They come in all colors and styles. They can be dressy, casual, or sporty. And they’re so easy to just slip on as you walk out the door. Good old flip flops!

So despite their versatility, style, and ease, flip flops may be the cause of foot trouble for some. Since they have no back/strap or support around the ankle or heel, the smaller muscles of the feet must work very hard to keep them from falling off as you step (making it more difficult than walking bare foot). In addition, they offer little to no arch support, which translates to increased strain to the plantar fascia as well as muscles along the bottom of the foot. This is why wearing flip flops on a regular basis can contribute to plantar fasciitis or Achilles tendinitis. In addition, they also aren’t particularly stable and can contribute to trips, twists, and falls, increasing the likelihood of ankle sprains or fractures.

Believe me, I love my flip flops for quick trips, lounging in the yard, and beach outings, but my feet get so sore as soon as I start to wear them in the summer. This is when I think about what I put on my feet. For any prolonged walking or standing, I try to select sandals or shoes that offer more support, contour, and cushioning. There are a lot of stylish, foot friendly choices out there now for summer footwear, including light weight, breathable sneakers that offer lots of arch support and heel stabilization. Shop around and be good to your feet…so you can enjoy every step of summer.

An often overlooked muscle group when it comes to stabilization exercises for the pelvis and low back are the pelvic floor muscles (the levator ani and coccygeus). This is a group of muscles that connect from the front of the pubic bone to the tailbone. They create a hammock between the legs and assist in stabilizing the pelvis as well as supporting the abdominal organs, particularly the bladder and bowels.

Weakness in the pelvic floor muscles can contribute to back pain, sacroiliac joint pain, pubic symphysis pain, as well as incontinence (leakage of urine) when you cough or sneeze. Dysfunction in the pelvic floor muscles can be due to trauma, as a result of childbirth, or due to poor posture with associated muscle imbalances.

To exercise the pelvic floor muscles, try to envision pulling the muscles of the saddle area up and in towards your abdominal cavity. You should not feel your buttocks, thighs, or abdominals tightening as you do this. One of the simplest ways to learn to contract the pelvic floor is to stop the flow of urine while you are on the toilet. You can try this technique to verify which muscles to isolate, but avoid doing this often, as it can cause urinary tract infections.

This type of pelvic floor contraction is also known as Kegel exercises. Though it can be difficult to learn how to isolate these muscles, they are an important component of a lumbosacral rehabilitation program. (They’re also very important to do throughout pregnancy and immediately following birth in order to prevent and manage incontinence.) If you are not certain that you are performing these with the correct technique, discuss it with your health care provider or physical therapist.

When I was in college I had my fair share of running injuries…mostly because I didn’t stretch enough. I developed Achilles tendinitis, which is an inflammation of the Achilles tendon, the thick, fibrous tendon that travels from the calf muscles along the back of the ankle.

When the Achilles becomes inflamed, there is less space within the connective tissue sheath that surrounds it. It can feel squishy, or even like it gets stuck as you try to flex and point the foot, due to adhesions that develop. These prevent the tendon from gliding smoothly. The pain can be mild or severe, and is worse during the push off phase of walking or running, or any time you point the foot and toes downward.

Often, there is associated weakness in the Achilles and possibly weakness in the anterior muscles of the shin, with tightness in the calf and Achilles. Both stretching and contracting of the calf muscles may reproduce pain.

Managing this type of injury requires frequent icing to reduce inflammation. Rest is also key. High impact activities, particularly any sports that involve running or jumping should be avoided. Cross friction massage is also very beneficial to improve circulation and reduce adhesions and promote optimal alignment of collagen fibers. It may be that flat feet or high arches contributed to the problem, and orthotics may be helpful in restoring better alignment to the foot and ankle. There are also braces and night splints available for more severe cases that allow the calf muscle to rest and have a gentle sustained stretch. Frequent active stretching of the gastracnemius and soleus, the 2 muscles that form the Achilles tendon, is also essential.

Seeking treatment early will help prevent a chronic inflammation from developing. Physical therapy can be very helpful in correcting any muscles imbalances, retraining the joint receptors, and helping to reduce inflammation with various modalities (such as ultrasound, iontophoresis, and electric stimulation). A PT can also help develop a sports specific rehab program to help get you back to your sport safely and as quickly as possible, teaching you ways to avoid the same condition in the future.

Well, I didn’t make it to watch the 11:00 news last night, but I did read the story this morning. Check out this link to see why one New York doctor thinks the cure to back pain is all in your head.

http://www.thebostonchannel.com/health/16301412/detail.html

It seems there are always new products, gimmicks, exercise plans, and support groups that claim to offer the most effective, latest and greatest forms of weight loss. I see it on TV, in magazines, newspapers, and I even received a marketing piece in the mail the other day claiming to be the solution to my weight loss problem (which I incidentally don’t have).

I’m starting to hear and see a lot of the same about back pain. On the radio today they were promoting the newest “controversial” cure for back pain that is supposed to be highlighted on the 11pm news (I hope I stay awake long enough to see it). There are a slew of new products from braces, supports, pillows, and supplements. Not to mention, many, often contradicting types of exercise programs. Even the physical therapy treatments range from very aggressive, to passive and gentle. So how do you know where to start or what to invest in?

I wish there was an easy answer…and if there is, I unfortunately don’t have it. I don’t think there is a magic answer to back pain and for many reasons. Here goes:

1. Every body is different and will respond differently to each product and treatment available.

2. Mental /emotional pain and stress will often contribute to physical pain and if not addressed, the individual may not experience relief from a given remedy.

3. Motivation and commitment make a huge difference. If you are supposed to wear a brace for a certain number of hours a day but don’t, the results may not be as implied. Or if an exercise program takes an hour and you only find 15 minutes, you’re not going to get results.

4. It’s often difficult for me to bring up the topic with patients who are overweight, but finding a weight management program is often needed to find relief from back pain. As hard as it is to lose weight, it is so important to make lifestyle changes that include healthy, mindful eating and exercise.

5. The spine is complex structurally, with so many joints, ligaments, muscles, discs, and nerve, that there is lots of room for things to go wrong. Any imbalance can create pain and result in muscle spasm that can lead to weakness and loss of motion over even a short period of time.

6. If there was a magic answer, there wouldn’t be so many resources, products, and treatments available.

I encourage people to tackle back pain quickly to prevent a chronic problem from developing. If one treatment isn’t successful and you are consistently following through with whatever components were recommended (you have to be honest with yourself here), then discuss alternative approaches with your current provider or seek out complementary treatments. Evaluate your lifestyle and overall physical and mental well-being to see what other directions you may need to follow for treatment. Keep an open mind and open lines of communication between all of your providers so you can achieve the best outcome possible.

And who knows, maybe the 11 o’clock news tonight will have a miraculous break through treatment new to all of us that will put an end to back pain forever.

My friend’s mom is newly diagnosed with spinal stenosis. She began to experience back pain a couple of months ago and her primary doctor referred her to physical therapy with a diagnosis of a bulging disc based upon her symptom: back pain that radiated down her leg.

Based upon her diagnosis, her therapists had her working on spinal extension exercises based upon the McKenzie method. These exercises encourage back bending of the spine and are designed to encourage the disc to migrate back into position, thereby relieving pressure on neighboring nerve roots. She did not improve, and in fact she experienced an increase in pain and further loss of function. Everyday walking and going to her gardening club became impossible.

She was then referred to a specialist who ordered an MRI. The results revealed that she has significant spinal stenosis. This condition also causes pressure on nerve roots due to arthritic changes around the spinal column which result in crowding of the canal.

In general, people with spinal stenosis respond well to flexion, or forward bending exercises, which help to open up the stiff, crowded joint spaces in the spine. This is quite the opposite of what she experienced in her first go around with physical therapy.

As a result of her negative experience, she opted to try acupuncture and steroid injections into her spine. I have tried to encourage her to resume some exercise, such as stationary cycling, or gentle water exercise. Walking, which naturally promotes spinal extension, truly aggravates her symptoms, but doing no exercise will only exacerbate the stiffness and mobility limitations within her spine. She is still reluctant, and rightfully so given her current pain level and her prior PT treatments…which were unfortunately for the incorrect diagnosis.

I don’t think her primary doctor is to blame here. Doctors must make their best educated diagnosis based upon a patient’s presenting symptoms and in these days of managed care, do try to avoid ordering expensive tests, such as an MRI until necessary. Many of my patients with back pain come to physical therapy before MRIs are performed, and many do in fact get better without having a confirmed diagnosis. In this instance, however, an earlier MRI may have resulted in a better outcome. Earlier access to the appropriate form of physical therapy or other treatment may have provided more rapid relief of pain and prevented a decline in her function and activity level.

Many of my patients with back pain experience an increase in pain when they get in and out of bed. And believe it or not, there is a right and a wrong way to get out of bed, or at least a way to do it that minimizes the forces on the spine.

If you are on your back, roll onto your side with your knees bent. If you are a side sleeper, you will already be in this position. Bring your legs over the side of the bed as you simultaneously push your torso up to a sitting position. The incorrect method is to transition from supine (flat on your back) to a long sitting position (sitting with legs straight in front of you). This movement requires significant abdominal strength and places strain on the lower back. Particularly if you have tight hamstrings and upper back muscles, this will be a difficult and potentially aggravating way to do it.

Using this “logroll” technique to get back into bed is also effective. Start by sitting at the edge of the bed. Start to lower onto one arm as you bring your legs up with the knees bent, into a side lying position. Keeping the knees bent, you can then roll onto your back.

This morning as a gift to myself on mother’s day, I escaped for an early morning yoga class at a studio I’d never been to before. They specialize in hot, power yoga classes, which is not the style of yoga I typically practice, but do enjoy once in a while.

The heat was set to about 98 humid degrees, and the teacher was pushing the 40 or so of us that filled the room at 7am to our limits. During my peaceful hour and a half, I remebered why I enjoy subjecting myself to classes of this sort:

1. Being pushed to the limit and realizing how strong you are can be empowering.

2. Sweating (and I’m talking about the dripping, soaking wet kind of sweating that you don’t often experience) really does leave you feeling lighter and like you released a lot of toxins. (And I always replenish and rehydrate with lots of water afterwards.)

3. Varying your practice or exercise routine is a challenging, stimulating, and highly effective way to optimize your overall fitness level.

4. Any yoga leaves my mind and body feeling more at ease.

And I started thinking how all of these points relate in a way to my own experience of injuries, and those of my patients. (And I hope may help you)

1. As a PT, I am the one sometimes pushing the patient to their limit…and I’ve worked with many patients who push themselves to the limit. This can be good when they are motivated and work hard, but this can also lead to overuse injuries, so it’s important to find a good balance.

2. As far as sweating, well, this one doesn’t relate as much. However, the process of releasing toxins is so beneficial. Massage and water therapy, such as a warm whirlpool, are two ways to experience a release and should also always be followed up with adequate rehydration.

3. When recovering from an injury, it’s important to change and progress your exercises in order to continue making gains. If you stick with the same 3 exercises forever, you may not see results.

4. Finding a means of relaxation and stress relief helps to reduce overall pain levels. The more stressed you are, the more likely you are to tense up your muscles, restrict circulation, and lose muscle flexibility. If yoga’s not for you, it’s important to find some other form of phsical or mental therapy to help induce a state of mental peace.

So maybe today you will think about trying something a little bit different. Your health care provider may have some helpful suggestions if you’re not sure where to begin.

The knee is a common site for osteoarthritis and various other joint and soft tissue injuries. If you have intermittent aching in your knees, the first thing I would recommend (if I wasn’t able to see you to look at it) is to start to work on strengthening and stretching the quadriceps.

The quadriceps are a group of 4 muscles that run along the front of the thigh and over the knee cap. When they contract, the knee straightens and the knee cap glides up towards the hip. Strong quadriceps help to improve the stability of the knee joint, encourage proper function of the knee, and allow us to easily walk, go up and down stairs, and stand up and down.

When the quadriceps are tight, the degree of flexion, or bending of the knee can be restricted. Tight quadriceps also create undue stress on the kneecap and cause a compression at the knee joint. The result may be pain with activities such as stairs, squatting, running, and prolonged sitting.

Try these quariceps stretch and strengthening exercises and you may notice your knees start to ache just a little less.

A bunion is a bony overgrowth that occurs at the big toe joint, often with an apparent visual change where the big toe angles in towards the other toes. As bunions progress, they can become problematic in terms of discomfort and difficulty with finding well fitting shoes.

If you have a family history of bunions, you may be more likely to develop one. In addition, pointy toe shoes contribute to bunions as they tend to rub on the inner side of the big toe joint as they angle the big toe inward.

The best way to prevent the growth of a bunion is to wear shoes with a wide toe box. If you already have a bunion, wearing a gel or soft plastic toe spacer will help keep the big toe in better alignment and reduce the pressure and deformity of the big toe joint. Orthotics may also help to improve the alignment and mechanics of the foot.