Flip Flop Feet

With last week's plunge in temperatures in the Northeast, it seems hard to believe that beach season kicks off in a month from now.  With that comes a return to less restrictive footwear, which for many of us means flip flops.

There are people in the world of rehabilitation and movement who think that flip flops are the root of all evil.  I'm not one of them.  In fact, I just returned from running some errands in my flops for the first time this spring.  I am not one to speak in absolutes when it comes to injuries and prevention.  Our bodies and movement strategies are just too variable to make declarations that something is "all bad" or "all good", including wearing flip flops.  After all, if flip flops are so bad, then wouldn't everyone who dons a pair end up with plantar fasciitis, shin splints, posterior tibialis tendonitis, low back pain, or some other malady?

That being said, I do think that some simple mindfulness makes sense when it comes from transitioning from cold to warm weather footwear.  As with many overuse injuries, it's a simple case of the demand being placed on your tissues overwhelming your ability to adapt to those forces.  Another way to put it is that overload (too much, too quickly) may lead to injury.  But the good news is that you can do something to diminish the risk of that happening.

I'm fortunate in that I spend the majority of my day without shoes on.  This is a reflection of the nature of my daily work, which involves a lot of demonstration on gym matts.  Oddly, nobody ever questions why I'm only wearing socks, but perhaps it's because I generally have them barefooted through their entire session too.  However, I recognize that many of you don't have the luxury of walking around your offices without shoes.

Why does this matter?  Many "dress" shoes are very restrictive.  Toe boxes are too narrow.  Soles are too rigid.  Heels are too high.  This prevents your foot and its intricate system of bones, ligaments, muscles and tendons from doing what they are intended to do.  Then, when you put your feet into something like a flip flop, your body and brain are left wondering what the heck you want your them to do.

One of the criticisms of flip flops is that they place too much demand on your toe flexors.  Every time you stride, your toes have to grip to keep the flop from flying off.  The flexor hallucis longus and brevis (big toe flexors) and the flexor digitorum (2nd-5th toe flexors) muscles are responsible for gripping.  To feel these muscles in action, try this quick experiment.  Take your shoes off.  Now gently begin to lean forward.  As your center of mass displaces forward, your calf muscles will begin to kick in.  Continue forward and you'll feel and see your toes attempt to "grip" to floor.  These are the muscles that help keep those flops on. Overuse of your toe flexors could lead to pain in your foot and/or lower leg.

So, what do do about it, you might ask?  Your goal is to train these muscles so that they don't ever feel that they're being "overused" in the first place.  If you're a flip flop wearer, don't slip them on for the first time of the season and head out for a full day.  Rather, I suggest you start to train your toe flexors by beginning to wear them around the house first.  Gradually start getting them ready for the increased demand you're about to place on them for the next several months.  This will allow your tissues to keep pace with the increased demand, rather than becoming overwhelmed by it.

As bipedal beings, ground reaction force attenuation begins at the feet.  Keep them prepped and ready for all seasons so that you can enjoy them all without any pain.

A Lesson From My Father

Today is my father’s 72^nd birthday.  According to statistics, he’s fortunate to be here.

In 2008, my mother and father were just back from a trip to visit my younger brother in Australia, where he spent 5 months studying.  Their awareness of the dangers of skin cancer was heightened as Australia is noted to have a big depletion in the ozone layer.  One morning, there was a news segment centering on the importance of getting your skin checked regularly.  My father turned to my mom and asked, "Do you think this is something to worry about?" as he leaned forward to reveal something on the crown of his head.

As it turned out, it was.  Melanoma was the diagnosis.

Melanoma is a nasty cancer, with pretty grim statistics.  However, statistics are just numbers that reveal patterns.  When it comes to fighting a disease like cancer, the only sample size that really matters is n=1.

Over the past 7 years, my father has lived with this disease courageously and with dignity.  It has spread, popping up in various places.  Some have necessitated surgery, while others have not.  My father has been blessed with finding two excellent doctors close to home on Long Island whom he trusts.  Along the way, he has measured and considered all his treatment options, mostly choosing to try something rather than nothing.  Some have left him knocked out and feeling worse than the cancer itself.  I haven’t heard him complain once.

Anyone who knows my father knows that he is very active.  Whether it’s golf (his favorite passion/obsession), tennis, or platform tennis, he’s always outside playing.  While he never spent time in a gym lifting weights in his younger years (I don’t think many people did) he’s now a committed gym goer, dedicated to his fitness.  At his age, he moves better than many of my contemporaries, despite having 30 years on us.

I don’t remember my father spending Sunday afternoons watching football, or some other sport, on television.  He’s definitely a sports fan, but I recall him telling me once, “I’d much rather be doing something than watching something.”  It’s a lesson that has really resonated with me.  Life is too short to spend it on a couch.

During one particular treatment period, my dad was feeling pretty run down.  But on a 95-degree, oppressively humid day, he and my brother Brad played Bethpage Black.  This is a grueling, long, hilly golf course, one that does not allow golf carts.  So they walked, carrying their own bags for 18 holes.  It would have been understandable had he chosen to skip playing that day, in light of the physical demands and the way he was feeling.  But he has been completely committed to keeping on moving and participating in life throughout his ordeal.  It has been good for his body, and even better for his mind.

When given a diagnosis with associated statistics, I imagine it’s extraordinarily difficult not to harp on the potential negative outcomes.  Illness can be a mortality check, but the reality is, nobody is guaranteed tomorrow.  I have greatly admired the courage and example that my dad has shown over these years (along with my mother, who has been by his side throughout and is herself a tough 20-year cancer survivor). 

I know how cliché it is to talk about not taking one’s health for granted.  But I see it every day, people desperate to get back to the state of not having to think about their pain or illness.  It’s just so darn easy to take for granted feeling well and being without illness.  Take a moment to reflect on your good fortune should you be in good health.  It’s a blessing.  And if you’re not, get busy doing something about it.

My father’s approach and attitude remind me of a quote from my favorite movie of all time, “The Shawshank Redemption”:

“You can either get busy living, or get busy dying.”

Last week, my father was given the news that the experimental treatment he underwent last summer to target an inoperable tumor has been working.  His screens showed no sign of cancer.

Dad, thanks for choosing to keep on moving, no matter what.  It’s an invaluable lesson.  Happy birthday, and many more.

Spring Training

It's been a looooong winter! Tomorrow morning, the youth soccer program commences in my hometown.  Spring is finally here by calendar, if not by temperature. With many of us cooped up for the past six months, our bodies might not be prepared for the increased activities that spring inevitably brings.  Here are a few thoughts on ways to stay healthy and pain-free until next winter.  It's by no means an exhaustive list.  Each topic warrants its own lengthy article, but I've learned after writing these for the past few years that shorter is sweeter.  So here are just a couple of quick thoughts:

Runners:

1)  If you've been on a treadmill all winter and plan to resume outdoor running, be mindful of the change in surfaces.  Treadmills are more forgiving.  Consider easing back on the distances you've been covering once you hit the pavement.  Give your body time to adapt to the increased demand from the higher ground reaction forces imposed by pavement.

2)  If you like to run on a track, consider alternating directions so that you cover equal distances running clockwise and counterclockwise.  Going in only one direction will put asymmetrical demands on your legs as you go though the turns at either end of the track.

3)  If you run in the street, try alternating sides.  The camber (curve) of the street will place asymmetrical demands on your legs if you stick to only one side.

Overhead Athletes:

1)  Before going from your desk to your beer league softball game, check your shoulders.  Can you raise them above head without pain?  Can you reach behind your back to touch your opposite shoulder blade without pain?  Can you reach behind your head to touch the top of your opposite shoulder blade without pain?  If the answer is "no" to any or all of the above, your arm is probably not ready to throw a ball repetitively without risking rotator cuff tendinopathy, or imposing increased demand on your elbow.  These are just some quick and easy self-assessments that can alert you to the need for further care and attention.

2)  Warm up!  If you're showing up at the ball field straight from 8-10 hours of sitting at your desk, don't expect your arm to respond favorably if the first throw you make is from deep center to the infield.  Give yourself a few minutes to do a dynamic warm up routine (did you ever see the great Mariano Rivera go through the same paces each and every time he pitched?), followed by some short to progressively longer tosses.  Your arm will thank you for the extra care.

Tennis/Golf:

1)  There is a lot of lateral stress placed on the legs with tennis.  You're often running from side to side to cover the court, requiring quick, sharp cuts for directional changes.  Prep your ankles with ankle pumps, rolls and alphabets.  They're not getting this multi planar movement during your daily work grind.  In addition to keeping your ligaments and tendons pliable and strong, you want to give your joints and brain the sense that they've "been there before".

2)  Improve your lateral strength with banded abduction walks.  You can pick up a resistance band in your local sports store.  It's a rubber loop that you place around your legs above your ankles.  Simply walk back and forth across a room.  When performed correctly, you'll feel a good "burn" on the outsides of your upper legs and hips.

3)  Trunk rotation is a huge component of many sports.  We're multi-planar beings, gifted with the ability to move in the sagittal (front/back), coronal (side to side), and transverse (rotational) planes.  Unfortunately, modern life calls for a sagittal-dominant existence.  While there is movement in all three planes with every step you take, you're not challenging the increased ranges imposed by sporting activities.  So, if you plan on swinging a tennis racket, a golf club, or a bat this spring/summer, implement some rotational movements into your workout and warm-up routines.  Remember, your body is very good at sacrificing form for function.  If you lack rotation where you should have it (thoracic spine and hips), your body will seek it elsewhere, forcing mobility out of places that don't love to be mobile in the transverse plane (low back and knees).

3 Quick Bonus Self Assessments:

1)  Check your core stability by doing a plank.  Can you hold a straight and side plank for 20 seconds without compensating all over the place?  Athletic movements require mobile limbs to work off of a stable base.  If you can lock down a decent plank, it's a pretty good starting point for core competency.

2)  Can you squat deeply without assistance?  Being able to do a good body-weight squat under your own control will demonstrate adequate ankle, knee, hip and back mobility, along with the motor control to take you through the joint movements.

3)  Can you balance on each leg for 20 seconds?  If you find yourself flailing all over the place, balance and stability may be an issue for you.  Just like strength and mobility, this is trainable.

Again, this is a VERY brief list of things to consider.  I know how easy it is to think that we're still 18 years old, when we never had to put much thought into injury prevention.  Our bodies were simply more pliable and responsive.  But I KNOW that with a little extra care and attention, we're perfectly capable of enjoying all the activities we did when we were younger.  Whether the goal is to continue to compete with our peers, or to be able to participate with our kids, go for it.

Life is meant to be lived.  Have fun, and play ball!