Tag: exercise

Don’t Forget Your Back

Most of us spend a large portion of the day hunched forward.  Think about when you are working on the computer, cooking, driving or even relaxing.  Your typical posture during these activities is head and neck forward, shoulders rounded forward, back curved and hips flexed.    When you remain in this position for an extended period of time, the muscles in the front of the body tend to shorten or contract, while the muscles in the back of the body tend to weaken.    This can be a set up for back, neck and shoulder problems and in addition, tends to make you look shorter, heavier and less confident.

Stretching before and after exercise as well as during the day is often overlooked in the rush to “get your workout in”.   Stretching however, has numerous benefits.   According to a study published in the Annals of Physical Medicine and Rehabilitation Medicine in September 2016, by I Fekhfekh, et al, dynamic muscle stretching of the knee musculature actually resulted in an increase strength gain in those muscles.  Interestingly, this study also found a decrease in the postural stability of the knee after stretching.    In English, it appears that stretching helps your to build strength, but may decrease the stability of the muscles you stretch at least temporarily.

In general, stretching helps to improve flexibility, joint range of motion, and usually is helpful for injury prevention.    Stretching helps by increasing blood flow to the muscles stretched.  This increased blood flow carries important nutrients to your muscles to allow for muscle growth and repair.  In addition, the increased blood flow helps to wash away muscle “waste” which leads to decreased soreness and inflammation of the muscle.

If allowed to remain in a contracted position for a prolonged period of time, our muscles will shorten.  For example if you spend a large portion of your day sitting in a chair or driving, the muscles in the front of the hips, your hip flexors will shorten.  These muscles have a direct effect on both your posture and your back health.

 

So what should you do?

It is important to stretch the muscles in the front of the body at least daily.

Exercises that focus on the hip flexors:

-Kneeling hip flexor stretch  – in the position of a lunge, allow your back knee to touch the floor and drive the hip of your front leg forward.  This will stretch the hip flexor of the knee on the floor

–Pigeon stretch – extend your right leg straight back and bring the heel of your left leg underneath your right hip.  Then drive your hips forward towards the ground.  Stretch and repeat on the other side.

– Yoga poses such as: low lunge, crescent lunge, upward facing dog, and revolving side angle pose

 

Stretches that focus on the chest muscles and prevent rounded shoulders:

– Door Frame stretch- stand in a doorway or at the corner of a room with your arms up like you were going to stop traffic.  Line your arms up from the elbow to the hand with the doorframe or in the corners of the wall.   Step towards the door and you should feel a stretch in your chest (pectoralis “pec” muscles) and hold for 20-30 seconds.

– Wall slides – stand with your back to the wall and keep your shoulders against the wall.  Walk forward 1-2 steps and slide your arms up and down the wall and squeeze your shoulder blades together.  You should feel a stretch in your upper chest muscles.

–Shoulder squeeze stretch –  clasp your hands together behind your back and slowly try to lift your hands.  Squeeze your shoulder blades together to stretch out the chest wall.

– Yoga poses include : bridge pose, camel pose, cobra pose and cow face pose

 

Stretches for your neck:

– Chin Tucks (Neck Retraction) – keep your shoulders back and your head in a neutral position (eyes facing forwards, chin level) slowly move your head backwards until you feel a slight stretch in the back of your neck.  Hold for 10-20 seconds and repeat.  If needed you can apply a gentle pressure on your chin with your fingertips to press your chin backwards and deepen the stretch.

Incorporating these exercises into your daily routine will help to prevent shortening of the muscles in the front of the body which leads to poor posture and often pain of the neck and back.  As always, if you are having pain which persists you should be evaluated by a certified health care professional to ensure that these exercises are safe for you.

This week we primarily discussed stretching exercises to prevent muscle contraction, and next week we will discuss the importance of strengthening the back muscles to further combat the issues of a hunched posture.

Exercising With Arthritis

 

We have all different levels of fitness. Some individuals have been exercising for years, while other individuals have never exercised a day in their lives.  We are all at different levels in terms of our cardiovascular fitness, our muscle strength and flexibility and our overall health.   It is quite important to remain active in spite of arthritis.  In fact, movement in people with arthritis is crucial to health and well-being.

Despite what we once thought, it is my experience that it is possible to modify the severity of certain types of arthritis.   In my mind, arthritis, chronic pain and other autoimmune diseases are the result of multiple factors.  All these factors such as genetics, environmental exposures, nutritional deficiencies, dietary influences, and gut health to name a few factors, all line up as if you were to “win” in the slots.  When this potent combination occurs in your body, havoc ensues.   The result is inflammation and chronic disease.   While you can’t change your genes per se, it is now thought that you can change or modify your gene expression.  In addition, you can certainly modify some of the other risk factors just mentioned to offset the severity of your debility.

In most cases, moderate exercise is essential to health and well being.  Proper, varied forms of exercise raises heart rate, raises endorphins, improves muscle strength, improves balance, improves flexibility and increases blood flow throughout the body including the muscles and joints.  In the case of arthritis, there is inflammation in the joint capsule and the bones themselves which leads to severe pain and often deterioration.     The nerve endings in the joint become super sensitive and pain can be unbearable.

Believe it or not, your choice of diet can directly impact your ability to exercise. When you consume an Anti-Inflammatory Diet, often you will notice you will able able to exercise with less pain is because this diet eliminates many known triggers for arthritis.

 

Some examples of arthritis triggers include:

  • Fried and processed foods
  • Thought to be due to compounds called AGE – (advanced glycation end products) These products are the result of heating, grilling, and frying foods.  The body utilizes pro-inflammatory molecules called cytokines in an effort to break them down and the result is excess inflammation in general as well as in the vascular system (blood vessels).
  • Sugary foods
  • Dairy
  • Alcohol
  • Foods/Oils with Omega-6 fatty acids – such as vegetable oil (safflower), corn oil, fried foods, certain nuts and seeds, mayonnaise

 

Some examples of beneficial foods include:

  • Foods containing high levels of Omega-3 Fatty acids – (ex. salmon, herring)
  • Avocados
  • Flax seed
  • Cherries and other berries (contain anthocyanins that are thought to be anti-inflammatory)
  • Leafy vegetables, broccoli – contain vitamin D
  • Green tea – has EGCG (epigallocatechin-3-gallate) a powerful antioxidant
  • Vitamin C containing foods (ex. papaya, brussel spouts, broccoli, citrus fruits)
  • Garlic, onions and leeks

 

It is very important to listen to your body.  Pay attention to the foods you are eating and the way you feel.  Often times, foods that are considered healthy may cause issues for you.  If you suffer from arthritis, try rotating your foods (i.e. do not eat the same food everyday).   If there are certain foods you think might bother you, wait 3 days in between eating them.  Then pay attention to the way you feel when you re-introduce those foods.  If you notice you have more difficulty with pain or decreased ability to exercise try eliminating the offending foods for a week or two.

Typically, it will take several weeks of following the diet closely before you see results with regard to decreased pain from inflammation.

When exercising with arthritis, it is important to modify your exercises as per trainer recommendations.  If exercises hurt, if possible, discuss with your trainers to find another way to exercise that muscle group.  In the beginning, there may be some exercises you simply cannot do.  What is important is that you are attempting to exercise.  With each passing week you will find that you can do a little more than the previous week.  Progress may be slow, with ups and downs.  As always, if despite closely following the diet, you are still having issues, it might be time to seek the advice of a health care professional.

Aerobic Versus Anaerobic Exercise

There are various types of exercises that affect our bodies differently.  Done in combination, this affords you the most “bang for your buck”.    By changing up the type, frequency, intensity and cardiovascular demand in your exercise regimen on a daily basis, you will have a synergist effect and derive numerous benefits from your exercise.

There are to major classes of exercises with regard to oxygen utilization. Aerobic exercise, exercises that utilize oxygen for energy, and anaerobic exercise, exercises that utilize fuel already present in the muscle for energy.

 

Aerobic exercises:

In this type of exercise, our muscles require the oxygen carried in the blood to be used for energy production.  Our muscles use this oxygen to burn both fat and carbohydrates as fuel.  Fuel can be constantly produced in the presence of oxygen, therefore, aerobic exercise can be sustained for a prolonged period of time. The body reacts accordingly by increasing the heart rate and breathing rate to keep up with the muscle oxygen demand.   Over time with training, our muscles become more efficient at extracting oxygen from the blood stream and thus we become “fitter”.  When this happens, you will notice that you will be able to exercise at a higher intensity without feeling winded or noticing a significant increase in your heart rate.   During aerobic exercise, you should feel slightly out of breath, but be able to carry out a conversation.

Some benefits of aerobic exercise includes: 

  • Improved overall level of fitness
  • Improved mood
  • Possible reduction of
    • Cancer risk
    • Cardiovascular disease
    • Osteoporosis
    • Diabetes
  • Higher level of fat burning (as opposed to anaerobic exercises)
  • Improved bone density (less beneficial then anaerobic exercises)
  • Moderate reduction in blood pressure
  • Decreased insulin resistance
  • Increases likelihood of surviving a heart attack

Anaerobic exercise:

In contrast to aerobic exercise, anaerobic exercise is exercise performed without oxygen.  This type of exercise is performed at a higher level of intensity and can only be sustained for a few moments.  Sprinting and heavy weight lifting are two examples of anaerobic exercise.   Anaerobic exercises utilize the energy that is already present in the muscle tissue.  However, because no oxygen is present to produce more energy, these exercises cannot be sustained once the fuel present in the muscle runs out after about 10-15 seconds.

Some benefits of Anaerobic exercise:

  • Strengthen bones and improves bone density
  • Builds and maintains lean muscle mass
  • Burns fat (though less so then an aerobic exercise)
  • Increases performance in sports by increasing strength, speed and power

A specific type of anaerobic exercise is Plyometric exercise.

Plyometric Exercises:

These types of explosive exercises are known as plyometric exercises (jump training).    This type of exercise uses your own weight and the force of gravity to provide resistance during the exercise.    The reason to incorporate these exercises into our exercise regimen is that plyometric exercise helps to develop explosive power and increase agility.

Without getting too technical, plyometric exercises are based on the muscle stretch reflex.

Whenever a muscle is stretched, a signal is sent to the nervous system that indicates that the muscle has been stretched.  The nervous system processes this signal and stimulates the muscle to contract in response to this stretch.    This is a reflex because the response is instantaneous.  Over time and with training, the fibers in the muscle (fast twitch fibers) become more sensitive to the stretch and maximize the speed and number of motor units that respond to the stretch.  By increases the fiber number and sensitivity, the muscle response becomes more explosive and generates more power.

Numerous studies have demonstrated that plyometric training should start slowly and work up gradually in intensity.  Plyometric training can be general such as jumping, jump squats, jump lunges but can also be more sports specific depending on the activities you would like to improve.    Typically plyometric exercises tend to focus on the lower body and utilize muscles around the knee and hip.    However, the use of medicine balls allow for plyometric activities of the shoulders and arms.

It is very important to warm up properly to increase the flexibility of the muscle and connective tissues around the joints to prevent injury.  It imperative that you slowly add in and increase your plyometric exercises when you feel your body can handle the impact.   For example, start off doing stepping jumping jacks and then gradually add in 1 jumping jack for every 5 stepping jacks.  Over a period of days to weeks, continue to add more jumping jacks and decrease the amount of stepping jacks.  Once you are able to comfortably complete a minute of jumping jacks without any pain or significant shortness of breath, you can start adding in superman jacks.   Again add 1 superman jack for every 5-10 jumping jacks and gradually increase the amount of superman jacks.   Since this is an anaerobic, plyometric exercise, if you are doing them correctly, you will only be able to do about 10-15 seconds of this until you become winded and need to take a break.

Shortness of Breath During Exercise

 

According to the American College of Sports Medicine, to attain the cardiac benefits from exercise, the exercise should be

  • At least 3 times per week for at least a 12 week duration
  • At least 30 minutes per session (can be broken up into 3 ten minute sessions)
  • Performed at an individual’s perceived intensity of 13-15 on a scale of 6-20 (the Borg Exertion scale) or at a level of “somewhat hard to hard”.

Some of the most common benefits of exercise include:

  • Improved exercise tolerance
  • When Exercise and Diet is combined:
    • Improved Lipid (fat) and Lipoprotein (fat/protein) levels
    • Decreased blood pressure
  • Stress Reduction
  • Improved Psychological well-being

One important question, especially among beginning exercisers and those returning to exercise after a long hiatus, is “Is this safe for me?”

Certain risk factors increase the likelihood of heart attacks and strokes and it is important to be aware of these factors when deciding on your exercise regimen.   Some risk factors are modifiable and can improve with exercise and diet, while others are fixed risks. Some common risk factors are:

  • High Blood pressure (hypertension)
  • Diabetes
  • Elevated Cholesterol or abnormal lipid (fat) profile
  • Family history of heart disease or strokes
  • Smoking
  • Sleep Apnea
  • Abdominal Obesity

According to Dr. Baggish, the Associate Director of the Cardiovascular Performance Program at the Massachusetts General Hospital, “ Everyone can do a form of exercise, if it is done carefully, with the supervision of a doctor”.  If you are starting and exercise regimen with a significant number of risk factors, it is important to first be evaluated by your Primary Care Physician or Cardiologist for clearance to begin an exercise regimen.   In general, it is important to “start low and go slow”.   Even just doing brisk walking does provide substantial improvement in overall health.

 

When beginning with an exercise regimen it is perfectly okay to try modifications first and increase your intensity as tolerated. Sudden start and stop exercises can put extra stress on the heart, especially if you are normally sedentary so it is important to all yourself a cool down period after exercising.

SYMPTOMS occurring during exercise that can require immediate attention are:

  • Left sided chest pain
  • Pain radiating into the jaw or down the left arm
  • Significant shortness of breath that does not quickly improve with rest
  • Dizziness
  • Sensation of an irregular heartbeat or pounding in the chest
  • Nausea or indigestion (usually Gastrointestinal related but can be a sign of heart issues)

In addition, if you suffer from chronic shortness of breath with minimal to no exertion, or from swelling in both legs, this can indicate issues with the hearts ability to pump.   It is important to note that individuals with diabetes, especially females, may not always have the “classic” symptoms for heart issues.   Vague complaints, flu-like symptoms and/or indigestion may be the only symptoms. Or you may have none at all.

If you suffer from any of the above listed symptoms, it is crucial to be evaluated to make certain that you are not putting your self at risk during exercise.

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.

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

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.