When you take your first steps of the day, do you feel a stabbing pain in your heel? Or does your foot ache part way into a jog or run? That could be plantar fasciitis talking to you. Plantar fasciitis is the inflammation of the plantar fascia connective tissue (that big tendon on the bottom of your foot). It extends from your calcaneus bone (heel) to the phalanges (toes). This thick tissue is shaped like a bowstring that helps support the arch of the foot while also absorbing shock while walking. 

When the plantar fascia is put under too much tension and stress and repeatedly stretched, it can cause minuscule tears that result in painful inflammation. 

What causes Plantar Fasciitis?

Although there is no one clear cause for plantar fasciitis, a variety of risk factors can contribute to the onset of this painful condition and can happen to anyone. Plantar fasciitis is commonly seen in active and sedentary populations. So what gives?

If a person has a sedentary lifestyle in combination with being “overweight,” they are susceptible when the extra weight causes extra strain on plantar fascia while doing daily activities. Athletes on the other hand, may experience the same pain as a result from excessive running or being on their feet for prolonged periods of time. Of course people in between, that are mildly active and in the “appropriate” weight range for their height can also experience plantar fasciitis. Hurray.

Then there’s your foot’s biomechanics to consider. Individuals with flat feet / low arches (also called pes planus) and high arches (pes cavus), may play another major role in developing plantar fasciitis. Those with flat feet  often experience over pronation of the foot which can result in excessive strain of the plantar fascia, while pes cavus foot types cannot dissipate force evenly due to limited range of motion in the joints, which results in decreased flexibility in the calf muscles and Achilles tendon. 

What activities might cause plantar fasciitis? Should I avoid them?

Plantar fasciitis is quite common in runners, likely due to the accessibility of the activity amongst marathoners, weekend warriors and people just trying to get into it. It can also affect athletes whose sports require explosive power (i.e. gymnasts, basketball, tennis, dancers, etc.)

In runners, the loading force can be up to 200% of their body weight. With repetitive motion and increasing intensity during training, it can lead to overuse and result in pain and inflammation in the heel.

While avoiding the activity altogether to prevent getting plantar fasciitis isn’t recommended, we suggest starting any new activity slowly to allow your body’s joints, muscles and tendons to properly adapt over time. 

How to manage plantar fasciitis

Depending on how severe the condition is in each individual (please see your doctor to make sure your diagnosis is correct and the pain / discomfort actually is plantar fasciitis and not something else like a bone fracture etc), there are both conservative and radical approaches to treating plantar fasciitis:

Conservative therapies may include:

1. RICE method – Rest, Ice, Compression, Elevation. Although the focus is on Rest and Ice if you notice heat and swelling in the area.
2. Taking analgesics as prescribed like Advil (ibuprofen) or Tylenol (acetaminophen) to relieve pain caused by plantar fasciitis accompanied with sufficient rest 
3. A physical therapist can use modalities to help speed the body’s natural healing process. They may have you work with a kinesiologist and prescribe a series of exercises or stretches that can strengthen the lower leg muscles and lengthen the Achilles tendon (see below for exercises)
4. For those with pes planus foot types, foot orthotics can help to prevent overpronation of the foot, and help distribute forces more evenly

How can a kinesiologist help me with my plantar fasciitis?

Strengthening exercises are often recommended for muscles surrounding the ankle joint and supporting the foot, such as the tibialis anterior, tibialis posterior, and peroneal muscles, presumably to control pronation.

Again, depending on the root cause, if a client has pes cavus, the focus would be on stretching the calf to decrease muscle tightness. If someone has pes planus, focusing on strengthening the muscles in the arch of the foot take priority.

In both cases, since plantar fasciitis follows you around if you’re on your feet, and assuming you use your feet daily, we’d check that proper footwear or orthotics are a measure to support your foot while it heals. Not all people need to wear supportive footwear 24/7, especially if the issue can be corrected through exercise, stretches and time, however if you’re suffering from it now, and need to get your 8k run in tonight, no amount of stretching and strengthening this morning is going to help you during your run. Some individuals have been able to forgo use of orthotics and shoe insoles after time but this could depend on the root cause of the issue. Again, speak with your doctor about your options.

Exercises and stretches to help plantar fasciitis

1. Heel raises: Stand on an elevated surface (stairs or step bench will work) with the ball of your foot, and put a rolled towel underneath your big toe joint. This puts your foot into a “toes-up” flexed position. Your heel should be elevated. As this isn’t a balance exercise, hold on to a banister or a stable structure, such as a chair or wall, for balance. Begin the heel raise with the concentric contraction by raising up for 3 seconds, holding the contraction for 2 seconds at the top. Lowering the heel towards the ground slowly (take another 3 seconds) and holding the stretched position for 3 seconds. Repeat this exercise for 8 – 12 repetitions, 3 sets a day. Start with two feet if your plantar fasciitis is quite acute and tender, then progress to one leg as your strength and comfort increases.
2. Towel gathering: Seated on a chair with a towel laid flat in front of you, place your foot on top of the towel and using your toes, scrunch the towel towards you. Then, use your toes to push the towel away from you. To make this exercise more challenging, place a weighted object such as a soup can on the other end of the towel and repeat the exercise.
3. Foot / calf stretch: Seated on a chair, place a rolled towel around the ball of your foot, and hold both ends of the towel in your hands. Gently pull on the towel so your foot flexes and pull your toes towards you, while also ensuring that the knee is straight. Hold this stretch for 15-30 seconds. For individuals who have a bit more flexibility and may find this exercise too easy, the exercise can be modified by using your hand to grab on to your toes, instead of using the towel. Without bending the knee, slowly lean forward until you feel your calf stretching.

If you’re suffering from plantar fasciitis, hopefully one of the above strategies sounds familiar as something your doctor or physio recommended for you, and remember to stick to the recommended regime for best results. If you’ve tried them but aren’t seeing any improvement, we strongly suggest checking back in with your physio or GP to rule out any other issues such as a fracture. In some cases where strengthening and stretching exercises aren’t making a difference, they may also refer you to a podiatrist for specialized help. 

Co-Authored by Brian Lau

The post Help I think I have plantar fasciitis first appeared on Le Physique | Vancouver Personal Training.

Now that you are fully rehabilitated from carpal tunnel syndrome (CTS), we are ready to progress to strengthening your grip again. If you are still feeling or begin feeling symptoms of CTS, read my previous blog here for some rehabilitation exercises.

The primary muscles involved in determining grip strength are your forearm, hand and finger muscles. These muscles are often indirectly engaged during your typical workout routine. The performance of rows, pull downs and bicep curls assist these muscles to a certain extent, however, further training would need to be performed to maximize grip strength.

Whether individuals want to improve grip strength for a competitive sporting event or for daily activities, adequate grip strength will greatly benefit the individual. Most sports require the athlete to hold an object or equipment and it can often be the determining factor in the amount of power being generated. On the other hand, gripping exercises are used in almost all day-to-day activities. Whether opening a jar of peanut butter, carry grocery bags from your car or washing dishes, grip strength is necessary to complete these actions. A nice firm handshake can also showcase confidence and add personality to your character.

Aside from improving grip strength, having conditioned forearms can greatly benefit the connective tissue such as your ligaments and tendons.

Muscles involved in Grip Strength

Interossei (Dorsal and Palmer) muscles – The dorsal interossei enables us to spread our fingers apart while the palmer interossei pulls our fingers close. They are located in between your finger joints at the base of the hand.

Hyperthenar + Thenar muscles – The hyperthenar muscle group forms the majority of the pinky side of the hand and enables movements on that area. The thenar muscle group is responsible for movements on the thumb side.

Flexor digitorum profundus/superficialis – These muscles are responsible for flexing the finger muscles and enable you to make a fist with your hands

Extensor indicis, extensor digiti minimi, extensor digitorum – These muscles are responsible for extending the finger muscles and allow you to spread your fingers apart

Lumbricals muscles – These muscles are located at the base/middle portion of the hand is is responsible for straightening the fingers

Adductor pollicis muscles – This muscle is located between your pointer finger and your thumb and enables you to pinch objects.

Flexor carpi radialis, flexor carpi ulnaris, flexor pollicis longus muscles (flexor muscles of the forearm) – These muscles are located on the inside of your forearm and are all used to flex the hand (bringing the palm of your hand towards the forearm).

Extensor carpi radialis brevis/ longus, extensor pollicis brevis/ longus muscles (extensor muscles of the forearm) – The extensor muscles allows the hand to perform extension (lifting the back of the hand towards the forearm).

Here is a link with diagrams and more information about the muscles I have listed above.

Exercises to Improve Grip Strength

Farmers walk

Perform 3 sets of 45-60 seconds

• Grab a dumbbell or kettlebell of the same weight in each hand
• Begin walking from point A to point B OR perform a loop around your gym floor with weights by your side and palms facing inward
• Each length should be at least 45-60 seconds in duration for maximum effect

Tip: Have a strong grip on the weight to fully engage your forearms during this exercise

Dead hang

Perform 3 sets of 30-60 seconds

• Standing below a bar that enables you to stay elevated above the ground when hanging on
• Jump up or use a stool to reach the bar, grasping slightly wider than shoulder width apart
• Hang for 30-60 seconds before releasing

Tip: Try to minimize swinging by keeping your legs crossed at the bottom or using an object to prevent swaying.

Stress ball or grip strength tool

Perform 3 sets of 15 reps per hand

• Using a stress ball or grip strength tool
• Fully contract the hand creating as much tension as possible before releasing and repeating
• Switch hands

Tip: As your grip strength improves, gradually use denser objects for this exercise. Begin with a stress ball and work your way towards a tennis ball. Ultimately a lacrosse ball or similar material object will be used. Alternatively, different weighted grip strength tools can be purchased to match power.

Dumbbell shrugs

Perform 3 sets of 12-15 reps

• Grab dumbbells with palms facing inwards and standing shoulder width apart
• Let dumbbells hand by your side
• Contract the trapezius muscle by bringing your shoulders towards your ear lobes
• Hold this position for .5 – 1 second before relaxing the muscle
• Return to starting position and repeat

Tip: Ensure dumbbells are facing forward and not slanted by externally or internally rotating shoulders.

Wrist curls (Supinated & Pronated)

Perform 3 sets of 12 reps for each exercise

• Start with a light dumbbell in each hand and go into a kneeling position
• Place forearms on a bench, perpendicular to the length of the bench about shoulder width apart
• Begin with palms facing up (supinated position) and let the wrists drop
• Curl the wrist up by flexing the dumbbell towards you
• Switch and perform the same exercise with palms facing down (pronated position)

Tip: Make sure to maintain proper posture and keep back straight

• Perform the exercise slowly to feel the burn in your forearm extensor and flexor muscles
• Ensure dumbbells are horizontal and do not tilt excessively
  

  

Pull ups or chin ups

Perform 3 sets of 12 reps

• Standing below a bar that enables you to stay elevated above the ground when hanging on
• Jump up or use a stool to reach the bar, grasping slightly wider than shoulder width apart OR use a chin up handle bar with palms facing each other / yourself
• Retract shoulder blades and pull yourself until your chin is over the bar
• In a controlled manner lower your body back down until fully extended at the bottom

Alternatively this exercise can be done on a assisted pull up / chin up machine or with a resistance tube under a single foot

Hammer curls

Perform 3 sets of 12 reps

• Grasping dumbbells with palms facing the body and being seated on a 90 degree bench
• Place feet about shoulder width apart and plant firmly into the ground
• Flex at the elbow joint bringing the forearm towards the upper torso
• Hold for a brief moment at the top of the lift before lowering the weight down slowly
• Ensure palms are facing each other throughout the lift

Tip: make sure back is pressed firmly against the bench and no arching persists

Plate pinches

Perform 3 sets of 30-60 seconds

• Holding a plate (preferably a bumper plate, however, a regular plate will do) with palms facing each other
• Pinch the plate with thumbs and four fingers
• Hold this position for 30-60 seconds
• Switch hands and perform the exercise again

Tip: If your grip strength is strong enough, you can perform this exercise with both hands simultaneously.

Get Fat grips

Fat grips can be used to wrap around dumbbells, barbells and cable attachments to provide a greater difficulty for the exercise. They increase grip strength by increasing the width around the weight requiring greater effort upon lifting. This increases forearm muscle activation and enhances the stimulation of muscle fibers.

Kevin Kwok – Studio Coordinator

Kevin enrolled in numerous sports program as a child, which exposed him to an active lifestyle early in life. He played ultimate frisbee competitively at the junior level while in high school. Kevin now focuses his training exclusively on dragon boating. He has been paddling for the past 3 years and hopes to make the Canadian National Team in 2019. He hopes he can motivate others to accomplish their short and long term fitness goals!

The post Carpal Tunnel Syndrome – Part 3: Exercises to Improve Grip Strength first appeared on Le Physique | Vancouver Personal Training.

Are you hunched over sitting in an office all day? Do you find yourself leaning to one side while standing? Both of these and many more daily activities can be the source of poor posture. This can lead to spine misalignment. The spine has a natural curve to it which allows for optimal functioning of the human body. Aside from the visible symptoms of poor posture, prolonged periods in unnatural positions can cause numerous internal problems to arise. This can include but not limited to muscle soreness and pain, increased stress and indigestion.

Muscle Soreness and Pain

People will find themselves being sore constantly. When you are hunched over, your muscles are working harder to keep the body upright, causing increased strain to affected areas. Poor posture puts additional strain on the spine which ultimately leads to lower back pain.

Increased Stress and Poor Mood

Poor posture is known to be associated with increased stress levels and gloomy moods. People who are slouched over have higher levels of depression and lower energy levels when compared to those who sit upright.

Indigestion Problems

You may think digestion is unaffected by poor posture but in fact it delays and prevents digestion from occurring. When sitting in a hunched position, the digestive system is compressed and does not allow for optimal functioning. The intestinal tract will have difficulty absorbing nutrients as well as moving waste causing constipation to occur.

But not to worry! These exercises will help treat poor posture.

Exercise 1 – Cross Scapular Retraction

• Step on one end of a rubber tubing or a band
• Using your right hand grab the other end of the tubing
• Standing upright and maintaining a straight arm raise the right arm diagonally from the bottom left side to the upper right side
• Do both sides and repeat for 10 repetitions

Exercise 2 – Wall Angels

• Stand shoulder width apart on a flat wall
• Externally rotate arms at the shoulder joint until the upper arm, forearm and back of the hand are flat against the wall
• Raise hands straight above head, maintaining contact with the wall at all times
• Repeat for 12 repetitions
• Make sure back is flat against the wall throughout the duration of the movement

Exercise 3 – Chin Tucks

• In a standing or seated position, maintain a straight back
• Roll shoulders back and look directly in front of you
• With two to three fingers, push chin and head back
• Hold for 5-10 seconds and repeat for 10 repetitions

Make sure to take your time when doing these exercises!

Kevin Kwok – Client Care Manager

Kevin enrolled in numerous sports program as a child, which exposed him to an active lifestyle early in life. He played ultimate frisbee competitively in at the junior level while in high school. Kevin now focuses his training exclusively on dragon boating. He has been paddling for the past 2 years and hopes to make the Canadian National Team in 2019. He hopes he can motivate others to accomplish their short and long term fitness goals.

The post 3 Exercises to Fix Poor Posture first appeared on Le Physique | Vancouver Personal Training.

Got shoulder pain? Don’t worry – you aren’t the only one! Shoulder injuries are common amongst athletes and older individuals. I am a competitive dragon boater and experience shoulder pain regularly. It is often associated with poor technique and over training. An effective shoulder conditioning program is crucial towards prevention and recovery.

The goal of shoulder rehabilitation is to restore function of the shoulder. Shoulder function can be defined as working in a proper way without causing any pain or discomfort. Through a series of strength exercises and mobilization techniques, recovery can be achieved at an accelerated pace.

Shoulder Function

There are two components when it comes to shoulder functionality; shoulder stability and shoulder mobility. A balance between the two is what contributes to normal shoulder function. Shoulder mobility is what allows the shoulder to move up, down, left and right in a free range of motion. Kinesiologists and physiotherapists may describe these movements as external rotation, internal rotation, flexion, extension, abduction and adduction at the shoulder joint. The glenohumeral joint (shoulder socket) is a ball and socket joint and enables the arm to perform multi-directional movements and rotation. Stability on the other hand, is the resistance musculoskeletal tissues provide to the joint from various movements. In other words, shoulder stability refers to the ability to keep the arm stable while performing various movements.

Pain Reduction

Pain is a major indication of a shoulder injury. At the onset of discomfort, exercise should be put to a halt to prevent further aggravation. The degree of impingement (pain) can vary depending on the seriousness of the injury. Rest is crucial during the first couple of days to allow the injured area to heal. Once pain levels begin to decrease, we can begin our rotator cuff exercises.

Our main focus is rehabilitating the rotator cuff muscles and restoring range of motion and increasing shoulder stability  The rotator cuff is responsible for stabilizing the shoulder joint and is made of 4 different muscles. These muscles originate at the edge of the shoulder blade and insert around the head of the arm bone, or humerus, forming a “cuff” like network.

Rotator Cuff Exercises

Scapular Protraction and Retraction

Scapular Elevation and Depression

Internal and External Rotation

Clock Exercises

 
Wall Angels

Dynamic/Plyometric Training

Once a full range of motion is achieved we can begin dynamic/plyometric training. Plyometric training focuses on increasing power and exerting maximal force during exercise. These exercises can be used to return the shoulder to optimal functioning. Make sure to start out with lighter weights and gradually increase the weights as the shoulder gets stronger.

Serrano Press

Wall Push-Ups

Overhead Forward Throw with Medicine Ball

l

Medicine Ball Slams

Have you ever done any of these exercises? Leave a comment below!

Kevin Kwok – Client Care Manager

Kevin enrolled in numerous sports program as a child, which exposed him to an active lifestyle early in life. He played ultimate frisbee competitively in at the junior level while in high school. Kevin now focuses his training exclusively on dragon boating. He has been paddling for the past 2 years and hopes to make the Canadian National Team in 2019. He hopes he can motivate others to accomplish their short and long term fitness goals.

The post Shoulder Rehabilitation Exercises first appeared on Le Physique | Vancouver Personal Training.

Pushups are a great body weight exercise that help strengthen the chest, shoulders, triceps and increase trunk stability. An essential and functional movement, understanding proper pushup technique and then incorporating them into your routine can have amazing effects on your overall performance, due to the complexity of the movement, use of the entire body and full body awareness it can create. Great pushup technique is even helpful in sport and activities like yoga and pilates. For example, newbie surfers will appreciate the application in popping up (getting up off your surfboard into an upright position).

Top 3 tips for proper pushups

1. Place your hands under your shoulders or slightly wider

Common mistake: hands are placed in front of the shoulders, so if you were to lay down with your hands in place, they would be at the level of your chin or ears, which is too far forward. Too far forward positioning can increase the stress to your shoulder joints, as your elbows tend to wing outward and forward, causing internal rotation and possible impingement of structures supporting your shoulder. In other words, potential shoulder and neck pain.

2. Maintain a straight plane through the hip and upper trunk

Common mistake: leading the movements with the head and shoulders on the pushup. This significantly compromises the intensity of the exercise, along with any improvements in trunk stability that you would experience.

3. Start to increase range of motion over time, as you become stronger

Common mistake: doing quarter range of motion pushups and always increasing the number of reps, versus increasing depth of movement to half, then full range of motion. Common mistake: Headbanger pushups. This is a combination of mistakes seen in tip 2a and 4a where you may notice someone doing many, many, many, pushups, but it really is a combination of many, many, many little elbow bends and head bobbing. This can lead to neck pain (you saw that coming, didn’t you?).

Rehabilitation Tips for Pushups

If your shoulders hurt

* Angle your elbows toward your feet, and imagine folding your arms in closer to your body, as though you are doing pushups in a skinny alleyway.

* Place your hands on a bench, table or stable surface like a fixed bar to reduce the angle, in order to decrease pressure in the shoulders, and focus on shoulder stabilization throughout the movement.

* In the top (plank) position, ensure your shoulder blades are in a neutral position before you begin the movement, and focus on keeping them there. Often people will shrug their shoulders up towards their ears during the movement potentially causing impingement.

If your neck hurts

* Have someone check to see if you are stabilizing your head in the proper position: neutral cervical spine and chin gently tucked.

If your wrists hurt

* Use push-up handles.

* Forms fists to push off of.

* Use the edge of an elevated, sturdy surface.

If your back hurts

* Lift, or keep your hips “high” to ensure they are not dropping below the level of your head (stay parallel to the floor, so they are on the same plane throughout the movement)

* Perform push-ups from your knees, so you can focus the effort on maintaining a strong core, before challenging your upper body

* Remember to engage your core before you start the movement

* Use the edge of an elevated, sturdy surface

The post Powerful pushups, done properly first appeared on Le Physique | Vancouver Personal Training.