Well, it’s that time again – time for colds, the flu, and all kinds of other germy things floating around to make us sick. By this time, we should all know basic things to help prevent us from feeling down right crummy, but reminders can help. So, here are some of the top tips on staying healthy this season.

1. WASH YOUR HANDS (watch the video – it says it all) – soap and water is best but if not available, hand sanitizers are better than nothin’
2. USE ARM SNEEZING TECHNIQUE – sneeze into your arm or tissue, not your hands (unless you are going to immediately scrub them without touching anything!)
3. COMMIT ACTS OF HEALTHFULNESS – eat healthy (foods rich in vitamins and anti-oxidants), exercise (unless you feel sick, then you should probably rest), limit alcohol, drink
some green tea
4. GET ENOUGH SHUT-EYE – your body needs this to restore itself
5. AVOID SICK PEOPLE – OK, some of these might be your friends and family but at least make sure they are practicing safe germ warfare and clean areas around you. By all means,
if you are sick, they say you should STAY HOME (don’t take that as license for a day off though).

Pass these tips around……………..it’s OK if they are contagious!

In Good Health,

Christine

Do you have any other tips for staying healthy this winter?

What NOT To Do With Your Medications

I recently moved – halfway across the country I might add, and like many people, I ABSOLUTELY dislike moving (I would say hate, but that’s not very nice). I thought that I had been holding up relatively well – handling all of the thousands of major and minor details involved, until moving day came.

I was in a panic, as most people get that day, and if it weren’t for some of my family members, I would not have made it with at least some portion of my sanity. My sister, brother, and my mom all came to help me on that dreaded day… to which I cannot thank them enough.

While I was in my stress mode in other parts of the house, I apparently neglected giving my mother enough to do. You see, she loves and needs to stay busy so she decided to clean out my medicine drawers. She meticulously checked the dates of all of the meds that had been collecting over quite a few years, set aside all of the out dated ones, tore the labels off of any outdated prescription bottles, and set them all in one area to be disposed of at some point.

When I found this out, I about had a cow – in my mind, I knew just how everything was in there.

One of my biggest aggravations and worries moving, was about how to get rid of things – the right way……things like gasoline, oil, any yard products, cleaning products, old electronics, wood, etc. So after working so hard at trying to get rid of this stuff, the medication thing really sent me over the edge, giving me just ONE MORE thing to do.

I explained to her that I buy bigger bottles of things like ibuprofen and then use it to refill smaller bottles that are easier to travel with or keep in strategic areas. She kindly said “you shouldn’t do that” because you won’t’ know when they have truly expired. I thought to myself – “hooey to that” – I want those smaller bottles.

After thinking about it and apologizing to my mom (at least 5 times), I realized that she was right (but of course she was, she IS a mother!). I am not big on taking medications in general, but over the years, I have recognized their usefulness in appropriate circumstances. I realized that I did have a good bit of “stuff” that I never used, some dating back to 2004!

Bless her heart, she took all of those old meds home with her to dispose of them the RIGHT WAY for me.

So, in case you’re wondering, here is a short video on how to get rid of them properly. It’s good for the environment, our health, and it will make my mom happy.

Many communities have places you can take them – check them out where you live or you can do it yourself by watching the video below:

ARE YOU USING ORTHOTICS FOR KNEE PAIN?

    Knee pain, particularly patellofemoral pain is a common complaint seen in family medicine, orthopedic and sports clinics, running and sports shops. Although the use of foot orthotics has been widely used by health professionals many over-the-counter versions exist and are purchased regularly (can you say Dr. Scholls?). Foot orthoses have been used for a variety of painful conditions including foot/ankle pain, back pain, diabetes, and hip pain.
Determining which individuals may actually benefit from the use of the orthotics for complaints of knee pain have yet to be identified. There have been several studies evaluating the use of orthotics in individuals with patellofemoral pain syndrome with the intention to develop clinical prediction rules. Vincenzo et al identified that those most likely receiving benefit were those who were older individuals, shorter individuals, individuals with lower baseline pain, and those with greater foot mobility. Another study by Sutlive et al identified three different predictors: greater forefoot valgum, reduced first metatarsophalangeal joint dorsiflexion, and reduced navicular drop. Restricted ankle dorsiflexion range has also been reported to be a potential indicator for the use of foot orthotics.This recent study by Barton et al, in Medicine & Science in Sports & Exercise was aimed at developing a preliminary clinical prediction rule to help identify individuals with patellofemoral pain syndrome who might most likely benefit from foot orthotics. The results of the study showed that 25% of the participants demonstrated marked improvement in a 12 week program of non-custom orthotics wear.
The number of participants with marked improvement increased to 78%. When three of the four criteria were met:

•   Foot wear motion control properties score of less than 5.0, which indicated less supportive footwear properties
•   Reports of less than 22 mm on a visual analogue scale (lower levels of pain)
•   Ankle dorsiflexion range motion with the knee flexed less than 41°
•   Reduced pain with a single leg squat while wearing the orthoses.

There were several takeaways for me in this article. First, the article mentions several outcome measures that I was not familiar with – the links are attached below. Some of these outcome tools might be of benefit to some clinicians and researchers.

Secondly, I think that the easiest measures that can be performed quickly in the clinic would be that of assessing ankle dorsiflexion range motion and determining immediate reduction of pain with a single leg squat while wearing the orthoses.

      And finally there is mention in the article that patients often do not respond to just one single intervention tool. Therefore, continuing to perform a comprehensive examination including hip/core strength and joint mobility would certainly seem to more than likely help in reducing knee pain in conjunction with the use of orthotics.  Let’s not forget about addressing other health issues such as weight and general physical inactivity.

Comments? Questions?

OUTCOME TOOLS to check out:
International Physical Activity Questionnaire
Footwear Assessment Tool
Foot Posture Index

Ref: Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain BARTON, CHRISTIAN J.; MENZ, HYLTON B.; CROSSLEY, KAY M. Medicine & Science in Sports & Exercise. 43(9):1603-1610, September 2011.

Understanding the 5 Stages of Change to Improve Healthy Behaviors

Examining the Stages of Change

Understanding some basic concepts about the process of change can be helpful to keep in mind as we move our patients/clients forward on their path to discovering better health.

Learning to recognize where our clients are in this process can not only help to move them forward from one stage to the next, but also help both you and the client learn how to handle any “backslides” that are bound to occur along the way.

There is more than one theory on how health behavior change occurs.  The Transtheoretical Model of Behavior Change developed by James Prochaska and colleagues which began in 1977 is a popular model currently used in many health and wellness practices. Prochaska’s book, Changing for Good along with research using this framework have made it a dominant model used for health behavior change.

What are the 5 Stages of Change?

1. 1. PRECOMTEMPLATION –the patient or client has no interest in change– they may state I’m not even thinking about it, “I Won’t” or “I Can’t”
2. 2. CONTEMPLATION – Statements such as “I May” or “I’ve thought about – getting more active, improving my eating habits or changing other health behaviors but haven’t done so yet, indicate they are in the contemplation stage.   They are ambivalent about changing.   During this stage, patients assess barriers (e.g., time, expense, hassle, fear, “I know I need to but …”).   They are sizing up, or contemplating the barriers versus the benefits.  People can stay in the contemplation stage for months to even years!
3. PREPARATION STAGE – If the patient has been increasing their activity level, exercise, or eating better but it has been inconsistent, they are in the “I Will” or Preparation Stage.  During the preparation stage, patients are starting to make a specific change. They may experiment with small actions or changes as their determination to change that specific behavior increases.
4. ACTION STAGE – If the patient has been exercising, eating better, or engaging in other activities to improve your overall health status consistently, but for less than 6 month.  They are in the “I AM” or Action Stage.  This stage can last up to 6 months while they are establishing your new habit
5. MAINTAINANCE STAGE – If the patient/client has been engaging in their new healthy activity for more than 6 months, they are in the Maintenance Stage, or “I Still Am!”. It is in this stage that the new behavior change has become a habit.  They are more confident in their ability to maintain the new behavior

Early in my career as a physical therapist, I struggled trying to figure out why some patients progressed more easily than others.  We all know those patients or clients that we love to work with – they listen to you, are more compliant with their treatment or rehabilitation program, and seem to get better with less difficulty.

Then there are the ones that I asked “what on earth can I do to help you, why aren’t you doing what you need to get better?  Learning to incorporate the Stages of Change into practice was instrumental in determining how to approach that particular individual, what information might be best for them at that particular time, and what might be the best intervention strategy for them to help move them forward along the spectrum of change.

Now that you know the basics of the stages of behavior change, in the next post, we’ll discuss how to incorporate them into your practice to help your clients achieve a healthier lifestyle.

This is the second in our series on Leading your Clients to Good Health.  If you missed the first one, go here:  http://www.healthpathtoday.com/?p=504

Health Bytes from around the News

1)  Health care quirk grants middle-class Medicaid

(CBS/AP)

(AP) WASHINGTON – President Obama’s health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.

Read more: http://www.cbsnews.com/stories/2011/06/21/politics/main20073175.shtml#ixzz1Q09w8yvM

2)         Treating PTSD with virtual combat

At Emory University, more than 90 veterans with Post Traumatic Stress Disorder are being treated with an experimental therapy that uses virtual reality to place them back on the battlefield, reports Mark Strassmann.

Watch video

Read more: http://www.cbsnews.com/1770-5_162-0.html?query=ptsd&tag=srch&searchtype=cbsSearch#ixzz1Q0CAkVxx

3)  Md. health officials investigate bath salts | Ben Giles | Local …

Hallucinogenic bath salts soon may be given the boot in Maryland. The Maryland Department of Health and Mental Hygiene has started a monthlong investigation into the synthetic recreational drug as it tries to discover …

http://washingtonexaminer.com/local/2011/06/md-health-officials-investigate-bath-salts

4)  Formaldehyde, Styrene Added To U.S. Health Department’s …

Formaldehyde, a preservative used in labs and mortuaries, and styrene, the chemical used to make styrofoam cups and food containers, were among six chemicals that were added today to the U.S. health department’s list of …

http://www.huffingtonpost.com/2011/06/10/styrofoam-carcinogens-formaldehyde_n_875054.html

5)  Joe Lieberman’s Plan to Make Health Care Worse and More Expensive …

So think of this as a national interest thing rather than a budget thing: Lieberman is proposing that we move a substantial number of older Americans into a worse, more expensive health care system. Why would you want to …

http://krugman.blogs.nytimes.com/2011/06/10/joe-liebermans-plan-to-make-health-care-worse-and-more-expensive/

Does Barefoot Running Cause or Prevent Injury?

I just got back the American College of Sports Medicine Annual Conference in the beautiful city of Denver. It was held in conjunction with the Exercise is Medicine meeting so you can imagine how much great information was packed in over the almost full week of lectures, symposiums, forums, etc.

One of the lectures that I found quite timely and informative was that on the differences between barefoot running, minimalist shoes and shod (that mean shoes for most of us). The research presented some fairly compelling evidence against those who are shod heel strikers.

The forces transmitted up the kinetic chain were shown to be significantly greater tin heel strikers compared to those who were forefoot or mid foot strikers. 75% of runners are heel strikers which creates a very high magnitude of force – 1.5-2x body weight.  Shoes make this heel striking pattern more comfortable and can slow the rate of loading.  Wearing shoes actually encourages you to heel strike.  Shoes also tend to be easier on calf muscles – they don’t have to work as hard.

Research by Dr. Daniel Lieberman has shown that 75% of habitual barefoot runners forefoot strike; 12% midfoot;12% heel strike.  He points out that there are variations in striking patterns.

Forefoot striking tends to encourage a softer, more gentle landing.  The same impact peak that appears on a force plate with shod running is significantly reduced to almost non-existent barefoot running.

Barefoot running forces you to run lightly and gently because where there is no collisional impact.  That all sounds great but does that mean that we should all kick off our shoes?  Of course not – you obviously can still have injury if not done correctly and so far, there are many unanswered questions.

We don’t yet know the impact of barefoot running on injury.  30-70% of habitually shod runners are injured per year.  There is no current evidence for decline over past 30 yrs despite all the really cool shoe features that keep coming out.

There is also no current evidence that says barefoot running decreases injury yet though either.  We don’t yet know: Are they running with proper technique? Are they getting injured at higher rates than shod runners?  More questions will be coming.

Although I certainly would never call myself a runner,  I did get a pair of what I affectionately call  ”fingerfeet” for my birthday and found them surprising quite comfortable (once I found out how to get the on!).  You definitely don’t feel like you want to heel strike in a minimalist shoe or barefoot as it is does not feel good at all.  Those who do, or try to go into barefoot or minimalist shoe running too quickly are more likely to pay the price.

The verdict is still out and up for debate as more research comes out – and it will!   If you are going to discuss it with your patients/clients, suggest to them that following a gradual training progression would be much to their favor – even if they are experienced runners.  As we know, many injuries occur from improper training.  So far, I haven’t seen too many injuries in my clinic as a result, but I don’t think that it is quite as popular yet in my area.

Here are a few tips you can suggest to your patients or clients:

• Start slowly – follow a transitioning program
• Pick smooth paved surfaces
• Good barefoot landing should feel gentle, relaxed
• Don’t point your toes too much – this will over work the calf muscles
• Land as soft and quiet as possible, keeping your center of mass as low as possible
• Do not over stride
• Listen to pain
• Cut mileage or number of days that you are running
• Slowly wean orthotics and/or shoewear down
• Do stretching, strengthening, balance/stability exercise

If nothing else, I think the ‘Fingerfeet’ are just darn cute!

What have your experiences been with barefoot running for you or your clients?