Category: Exercises

Belly Fat

 

Body image and self-confidence can be greatly improved with physical activity and dietary changes, but arguably more important, are the numerous health benefits of exercise and proper nutrition.

One misconception about belly fat or abdominal fat is that you need to target only the abs to reduce belly fat. This is not exactly the case because the body is not very efficient at targeted fat burning.   Instead, fat burning exercises, such as aerobic exercises, burn fat fairly evenly throughout the body. Losing belly (abdominal) fat can best be attained by combining several techniques, rather then focusing on just abdominal exercises such as crunches and sit-ups.

It is important to take note of your body habitus or shape. By now, you have probably heard about the “apple” and the “pear” body shapes.

  • Pear–shaped body: people carry fat around under the skin or “subcutaneously” in the hips, thighs and buttocks
  • Apple–shaped body type carries a type of fat known as “visceral” fat, or fat stored in the abdominal cavity

The danger of this visceral fat in the abdomen is that it surrounds internal organs such as the liver, pancreas, kidneys, intestines, etc. Visceral fat cannot be pinched. You can be skinny and still have visceral fat.   Fat cells are not passive, but in fact, active cells. Visceral fat cells produce fatty acids and inflammatory cytokines (chemicals) that can drive or worsen existing inflammation (such as arthritis or cardiovascular disease).   In contrast, subcutaneous fat (fat you can pinch under your skin) produces beneficial hormones such as leptins that drive your sense of fullness.

There are many factors that determine the placement of fat on our bodies. Some are modifiable while others are not. Genetics definitely play a role on visceral fat, as does various hormone levels, but so to does your total calorie intake. In addition, the composition of your diet, including the amount of dietary protein, level of dietary sugar intake, and type of fat consumed in your diet, all have implications on fat storage and overall health.

Elevated visceral fat (belly fat) has been linked to:

  • Metabolic disturbances
  • Cardiovascular disease (strokes and heart attacks)
  • Diabetes
  • Cancers (such as breast)
  • Arthritis
  • Demenita, Anxiety, Depression
  • Sexual dysfunction

According to the American College of Sports Medicine, you are at significantly increased risk of cardiovascular events if you have a waist circumference of > 40 inches in males and > 35 inches in females.   There is a test you can do to determine if you are at an increased risk called the Waist-to-Hip circumference ratio. Using a tape measure, check the circumference of your waist at your narrowest point and measure the circumference at the widest point of your hips.   If your ratio of Waist/Hips is > 0.95 as a male or > 0.86 as a female you are at significantly increased risk for cardiovascular events, hypertension, and type 2 diabetes.

So what should you do?

Diet: this is the most important component of your strategy to reduce your abdominal fat and bloating.

  • Avoid foods which bloat you (different for different individuals)
  • Avoid chewing gum
  • Avoid simple sugars and processed carbs
  • Avoid alcohol – the liver will burn this instead of fat for energy
  • Avoid dehydration – Drink water
  • Avoid bubbly drinks as this can worsen abdominal gas and bloating
  • Avoid wheat/gluten
  • Chew your food until it is liquefied for better digestion
  • Consider adding a probiotic if o.k. with your Physician or Health Professional
  • Add 10 grams of soluble fiber to your diet –(1 cup of peas or 2 apples)
  • Avoid trans-fats which are stored as visceral fats

Exercise:

  • At least 30 minutes of moderate intensity exercise 5 days per week
    • High intensity interval training – helps burn visceral fat
  • Strength train 2-3 times per week to build muscle mass
  • Target all major muscle groups when strength training
  • Core exercises build abdominal muscle which will in turn burn fat all over body (but not locally around the abdomen)

Other:

  • 5-8 hours of sleep per night is optimal per study done by Wake Forest
  • Try to reduce stress – cortisol (a stress hormone) promotes visceral fat storage
  • Have your doctor check your hormone levels if you are worried – low testosterone in males and low estrogen in females can be associated with visceral fat storage

One caveat to this is that after a significant weight loss, you are sometimes left with excess skin. Excess skin is very different from abdominal fat. Unfortunately, at this time, I am unaware of any medically sound practices that reduce large quantities of excess skin aside from plastic surgery at this time.   That being said, the reduction of visceral fat and increase of muscle mass, due to proper diet and exercise, have profound, lasting effects on your health and well-being.

Hamstring Injuries

 

The hamstring muscles are actually a group of 3 muscles located in the back part of your upper leg. The hamstrings muscles originate from the pelvis (buttocks) and the femur (leg bone) on the backside of the leg and cross the knee joint to insert on the medial (inside) and lateral (outside) part of the leg just below the knee. The main jobs of the hamstrings are to extend (straighten) the hip and to flex (bend) the knee.   In addition, some of the hamstring muscles play a role in rotating the lower leg.

The most common thigh injury is a hamstring strain.   These injuries can often occur when the hip is flexed and the leg is extended, as in a single leg front kick. This is because 2 of the 3 muscles that make up the hamstring group cross over two joints (the hip and the knee).   These muscles are maximally stretched when the hip is bent and the knee is straight, and if movements are quick, the muscle can get strained or even tear.

Certain physical findings can increase your chances of getting a hamstring injury, such as:

  • Tight hamstring muscles – (inability to completely straighten your knee on standing)
  • An imbalance between the muscle strength in the upper leg (hamstrings and quadriceps)
  • Tightness of the quadriceps or hip flexor muscles (inability to completely stand up straight while the legs are straight — you will notice that you bend forward at the hips slightly if your legs are otherwise straight)
  • Insufficient warm up before exercising
  • Poor muscle coordination
  • Muscle fatigue
  • Muscle strength or flexibility imbalances

Usually a hamstring injury will present with pain on the backside of the upper leg, possibly with swelling, bruising, and an associated popping sensation at the time of injury.   If the hamstring muscle is fully torn, there may be an obvious mass which is actually the muscle contracting into a “ball”.

Treatment of hamstring injuries can be broken down into the acute phase that occurs immediately after injury and for the first 2-3 days. The sub-acute phase that occurs for several days to a few weeks after injury and the chronic phase that begins several weeks after injury.

Acute treatment of a hamstring injury generally follows the acronym PRICE.

Protection – In a severe hamstring strain or tear, an individual may require a crutch or a cane to protect the injured leg while walking.

Rest – for the first few days, remain off the injured leg as is possible, as this will enable the hamstring to begin healing.   The caveat is that stretching muscle begin shortly after injury because the muscle will scar down as it heals leading to further muscle tightness and predisposing you for another injury.

Ice– using a plastic bag filled with ice and water for 20 minutes 3 times a day is helpful to further reduce swelling. Heat is initially not recommended because heat increases the blood flow and is thought to worsen swelling. However, a few days after an acute injury heat can be helpful as heat increases blood flow to the injured area and helps with healing.

Compression – An ace wrap or compression dressing should be applied to the upper part of the thigh to prevent further swelling.

Elevation – Elevating the injured leg helps to further prevent swelling.

As mentioned above, hamstring injuries require both stretching and strengthening in order to recover. The main issue is that after a tear or strain, the muscles heal by scarring down. This scarring results in decreased flexibility of the muscle.

One big mistake athletes and weekend warriors make after sustaining a hamstring injury is to return too quickly to their prior level of activity. It is very important to only return to exercise after the pain has subsided. This is because if you return to exercise too early, you will change your biomechanics (i.e. alter your posture or positioning) to compensate for the pain. This altered position or step length while exercising can allow the muscle to shorten. When the muscle heals and contracts (shortens and scars down) you are then at increased risk for a repeat strain or tear.   Typically it takes at least 4-6 weeks for the muscle to properly heal.

It is helpful to begin stretching and strengthening exercises under the supervision of a qualified physical therapist so that you do not re-injure yourself and you can recover optimally. It is possible to regain or even surpass your pre-injury strength and flexibility with a proper treatment regimen.

PRP or Platelet Rich Plasma injections are sometimes recommended for assistance with tissue repair and quicker recovery time. However, an article published in 2015 from the Department of Sports Medicine at St Lucas Andreas Hospital in Amsterdam, reviewed the data for the treatment of hamstring injuries and found that lengthening exercises (stretching the hamstrings) provided the quickest return to play time, but did not affect re-injury rate. PRP injections did not improve outcome or re-injury rate when compared to controls. Therefore, at this time, it appears that a physical therapy regimen focusing on first stretching the hamstring muscles, then strengthening them (while maintaining improved flexibility) provides the best chance for recovery and return to exercise.   It was also suggested in this study that progressive agility training and trunk (core) strengthening and stability might reduce re- injury rates.

As always, if you suspect you might have a hamstring injury or other leg injury it is important to be evaluated by a trained health care professional. It is quite possible that you will be referred to a physical therapist for optimal treatment that includes a both a stretching and strengthening regimen. While initially your treatment will focus on the injured muscles, it will be important to analyze and treat your body mechanics to prevent repeated injury.

Exercise as a Pick-Me-Up: Can You Combat Depression

Depression is a very complex emotion that is influenced by many factors.
Sometimes depression can be brought on by a serious illness in yourself or a family member. Other times, depression may be due to significant life altering events. In many cases, genetics and gene expression can play a crucial role.   While it is not thought to be possible to change your genes, it is possible to change your gene expression (they way your genes work). In addition, there are many lifestyle modifications you can make to improve your emotional state.  Today we will focus on the beneficial role of exercise in treating depression.

The number of research articles written on the causes and treatments for depression is staggering. It has been repeatedly demonstrated that people suffering from depression have altered brain chemistry and function. The ENIGMA consortium, a large multi-center collaboration of 70 institutions, has analyzed both genetic data and neuroimaging studies with regard to depression. They have established that the size of the hippocampus, the area of the brain responsible for memory and emotion, actually decreases in response to chronic depression.

So what can you do to prevent this?

Exercise!!!

An excellent article written by Lynette Craft and Frank Perna, in The Primary Care Companion – Journal of Clinical Psychiatry, published in 2004, address various theories as to why exercise helps depression.   It is highly possible that the combination of all of the theories presented below lead to the beneficial effects of exercise with regard to depression.

The first hypothesis as to why exercise benefits those with depression is termed the Thermogenic Hypothesis. The idea behind this hypothesis is that exercise raises your core body temperature and the temperature in your brain. When the temperature rises this increases the activity of certain areas of the brain thereby altering brain chemistry and improving depression.

Another theory is termed the Endorphin Hypothesis. This hypothesis asserts that exercise increases endorphin levels. Endorphins are substances what are released by the brain during exercise, and help to relieve pain and increase feelings of pleasure.   Endorphins essentially are morphine or opioid compounds produced by our bodies.   There is some criticism to this hypothesis because it is not known if these elevated levels of endorphins detected in the blood after exercise actually induce a change in brain chemistry.

Currently the Monoamine Hypothesis seems to have the most support. The basis for this hypothesis is that exercise causes an increase in the availability of neurotransmitters such as dopamine, norepinephrine and serotonin in the brain. The concentrations of these neurotransmitters are often lower in depressed people. In fact, most anti-depressant medications work by preventing breakdown of these important neurotransmitters.   Studies done in the 1970’s by RM Post and others have demonstrated an increase in these neurotransmitters both in the blood and in the urine after exercise.   Theoretically, this rise in neurotransmitters may lead to a decrease in depressive symptoms.

The Distraction Hypothesis states that intense exercise leads to distraction from worry and depressing thoughts.   In this hypothesis, exercise is likened to a meditative state and serves to provide solace and relief from feelings of despair.   These distraction activities serve as a type of coping mechanism.

Finally, there is the Self-Efficacy Hypothesis. This hypothesis asserts that by consistently participating in an exercise program, you develop a sense of confidence. This cycle becomes a self-fulfilling prophecy. Initially when you begin an exercise program, you are filled with feelings of doubt and insecurity, however as you begin to stick to the program and see benefits, you become more confident and determined to persist.   This confidence is thought to offset depressive thoughts.

Most likely all of these hypotheses are at least partially correct. So what’s the take home message?

Stick to it and continue exercising!!!  

The most common benefits of exercise include:

  • Improved endurance
  • Improved cardiovascular fitness
  • Improved balance
  • Improved strength and flexibility
  • Improved body composition (increased muscle mass, decreased fat stores)
  • Improved sleep
  • Improved self-esteem
  • Stress reduction
  • Decreased depression and anxiety

The most important times to exercise are the times you don’t want to exercise. It is rare that you will leave an exercise session feeling worse then when you entered. Not every day will be the best day, but you just need to show up and give it your all. If you are on the fence about coming in, just focus all the benefits you obtain from routine exercise!

The Common Pitfalls That Challenge the New Exerciser

 

As you begin your new exercise regimen it is quite common to have mixed emotions, which can range the gamut from determination to fear.

We all fall off the wagon sometimes and that is absolutely okay. Once you have committed yourself to the dietary and lifestyle changes, you will begin to see results and more importantly you will feel better. You just have to make the association in your mind between the positive lifestyle and dietary changes you have incorporated into your life and it will become much easier to continue and succeed in your mission of a healthier you.

Below are some recommendations to help you be successful:

With regard to exercise –Take it one day at time
Rather than worry about the remaining consistent with your exercise efforts for the entire challenge, remind yourself to take it one day at a time. Focus on setting your alarm and waking up this morning to head to class. If you exercise after work, bring your clothes with you and if possible change at work or at the gym so you are not tempted to go home after a long day. Focus on how you will feel after you have completed your first day of exercise. It does not matter what you are able to do during your class, it just matters that you show up and give it your best effort. Each day will become slightly easier than the last, however like everything, there will be bumps in the road. Progress is gradual, with peaks and valleys, but the overall trend will be up.

With regard to diet the opposite is true — Prepare in Advance
One of the easiest ways to fall off the diet is to find yourself hungry with no compliant food options. Preparation is key. Making sure that you carry compliant snacks and meals with you, or knowing where you can find access to purchasing food/snacks is crucial to your success. This is because the diet is structured so as to maintain your blood sugar at a fairly constant level. Once your blood sugar drops below a certain point, your body thinks that it is starving and will release hormones to prompt you to eat. This is when you get that ravenous sensation and will reach for a quick fix such as carbs or simple sugars. What you choose to eat during these periods of “hunger” will have a direct effect on the rest of the day. If you choose simple sugars or processed carbohydrates the cycle of insulin spikes and drops will be perpetuated and can foil your best efforts at staying compliant.

Purchase the Proper Footwear
Knowing your foot type and body habitus is very important when you begin exercising so you can purchase the proper shoes for the appropriate activity.  Improper shoe wear can cause many problems with your feet, ankles, knees, hips and even your back. Different shoes provide you with different types of support.

For example, tennis shoes provide medial lateral stability because you are constantly making quick side-side motions. However, they do not usually provide much support or cushion when you are jumping. I would not recommend using tennis shoes at MAX.

Basketball shoes are designed to provide shock-absorption and traction because of the sudden bursts of energy and rapid changes in speed and direction necessary during basketball. These shoes lace up around the ankle, and therefore much bulker, heavier, and can cause fatigue if used during sports other than basketball. Therefore, I don’t recommend these either during workouts.

Running sneakers come in many different styles and are best selected based on an analysis of your foot, ankle, knee and hip motion during running. These shoes are designed for endurance, and cushioning and are generally more flexible and lighter, but do not provide much in the way of traction or side-side support. Some running shoes may be appropriate for aerobic classes but those with very flimsy flexible soles (bottoms) may not prevent injuries.

A cross-training sneaker is usually recommended when exercising because these shoes are designed for multiple purposes and provide medial/lateral stability which prevents ankle injuries, as well as increased traction to prevent falls. That being said, it is important not to use cross trainers for running more than occasional short distances because they are not designed for this type of exercise.

Stay hydrated
It is common to confuse the sensation of thirst for hunger. Make sure you drink before, during, and after exercising to prevent dehydration. Water is best at quenching thirst. The majority of the “electrolyte sports drinks” are unnecessary and provide added sugars, calories or artificial sweeteners. Drink water and add a little bit of fresh lemon, mint, or other fruits for flavor if needed.

Don’t over do it
Injury occurs when body mechanics fail. Within a few weeks of exercising your heart and cardiovascular system become accustomed to the increased level of work and your exercise tolerance will improve fairly rapidly. People then often try to push themselves further or do double classes to increase their results, but improvements in your musculoskeletal system lag behind your cardiovascular system. In English, what this means is that your heart will be ready for an increased exercise intensity much faster than your body will be. By increasing your high impact exercises (i.e jumping, running, and cherry pickers, etc) too quickly, you will set yourself up for injuries such as shin splints, knee injuries, hip injuries and iliotibial band injuries. Give your body time to strengthen. You will get there.

That being said, do not skip class (unless you are really sick). There will be days you feel exceptionally stiff and sore and cannot imagine how you will be able to exercise. Those are the days it is most important to go to class. This is because soreness is usually the result of lactic acid build up in the muscles. By exercising, you increase blood flow to these areas and “wash out” this lactic acid and bring important oxygen and nutrients to your muscles to allow for growth and repair.

Listen to your body
Above all, listen to your body. You know yourself best, if you have cardiovascular or other health issues make sure you speak with your physician first to be cleared for exercise. Almost everyone can exercise to some degree, but it is important to know your limitations. It is more important to realize that your limitations today will not be your limitations tomorrow. Your strength and endurance will improve as long as you provide your body the proper nutrition and increase your exercise demands at an individualized pace to prevent injuries

Isometric Exercises, Isotonic Exercises, and Isokinetic Exercises

 

Last week we discussed the importance of aerobic and anaerobic training and this week we will focus on the importance of incorporating strength training into your exercise regimen. Basically, there are several different categories of exercise: Isometric Exercises, Isotonic Exercises and Isokinetic Exercises. By combining the first two types of exercises during your weekly workout regimen, you will attain synergistic benefits that both these exercises provide.

One of the main reasons for exercise is for weight loss and to improve your body composition. According to a study done at UCLA School of Medicine by Dr. Srikanthan published in July 2011 in the Journal of Clinical Endocrinology and Metabolism, building higher muscle mass may improve insulin sensitivity and decrease the risk for both pre-diabetes and diabetes. This finding is quite significant because provides motivation for those who have difficulty “losing weight”. By adding resistance (strength training) into your exercise programwe are still building muscle mass and therefore, decreasing our risk for pre-diabetes and diabetes and contributing to positive changes in our metabolic profile. In addition, several studies have demonstrated that strength training may improve our self-esteem and body image more so than aerobic exercises alone.

So what are the different types of exercises we perform?

Isotonic Exercises:
In this type of exercise, thereis no change in the muscle tone or degree of muscle tension throughout the exercise.In simpler terms, during these exercises, the muscle contracts and causes the body part to which it is connected to move. These exercise result in a change in the joint angle that the muscle crosses. A bicep curl results in bending and straightening of the elbow joint. Typically, isotonic exercises are more vigorous types of exercises such as cycling, swimming, running, tennis, etc. In general, isotonic exercises tend to burn more calories, improve bone density and lower risk of heart disease. Isotonic exercises can be further classified by the type of contraction that occurs in the muscle.

Concentric Isotonic Exercises:
In this type of exercise, (i.e. the upward motion of a bicep curl with weights), the force the muscle generates is greater than the resistance placed on the muscle (weight in the hand) leading to a shortening of the muscle. Concentric exercises always decrease the angle of the joint that the muscle crosses. For example, the upward motion of a bicep curl — starting with the arm fully straight with the hand and weight by the thigh and ending when the arm is fully bent with the hand and weight by the shoulder — is the concentric portion of this exercise.

The Benefits of Concentric Exercises Include:

  • Allows for specific muscle strengthening and repair of muscle damage
  • Improvement in the range of motion in the joint and muscles exercised
  • Improvement in strength in the muscle exercised

Eccentric Isotonic Exercises:
Eccentric exercises occur when the muscle is contracting but lengthening at the same time. In this case the force of the weight may be greater than the force that the muscle can generate. Examples of eccentric isotonic exercises include slowly putting down a heavy object, or the downward portion of the bicep curl — beginning with the hand and weight at the shoulder and slowly straightening the arm and elbow and ending with the hand and weight at the thigh. In eccentric exercises the joint angle that the muscle crosses gets larger. Eccentric exercises are the main cause of muscle soreness and are more likely to result in injury. This is because the muscle is contracting but lengthening at the same time which results in more micro-tears in the muscle belly. It is not the tearing of the muscle that builds muscle, but instead the repairing of these muscle tears which increase protein production and causes muscle growth and hypertrophy (swelling or enlargement). Eccentric exercises are thought to provide greater muscle strengthening as compared to concentric exercises because of the higher tension the muscle is under during the exercise.

Exercises such as cycling, swimming, weight lifting (upwards and downwards motion of the weight), and stair climbing all provide benefits of both concentric and eccentric exercise as the muscles are shortening and lengthening throughout the exercise.

In contrast, Isometric Exercises, occur when the muscle contracts but there is no change in the length of the muscle. It neither lengthens nor shortens throughout the exercise. In this case the force generated by the muscle is equal to the opposing force (such as a hand weight). Therefore, neither the muscle nor the joint moves. An example of an isometric exercise is holding a weight out in front of the body in a fixed position, or holding a squat in a fixed position. Isometric exercises can be further divided into:

Yielding Isometric exercises are those in which the weight is neither dropped nor lifted, despite the fact that the muscle has the ability to move the weight.

Overcoming Isometric exercises are those that no matter how much force is exerted by the muscle, the weight will not move. For example, attempting to move a 2000 pound boulder by pushing against it is an overcoming isometric exercise. The terms yielding and overcoming are somewhat of semantics as the benefits of both types are isometric exercises are fairly equal.

Benefits of Isometric Exercises:

  • Can be used in cases of arthritis when joint movement is painful
  • Used to heal injured muscles without much strain being placed on the joints
  • Improves muscle strength and size
  • Less chance of injury when performing these exercises
  • Ability to isolate certain muscles to allow for strength training and muscle healing
  • Increased bone density
  • Increase in lean muscle mass
  • Decreased blood flow during the prolonged muscle contraction may contribute to increased muscle growth because growth factors remain in the muscle tissues longer
  • Holding the contractions longer increases muscle mass
  • Increasing the number of contractions increases muscle strength

Risks/Caveats of Isometric Exercises:

  • Blood pressure rises during contractions which can be risky in individuals with high blood pressure or increased risk of stroke
  • Increases in strength are angle specific therefore it helps to hold the exercise in several positions. For example, an isometric bicep curl should be held with the elbow joint at approximately 45 degrees, 90 degrees and 135 degrees to strengthen different parts of the muscle belly.
  • No improvement in muscle speed, agility or power
  • If body alignment is poor, injury is more likely

Another type of exercise that exists is an Isokinetic Exercise. In this exercise, usually machines are used which control the speed of the muscle contraction within a specific range of motion. Essentially, these machines can control the resistance placed on the muscles and keep the speed of the muscle movement fairly constant. These machines combine the benefits of isotonic and isometric exercises. Examples of these machines include the stationary bicycle, and the Cybex arm machine.

Benefits of Isokinetic Exercise:

  • Used to rehabilitate muscles
  • Uses uniform resistance that adapts to the body
  • Less stressful on the body
  • Increases range of motion without muscle fatigue or muscle strain
  • Muscles are allowed to rest which avoids lactic acid build up

Typically, isokinetic exercises are utilized by Physical therapists and Occupational therapists for rehabilitating muscles after injury, or for treating muscle imbalances which may lead to injury. As with all exercise programs, it is important to start with little to no resistance and build up slowly both your resistance and your repetition count. If you have injuries, you should seek medical attention to determine which exercises are right for you and which can lead to worsening of your injuries.

Numbness in The Feet When Exercising

 

Numbness and tingling in the feet during exercise is a fairly common complaint I have come across during my years of treating patients. There are multiple etiologies for numbness, some of which are benign, and others that may indicate a more serious underlying issue. In this article we will focus on some of the causes of numbness and tingling and several factors that can be modified to alleviate these complaints.

Some common words used to describe pain related to nerve injuries include:

  • Numbness
  • Tingling
  • Burning
  • Electric Shock
  • Freezing
  • Pins and Needles

In addition, sometimes nerve pain can cause a sensation that is out of proportion to the amount of pressure or stimulation applied to an area. For example, when you lightly touch your skin, you know you are being touched, but it should not feel painful. When the nerves in the area you are touching are damaged, the light touch can actually stimulate a painful sensation.

One of the most common causes of foot pain and numbness during exercise is due to poorly fitting shoes or socks that are to bulky. The easiest fix is to have your shoe wear evaluated by a medical professional or even a specialty shoe store. If you are wearing shoes with a toe box that is too small or have stiff shoes with an exceptionally high arch support these might be the causes for your pain. By getting proper fitting shoe-wear for your body type, you maybe able to completely eradicate your pain.

The nervous system has two parts, the central nervous system, and the peripheral nervous system. The central nervous system is composed of the brain and the spinal cord, and the peripheral nervous system is made up of all the peripheral nerves in the body found outside of the spinal cord. The nerves themselves are composed of two basic parts the axon and the myelin. The axon is like a wire that carries the information from one part of the body to another. The myelin is the covering outside the nerve, like the insulation of a wire. In a nerve injury, the axon, the myelin, or both can be damaged. The type of damage sustained by the nerve determines the symptoms that are present and the duration of the injury.

Pain in the foot can be due to compression, inflammation, or infection anywhere along the path of the nerve. Pain during exercise is most likely due to intermittent nerve compression. There are certain places in the body which are prone to nerve compression because of our anatomy and the tight spaces the nerves need to pass through. It is important to assess the areas of the foot that are numb because this can help to localize where the compression is occurring.

Morton’s Neuroma
One example of nerve compression is a Morton’s Neuroma. This is the result of compression, stretching, or repeated irritation of the interdigital nerve usually between the 2nd and 3rd or 3rd and 4th toes. It is more common in females than males, and is sometimes described as walking on marbles. Typically the pain radiates into the toes closest to the neuroma and the forefoot. The pain is usually intermittent in nature and can be alleviated by removing shoes. Often sneakers with small toe boxes “tight shoes” and high-heeled shoes aggravate the neuroma. It is also more common in people with tight calf muscles and very flat feet due to their body mechanics. It can be treated temporarily with a nerve injection into the foot. In addition, changing your shoe wear and possible use of shoe insert or pad may be helpful. Physical therapy may also be indicated. If physical therapy and conservative interventions fail, then surgical removal may be necessary.

Tarsal Tunnel Syndrome
Another reason for nerve compression is a condition called Tarsal Tunnel Syndrome.  The tarsal tunnel is the canal formed between the inside of the ankle bone and a band of ligaments that stretch across the foot. The tibial nerve runs inside the tunnel and can get compressed. Pain and sensory disturbances due to tarsal tunnel syndrome is usually located in the bottom of the foot. Some causes for tarsal tunnel syndrome include, bony anatomy, ankle swelling (due to cardiac issues, inflammation, or injury), flat feet, arthritis or bone spurs. Non-surgical treatment options include, steroid injections, orthotics (braces, shoe inserts, and splints), anti-inflammatory medications and dietary modification (removal of inflammatory foods). If conservative treatments fail, a tarsal tunnel release may be indicated.

Common Peroneal Neuropathy
The common peroneal nerve can get compressed at the fibular head, which is the bony prominence just below the outside of the knee. If this happens, pain and numbness is present along the outside of the leg from the knee down into the top of the foot. The common peroneal nerve then further divides into two branches. If one of these branches gets compressed, the numbness and tingling will occur in a more specific distribution.

It is also possible for the nerves of the leg to become entrapped or compressed in the muscles of the back of the thigh, (i.e. Sciatica)or at the level of the spine (Disc Herniation, or Radiculopathy) . However with Sciatica and Radiculopathies the pain, numbness and tingling tend to include the leg as well as the foot.

Other mores systemic but common causes of foot numbness include, but are not limited to:

  • Diabetes peripheral neuropathy
  • B12 deficiency
  • Disk Herniation
  • Radiculopathy
  • Vasculitis (inflammation of the blood vessels)
  • Stroke (more likely if numbness is only on one side of the body)
  • Raynauds phenomenon

As always, if you suffer from foot pain during exercise, it is a good idea to have it looked at by a health care professional.

Some Common Causes of Headaches

Last week we discussed the importance of avoiding aspartame and artificial sweeteners due to the numerous deleterious effects on our bodies. One of the issues we addressed was the potential for headaches due to the use of aspartame. However, this is only one of the myriad of triggers for headaches.

When addressing headaches, it is important to determine the characteristics of your headaches. It is crucial to understand dangerous vs. safe headaches. I use safe as a relative term, because all headaches are painful and significantly impact our quality of life, but not all headaches are indications that a serious issue is going on. Headaches have been classified by the most common constellation of symptoms that occur with each type.

To begin, we will discuss the headaches that require emergent attention.

HEADACHES DUE TO BLEEDING IN THE BRAIN
A sudden onset of a severe headache, often described as the worst headache of my life is concerning for possible bleeding in the brain. These headaches can be associated with nausea, vomiting, visual changes, neurological changes and/or changes in consciousness. Especially if these headaches occur after a trauma or head injury, it is imperative to go directly to the emergency room for imaging studies to evaluate for any bleeding in the head. In addition, if you have a family history of individuals having bleeding strokes, you should be evaluated promptly.

Another headache that, if chronic, requires attention is a headache that presents upon waking up. Infrequent morning headaches are not generally worrisome especially if you have a cause, like a sinus headache, significant tension/stress, or an illness. However, if you have chronic morning headaches, which actually get better throughout the day it is a good idea to have these headaches evaluated by a health care professional. Especially if the headaches are associated with progressive neurological symptoms such as, but not limited too, numbness, tingling, weakness, word finding difficulties, visual changes, balance issues, and decreased coordination.

Finally, any headaches associated with fever, chills, light sensitivity, and neck pain should be evaluated promptly as these can be indications of infections in the brain and/or spinal cord.

TENSION HEADACHES
The most common type of benign headaches are TENSION HEADACHES. These headaches can be described as band-like in nature. Typically, there is dull aching pain around the temples. Often there is tightness or pressure in the forehead, sides or back of the head. In addition, you may have tenderness in the shoulder and neck muscles and even the scalp. Generally these headaches are brought on by stress and alleviated with stress reduction and relaxation. Exercise can be helpful to relieve tension headaches.

CLUSTER HEADACHES
These headaches are much less common and not very well understood. It is hypothesized that they are related to blood flow in the brain. These headaches by definition occur in groups or clusters. These headaches are always located only on 1 side of the face. Usually, they present around the eye but can radiate to the jaw, temporal region or forehead. They can be associated with symptoms on the side of the headache, such as eye tearing, nasal congestion, sweating, eyelid drooping, and pupil changes. These headaches can be worsened by alcohol consumption during the time when they are occurring. In addition, cluster headaches are associated with heavy smoking. These headaches tend to occur in groups (ranging from 1 time every other day, up to 8 times per day, by definition) and there can be periods of remission. Cluster headaches are more difficult to treat and require physician supervision for treatment and prevention.

MIGRAINE HEADACHES
Migraine headaches can also be described as the worst headache of ones life and therefore can be confused with headaches due to bleeding in the brain. Typically, migraine suffers have had a series of migraines and are able to tell the difference. In general, migraines can occur with or without an aura. An aura is a constellation of symptoms which presents before the actually headache ensues. For example, an aura can be visual changes, sensory changes (such as smells, strange lights,) or hallucinations (confusing thoughts). Migraines can be associated with nausea, vomiting, visual changes and even neurological symptoms. In addition, migraines can be associated with hormonal changes. Like Cluster headaches, Migraine headaches should be managed by your health care professional.

SINUS HEADACHES
These headaches are associated with sinusitis, or an infection/inflammation of your sinuses. Typically these headaches are associated with facial pressure, pressure above your teeth, congestion, and post-nasal drip. Treatment of these headaches should be focused on treating the sinusitis.

So what can you do to help alleviate your headache intensity and frequency?

Monitor your diet, because often headache triggers include foods. The most common offender is dairy. This can be because dairy leads to sinus congestion. However, other foods, such as alcohol, gluten, chocolate, bananas, sugar and artificial sweeteners can be implicated causes for headaches.

If you suffer from chronic daily headaches, keep a food diary and rotate your foods. Sometimes, headaches can occur even 1-2 days after eating the offending food. Try to eliminate foods and then re-introduce one food at a time every 2-3 days to determine if your headaches return.

Daily exercise also helps to alleviate most headaches, though you can get an exercised induced headache if you do heavy lifting, heavy exertion, or especially if you are dehydrated.

A few tips for preventing headaches:

  • Stay hydrated – drink lots of water and eat foods with a high water content such as cucumbers and watermelon
  • Coffee can help with headaches, however, caffeine withdrawal headaches are often a common cause of headaches
  • Foods rich in B vitamins, or the addition of a B complex vitamin to your diet can help prevent headaches. Both vitamin B2 and B3 deficiencies have been implicated in contributing to headaches
  • Foods rich in omega-3 fatty acids help prevent headaches (salmon, flax seed)
  • Bananas and foods rich in potassium are helpful for headache treatment and prevention
  • Magnesium containing foods or supplements are helpful in treatment and prevention of headaches (quinoa, spinach)
  • Co-Enzyme Q10 and Selenium have also been useful for treating headaches (speak to your doctor first before beginning these supplements).

As always, if you suffer from chronic daily headaches, address these with your healthcare provider for optimal treatment and prevention.