercise activity thermogenesis. This is the energy you need to live day to day life to do activities like walking or getting chores done. RMR, which is resting metabolic rate, can also decrease. The body will shift its focus to using energy for what is vital to live, versus paying attention to energy needed for less important factors like hair growth or something like nail growth. Overall, digestion can slow down. The body recognizes that less is being eaten so it slows down digestion to absorb as much as possible nutritionally from what foods that are consumed. TEF also decreases which is the thermic effect of food. 

Individuals have different experiences of gaining weight after a period of dieting. In general, maintaining weight loss can be difficult and it requires the work and effort that was put in to lose the weight. Hitting or reaching a goal then abruptly stopping this behavior would eventually lead to weight gain because of the shift. Some people let go and overeat in a rebellious manner. They might even eat the foods they were not supposed to have during restriction. Some bodybuilders might even deem this as a period of binging. Activity level, environment, and food choices are all influencing weight gain factors. 

The general guideline to reverse diet is that for the next 4 to 10 weeks after a diet, about 150 calories is added weekly to your eating until you get back to the amount you were having pre low calorie. The plan can be more conservative or aggressive where some people might add about 5% of calories back in weekly and others might add back in 15% each week. 

This is an example if you originally ate 2,000 calories per day, restricted to 1,200, and wanted to return to 2,000 over a 12-week time frame in a more conservative manner:

11,260 + 60 calories (5% of starting calories) = 1,320 calories
21,320 + 60 = 1,380 calories
31,380 + 60 = 1,440 calories
41,440 + 60 = 1,500 calories
51,500 + 60 = 1,560 calories
61,560 + 60 = 1,620 calories
71,620 + 60 = 1,680 calories
81,680 + 60 = 1,740 calories
91,740 + 60 = 1,800 calories
101,800 + 60 = 1,860 calories
111,860 + 60 = 1,920 calories
121920 + 60-80 = 1,980-2,000 calories

The gradual process will restore energy and more control over hunger cues with each week. Staying in a low-calorie deficit then eating more has its pros, cons, and risks. Finding an eating style that is lasting and sustainable is always better than any up and down approach. Eating for a specific goal might be a circumstance that would entail restriction that replenishing, but the approach is important for your metabolism to adjust to what is taking place. Food is fuel and nutrition, but we all have relationships with it that adjust during certain periods of life. How we respond and gradually find our way back to a healthy lifestyle is what matters. 

Originally printed on Every BODY’s Fit blog. Reprinted with permission.

Dr. Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health and a Ph.D in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

Resources/References

senior fit yoga

Chronic Disease Wellness: Disparities Among African American Active Agers

/19 September 2024/ All MFN blog/

Are you one of the 50% of people in the United States that suffers from chronic pain due to an illness or injury? Or are you the 1 in 4 adults with at least one form of arthritis or experience inflammation due to an autoimmune disease? Maybe you are a part of the 45% of people who have been diagnosed with type 2 Diabetes or the 12% that have at least 5 chronic illnesses?

According to the Center for Disease Control, an increasing proportion of Americans are dealing with multiple chronic illnesses and are living in chronic pain. However, the good news is that our medical and fitness industry has been making some headway when it comes to promoting and educating the public on the power of exercise to prevent and reduce the onset of chronic diseases. With the growing number of specializations and medical fitness certifications, the number of fitness professionals that are highly trained to work with this demographic is quickly growing due to the help of the most recent research that promotes exercise as way to prevent various diseases.

“You could really benefit from starting an exercise program.”

Do you have a doctor who understands the power of exercise? If so, that is a great start! Regular exercise such as: repetitive and exaggerated movements will activate and build muscle, which is valuable in restoring function, prolonging effects of diseases, and improving neural pathways, muscle memory & Neuroplasticity!

Exercise has been proven to help reduce pain, decrease the dependency on medication, and prevent diseases such as:

  • Heart Disease
  • Diabetes/Obesity
  • Metabolic Syndrome
  • Chronic Obstructive Pulmonary Disease
  • Stroke
  • Some Cancers

The benefits are seemingly endless, however, what about the people in the United States who lack the knowledge, time, money, or opportunity to implement and execute a fitness and wellness routine?  What if YOU are a part of the active aging African American community who faces significant disadvantages when it comes to health and fitness due to a combination of systemic, socioeconomic, and cultural factors?

What Do You Know About Cultural Disparities?

Historically, African Americans have had limited access to quality healthcare and fitness resources, which has led to a higher prevalence of chronic diseases such as hypertension, diabetes, and obesity. Additionally, socioeconomic barriers such as lower income and education levels often result in reduced access to healthy foods, safe exercise environments, and preventive healthcare services. These disparities are compounded by cultural factors, including mistrust of the healthcare system due to historical injustices and a lack of representation in health and fitness professionals, which can discourage engagement in health-promoting behaviors.

  • Access to Healthcare and Fitness Resources: African Americans often have less access to quality healthcare and fitness facilities in neighborhoods where they reside. In addition, they have little to no access to parks, sidewalks, and in some cases, transportation. 
  • Socioeconomic Barriers: Lower income and, in certain instances, education levels limit access to healthy foods, safe exercise environments, and preventive care.
  • Cultural Factors: Historical injustices and lack of representation in health and fitness professions contribute to mistrust and lower engagement. As a result, African Americans are disproportionately exposed to measurable physiological and psychological stress compared to those not of African American origin.  

Some statistics are quite startling: 

  1. African Americans are 1.7 times more likely to have diabetes compared to their white counterparts (American Diabetes Association).
  2. Only 23% of African American adults meet the federal physical activity guidelines, compared to 33% of white adults (CDC).
  3. African Americans have a 50% higher prevalence of hypertension than their white counterparts (American Heart Association).
  4. African Americans are more likely to die at an earlier age due to earlier prevalence of chronic conditions or diseases such as: diabetes, heart disease, cancer, stroke, asthma, HIV/AIDS.  (CDC & The Office of Mental Health, part of the Department for Health and Human Services.  

Addressing Disparities in Health and Fitness

Health and fitness coaches can play a crucial role in addressing these disparities by implementing culturally sensitive and accessible programs. Firstly, coaches can provide education on the importance of regular exercise and balanced nutrition, tailored to the specific needs and preferences of African American Active Agers. This can include offering workshops in community centers, churches, and other familiar settings, making it easier for individuals to participate. Secondly, coaches should advocate for and facilitate access to affordable fitness options, such as sliding scale gym memberships or community exercise programs. Ensuring that these programs are welcoming and inclusive can help reduce the intimidation or alienation that many African Americans may feel in traditional fitness environments.

  • Culturally Sensitive Education: Tailored workshops and programs in familiar community settings.
  • Affordable Fitness Options: Sliding scale memberships and community exercise programs.
  • Inclusive and Welcoming Environments: Reducing feelings of intimidation or alienation in fitness settings.
  • Provision of Resources:  Having a database of resources to help clients with areas outside our scope of work/care/expertise.  

Additionally, health and fitness coaches can foster partnerships with local healthcare providers to create a holistic approach to wellness that addresses both physical and medical needs. They can also serve as advocates for policy changes that improve access to health and fitness resources in underserved communities. By building trust and providing consistent support, coaches can empower African American Active Agers to take charge of their health and improve their overall quality of life. This multi-faceted approach not only addresses immediate fitness needs but also contributes to long-term health improvements and reduced disparities.

Nicole Gordon is a seasoned women’s fitness and health coach with over a decade of experience, specializes in empowering busy women to achieve holistic wellness. As a certified personal trainer, group exercise instructor, and integrative nutrition health coach, Nicole advocates for balanced relationships, meaningful movement, creativity, and spiritual well-being. Her coaching philosophy, centered on “staying in your lane” while striving for progress, helps clients attain improved mobility, flexibility, strength, and energy for a balanced life.

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is currently writing the MedFit Network Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

parkinsons-word-cloud

Parkinson’s Bone Health: Camptocormia

/17 September 2024/ All MFN blog/

Welcome back fighters, care-partners and fitness professionals! At Bridges For Parkinson’s, posture/vertical stability is a big concern and one we address in every class. Why? Because a strong, vertical spine means reduced falls, better gait, less back pain, increased lung capacity, ability to enjoy activities and live independently. However, fitness professionals observe some folks living with Parkinson’s disease having a severe forward lean at a 45-90 degree angle.

What is this? What causes it? And, is there a solution?

This forward lean is called “Camptocormia”, derived from two Greek words: Kampto- (To bend) and Kormos (trunk). Camptocormia was first documented in the 17th century by the Spanish painter Francisco de Zurbaran. In the 19th century, Brodie wrote about it. Later the term was coined by Rosanoff and Saloff who described the abnormality in World War 1 soldiers traumatized by shell shocks.

Camptocormia is defined as bent spine syndrome (BSS), an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position.

According to Srivanitchapoom and Hallett, approximately 3%-17% of the Parkinson’s population suffers from Camptocormia. See below examples of Camptocormia syndrome.

What Causes “Camptocormia”?

From a muscular perspective, the paraspinal, hip and glute muscles are in a weakened state making it difficult for the body to “fight back” against the neurological side of Camptocormia which we will discuss later in this article.

The paraspinal muscles are located on the left and right side of your spine and are made up of three groups.

  • Iliocostalis
  • Longissimus
  • Spinalis

Paraspinal muscles

The job of the paraspinal muscles is to extend your spine and to bend it over to the same side on which the contracting paraspinal muscle is located. For example: bending to the side to pick something off the floor.

The four main hip and glute muscles include:

  • The gluteal group (butt muscles) – responsible for stabilizing the upper body and pelvis, aid in locomotion and extend the hip. Example: when your leg travels behind you before kicking a ball.
  • The adductor group – responsible for pulling the thighs together and rotating the upper leg inward and stabilizing the hip. Example: When the leg moves to the center of the body after stepping out for a half-jumping jack..
  • The lateral rotator group – responsible for rotating the hip joint laterally. Additionally this group will aid in extension and adduction of the hip. Example: Piriformis stretch also known as the “figure 4 stretch”
  • The iliopsoas – this is the primary hip flexor and assists with external rotation of the hip joint. It plays an important role in correct posture for standing/sitting lumbar position and walking/running.

These muscle groups play a vital part in your activities of daily living! Bridges For Parkinson’s addresses these muscles groups with exercises such as:

  • Sit to stands
  • Squats
  • Bridges/Bird dog/Seated Back Extension (with tubes)
  • Clamshells
  • ½ Warrior step
  • Deadlifts
  • Lunges (forward, reverse, lateral and diagonally)
  • Rows
  • T’s

And we progress the exercise to a higher level of difficulty by:

  • Standing on one leg
  • Adding repetitions or length of time
  • Standing on the BOSU/Pad

Now, let’s discuss the neurological aspect of Camptocormia. Much like “Pisa Syndrome”, the root cause is multifactorial and largely unknown.

Camptocormia is largely considered a neurological disorder due to its comorbidity with other neurodegenerative and movement disorders such as ALS, dementia with Lewy Bodies, Alzheimer’s, and Parkinson’s (Srivanitchapoom & Hallett, 2016). As mentioned, although the presentation of this disorder is largely based on the forward lean, with a tendency to worsen throughout the day due to muscle fatigue, the causes are up for debate in research. For now, the best guess we can take is that the association with PD and other dystonias translates to a faulty cascade of events in the major movement centers of the brain, and the brain-body connection as consequence (Margraf et al., 2016).

Typically, you will find Camptocormia in the more advanced stages of PD, such as those living with Parkinson’s for 7 or more years, those with previous spinal issues, and those who indicate lower motor function on neurological exams (Srivanitchapoom & Hallett, 2016). However, even if you meet any/all of these criteria you won’t necessarily develop this disorder.

The onset of Camptocormia can be mitigated with proper preventative care such as exercise and physical/occupational therapy. Additionally, for individuals with this syndrome, botox and surgery (DBS) can alleviate the severe forward lean.

Botox may be used as a treatment that “freezes” the muscles affected in this disorder, allowing the muscles to lengthen, in turn helping to improve posture. However, this is neither a permanent nor strong solution, although it is seemingly effective in smaller studies assessing the benefits of this treatment (Bertram et al., 2015; Todo et al., 2018; Anandan et al., 2021) . There are also long term drawbacks, the biggest one being muscle weakness that can cause overall worsening of the disorder. There are other, more permanent ways of managing this as well, but are much more invasive. Spinal surgery and Deep Brain Stimulation are two of the more “common” options, although to be considered for these the symptoms must be severe (Margraf et al., 2016). The best ways to manage this disorder are to continue taking your prescribed medication, and exercise to strengthen the muscles involved with keeping your posture upright.

How Does Camptocormia Affect Activities of Daily Living?

Similar to Pisa syndrome, Camptocormia is a non-fixed flexion of the trunk, which can lead to significant deficits in posture, balance, safety, and ability to perform daily activities. Posture is one of the pivotal components for ALL ADLs. So, from an occupational therapy scope, restoration of posture and maintenance of current occupational performance is key.

ADL training: due to posture changes when standing, patients may experience difficulty maintaining routine activities with dressing, bathing. ADL retraining helps to maintain independence and current level of occupational performance.

Seating and positioning: in order to promote improved posture, position hips in an anterior angle, which can allow for increased participation in ADL’s such as feeding or grooming. This can also help with visual ability and increase social participation. Positioning during sleep is another potential area to examine as we do not want to encourage further postural deformity.

Visual strategies: due to the posture changes while standing, camptocormia can lead to difficulty interacting with our environment as we typically would, especially visually. Implementing visual cues or compensatory strategies can help promote improved posture and allow for safe interaction within their home or social environment.

Examples of Cues

1. Sit/stand with shoulders down and shoulder blades pinched together as if you are royalty. Automatically, people position their head over the shoulders and sit/stand taller.

2. Walk with eyes lifted and looking in the distance. When people look down they tend to bend over and slump their shoulders. Looking in the distance prepares them for what is ahead and trains them to use peripheral vision for what is right in front of them.

Home Modifications: modifying home and using assistive devices such as installing grab bars, removing trip hazards (rugs), training with reacher will ensure safety and promote ADL participation.

Energy conservation: as the day continues and the patient feels more fatigued, posture will be more difficult to maintain. Learning and implementing energy conservation techniques could help to promote improved posture throughout the day.

Supine exercises: Supine exercises (on your back) will help to maintain muscle strength and endurance while maintaining proper posture throughout range of motion. These exercises eliminate gravitational pull and forward flexion due to Camptocormia.

In closing, Camptocormia is unique in that it develops over time in conjunction with a movement disorder. The strength of your physical structure depends on having the knowledge to identify possible bone issues such as Camptocormia, properly addressing the issue with corrective exercises and a team that provides support and encouragement.

Bridges For Parkinson’s focuses on helping our fighters and care-partners develop a sense of awareness, provide corrective exercise therapy for those dealing with Camptocormia or preventative exercises to support a strong, vertical spine!

Fit Pros: You Can Improve the Lives of Those Living with Parkinson’s

Enroll in Colleen’s 12-hour online course, Parkinson’s Disease Fitness Specialist. The course brings the research, medical and fitness fields together so that fitness professionals gain a comprehensive understanding of Parkinson’s disease, and learn how to work with those who have it.

Originally printed on bridgesforparkinsons.com. Reprinted with permission.

Written by:

  • Colleen Bridges, M.Ed., NSCA-CPT, Parkinson’s Disease Fitness Specialist
  • Renee Rouleau, PhD candidate, Jacobs School of Biomedical Sciences, University at Buffalo
  • Betsy Lerner, ISSA-CPT, MA English and African American Lit, Parkinson’s Disease Specialist and Rock Steady Boxing Certified
  • Cindy Nyquist, LPTA, ATC, Rock Steady Boxing Certified

References

  • Anandan, C., & Jankovic, J. (2021). Botulinum Toxin in Movement Disorders: An Update. Toxins, 13(1), 42. MDPI AG. Retrieved from http://dx.doi.org/10.3390/toxins13010042
  • Djaldetti R, Mosberg-Galili R, Sroka H, et al. Camptocormia (bent spine) in patients with Parkinson’s disease-characterization and possible pathogenesis of an unusual phenomenon. Mov Disord. 1999;14:443–7.
  • Margraf NG, Wrede A, Deuschl G, Schulz-Schaeffer WJ. Pathophysiological Concepts and Treatment of Camptocormia. J Parkinsons Dis. 2016 Jun 16;6(3):485-501. doi: 10.3233/JPD-160836. PMID: 27314757; PMCID: PMC5008234.
  • Schäbitz WR, Glatz K, Schuhan C, et al. Severe forward flexion of the trunk in Parkinson’s disease: focal myopathy of the paraspinal muscles mimickingcamptocormia. Mov Disord. 2003;18:408–14.
  • Srivanitchapoom P, Hallett M. Camptocormia in Parkinson’s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):75-85. doi: 10.1136/jnnp-2014-310049. Epub 2015 Apr 20. PMID: 25896683; PMCID: PMC5582594.
  • Todo, H., Yamasaki, H., Ogawa, G. et al. Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson’s Disease. Neurol Ther 7, 365–371 (2018). https://doi.org/10.1007/s40120-018-0108-x
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gout feet

Fitness Tips and Strategies to Prevent Gout Flare-Ups

/12 September 2024/ All MFN blog/

Gout, the disease of kings, is quickly becoming a global epidemic. You’re probably wondering why we called it the “disease of kings.” Well, the reason is pretty simple. Gout is (or was) called the “disease of kings” because it was a result of the overindulgence of food (like red meat) and alcohol in medieval times. Due to the cost of such a diet, the condition was associated with nobility. Hence the nickname “the disease of kings.”

Gout is one of the oldest joint diseases known to man, as far back as 2640 B.C. However, gout remains the most common form of inflammatory arthritis that haunts mankind in the 21st century. Although certain foods worsen this condition, scientists have found that gout occurs due to very high concentrations or build-up of uric acid in the blood.

In this article, we will shed more light on what gout is and explore useful fitness tips and strategies to help you prevent gout flare-ups. From choosing the right exercises to incorporating healthy habits into your daily routine, these tips can help you manage your condition and lead a more comfortable life.

Let’s get started on the path to better health and fewer gout attacks!

What is Gout?

Gout is a painful inflammatory arthritis caused by excessive build-up of uric acid in the body/blood. Uric acid is a natural substance in the body. It is an end-product of human purine metabolism and is excreted by the kidneys in urine. However, if it becomes too much, the uric acid circulating in the blood will form crystals that gather or deposit in the joints, leading to swelling, redness, and pain in the joints, tendons, and surrounding tissues.

Therefore, gout occurs when there’s an overproduction of uric acid in the body or when the kidney removes too little uric acid from the body. Both ultimately lead to an excessive build-up of uric acid in the body.

This condition causes painful swelling in the joints, most commonly affecting the big toe joint. However, you can have gout in the ankle, knees, feet, elbows, hands, and wrists. Gout is a chronic condition with symptoms that come and go (recur) in episodes known as gout attacks or flares. The symptoms tend to worsen during these episodes.

If left untreated, gout can cause permanent joint damage, joint deformity, and chronic pain. This can lead to immobility or a sedentary lifestyle, which will lead to muscle weakness and stiffness of the joints.

Tips and Strategies to Prevent Gout Flare-Ups

Whether you have gout and simply want to prevent future flares or you are at risk of having gout, making certain lifestyle changes will help. Prevention and management of flares is a possible endeavor.

Here are several tips and strategies to help you prevent gout flare-ups. By following these tips, you can manage your condition better and reduce the chances of experiencing painful attacks.

  1. Stay Hydrated Always

Staying hydrated (by drinking more water) is one of the simplest and most effective ways to prevent gout flare-ups and reduce symptoms. The ability for uric acid excretion is proportional to urine flow. Increasing water (or other fluid) consumption helps flush uric acid out of your body. It forces the kidneys to release excess fluid, reducing uric acid concentration and the risk of crystal formation in your joints.

Water is the best and easiest way to stay hydrated. A study found that adequate water consumption in the 24 hours before a gout flare significantly decreased recurrent gout attacks. However, other fluids like herbal tea can suffice. Nevertheless, soda, alcohol, and fluids high in purines must be avoided. Aim to drink at least eight glasses of water daily to stay well-hydrated. If you have kidney disease or congestive heart failure, consult with your doctor before increasing your fluid consumption.

  1. Choose Low-Impact Exercises

Exercising decreases uric acid levels in the blood, reducing the risk of gout or gout flare-ups. When the body doesn’t move often, the joints become stiff and less flexible. A study found that physically active males had a lower risk of gout than sedentary males. However, the pain from gout attacks makes it difficult to move around. Fortunately, exercise modalities can help restore mobility after a gout flare-up.

High-impact or strenuous muscle exercises can put too much pressure on your joints and increase uric acid levels, potentially triggering a gout attack. Whereas moderate or low-impact exercises do not have such an effect. Moderate-intensity physical activity reduces uric acid concentration in obese individuals. Therefore, opt for low-impact exercises like swimming, cycling, or walking. These activities are gentle on your joints while still helping you stay fit and active.

  1. Maintain a Healthy Weight

Carrying extra weight increases the stress on your joints and raises your uric acid levels. In summary, weight gain is a strong risk factor for gout attacks. The good news is that it is possible to lower uric acid levels and the risk of gout by reducing body weight. This can be achieved through dietary modifications and regular exercise. When you shed excess weight, it corrects both the body’s underexcretion and overproduction of uric acid.

Keeping a healthy weight through a balanced diet and exercise can lower your risk of gout flare-ups. Even losing a small amount of weight can make a big difference.

  1. Eat a Balanced Diet: It Does Wonders!

What you eat plays a big role in managing and preventing gout. After all, people with gout (or hyperuricemia) typically have a poor diet. The trick is to have a balanced diet. By balanced diet, we mean a combination of nutrient-dense and minimally processed foods. These foods will help reduce uric acid levels and the risk of gout flares.

Avoid foods high in purines, such as red meat, shellfish, and sugary drinks, as they can increase uric acid levels. However, not all purine-containing foods increase uric acid levels and gout risk. Plant-based foods like beans and nuts are okay to eat, while animal-based foods like red meat and shellfish are not recommended.

Nevertheless, focus on a diet rich in fruits and vegetables. They contain high amounts of antioxidants, which can reduce inflammation. People with gout can also have a diet of low-fat, whole grains, low-carb, and lean proteins. Foods like cherries, which have been shown to reduce uric acid levels, can be especially beneficial.

  1. Avoid Alcohol

Alcohol, especially beer (which is high in purines), can raise uric acid levels and trigger gout attacks. Unfortunately, there’s no way around this. Alcohol intake triggers gout attacks, regardless of the type of alcohol. So, try to limit your alcohol intake of all types of alcohol or avoid it altogether. If you choose to drink, opt for wine (as it contains antioxidants and phytoestrogen) instead of beer and do so in moderation.

Conclusion

Living with gout flares can be a painful and exhausting ordeal. Plus, the inflammation that comes with it is just too much to deal with. Fortunately, you take back control by employing the fitness tips and strategies outlined in this article.

It’s not too late to make these healthy lifestyle choices. By following the tips mentioned in this article, you can prevent gout flare-ups and live a more comfortable life. Remember, small changes in your daily routine can make a big difference in managing and preventing gout flares.

Frequently Asked Questions

How can I fix gout permanently?

Gout cannot be cured, but it can be managed to prevent flare-ups. Some treatments can help slow down the progression of gout and reduce the frequency and severity of flare-ups or attacks. Making lifestyle changes and fitness strategies, such as eating a healthy diet, maintaining a healthy weight, and drinking plenty of water, can keep gout under control.

Are eggs bad for gout?

No, eggs are not bad for gout. In fact, they are low in purines and may lower uric acid levels in the blood. Plus, they are a good source of protein. So, people with gout can include eggs in their diet without worrying about a gout flare-up.

Can you squeeze gout out?

No, you cannot squeeze gout out. The inflammation caused by gout is quite tempting to squeeze. Moreover, gout cannot be excised without affecting the surrounding tissue. There’s simply no way to break up gout crystals physically, and trying to squeeze or massage the affected area will make the pain worse. The only way to manage gout symptoms is to reduce uric acid levels in the blood.

Victor Alex is a seasoned freelance writer with a passion for health and wellness, fortunate enough to turn his interests into a fulfilling career. With a keen eye for the latest developments in overall wellness, he crafts engaging content that resonates with his audience. When he’s not writing, Victor can be found exploring the latest trends in fitness and nutrition.

References