Now that we are in the middle of summer, many of our patients ask us about outdoor activities and what they should do and not do. We usually instruct our patients to warm up a little with some walking and some simple range of motion stretches involving the major muscle groups before starting their outdoor projects. For our more sedimentary patients, we may even tell them to take time every 15 minutes to stand up and stretch after they have been in one specific posture for a period of time. For many people, spring and summer bring on a new resolution of getting out and exercising more frequently. This commonly is in the form of walking, jogging, and for some, running.
Besides recommending specific stretches to our patients, there are other concerns we should discuss with them to help support them as they begin to exercise. They may seem like common sense tips but, for many patients who do not regularly exercise, these tips will be a good reminder to them to be safe and healthy as they exercise.
Discussion points to have with patients who are starting exercise routines:
• How to stay hydrated—A safe recommendation is drinking at least 50 percent of their body weight in ounces over a given day.
• Wearing appropriate workout clothing—This includes reflective clothing if patients are walking in the early morning or once the sun is beginning to set. Rain gear can be helpful to keep them on their regime and not using bad weather as an excuse to skip exercise.
• Use of adequate sunscreen or wearing a hat when appropriate.
6 S’s of Running/Walking
I like to keep most of the focus on what is called the “6 S’s of running/walking.” These include stretching, speed, strength, surface, shoes and structure. Paying attention to each of these six points makes a world of difference for patients to stay healthy while beginning an exercise regime.
We already mentioned stretching earlier, but it is important that even the casual walker do some stretching, especially in the lower legs. Stretching of the gastrocnemius and Achilles are crucial, because these are common areas of cramping for beginning walkers and runners. The older our patient is, the more vulnerable he or she is to Achilles strains and sprains, which can be very slow healing and interfere with normal gait pattern movements. One very important aspect of stretching is to remind patients to stretch again after they have exercised to help loosen up the muscle groups and reduce lactic acid build ups.
Speed can mean different things to many people. Our focus should be on developing a comfortable pace for patients. They should not start out going too fast or too far too soon. Building up speed and distance on a weekly goal can be achieved by most people. Many overuse injuries are caused by simply trying to do too much before the body is ready to handle the pace or distance the runner is trying to achieve.
Many patients use strength as an excuse not to exercise. We have all heard it a million times, “I do not have enough strength to do….” The important thing here is just getting the patient to do something. They need to understand that strength will be gained by being active, not inactive.
Where people live can decide how and when they walk or run. The important factor in surface is staying on a level and fairly smooth surface. For more experienced walkers and runners, adding hills, unlevel surfaces (grass, dirt roads or paths) can make a walk or run more challenging. For our beginners, the smoother and the flatter, the better. It is common today to see people walking in shopping malls, schools, etc. The goal is to just get out there!
The last two S’s—shoes and structure—are very important, regardless if our patient is a beginner or a seasoned veteran. Wearing the correct shoe can make all the difference between enjoying a good experience or a bad experience. The last thing we want is our patient to be discouraged due to blisters or sore feet. Your recommendation of the correct shoe is vital. If you are not comfortable making a recommendation, then recommend that your patient go to a running store to get correct information on what shoe is best for them. Running shoes are designed on three types of foot structure: the supinator, neutral and hyper-pronated foot. The supinator, or high-arched foot, is usually demonstrated as a C-shaped shoe. This shoe is usually more flexible and has additional shock-absorbing support. The neutral foot shoe is semi-curved with adequate support and shock absorbing capabilities. The flat foot, or hyper-pronated foot, requires a shoe that is referred to as a motion control shoe. It is designed to add additional support on the medial side of the shoe to assist with pronation. This shoe is usually straighter in its appearance.
I am often asked by doctors when I am lecturing, “If we place a patient in a motion control shoe, do we still need to recommend an individually-designed, flexible orthotic?”
The answer is YES! Remember, the individually-designed orthotic is designed to balance the three arches of the foot to allow a symmetrical heel-to-toe transition. If you put your hand inside the shoe, you will find that the shoe is usually flat on the inside. The additional stability to the shoe is placed in the medial side for additional support as the weight bearing forces go medial. They are not designed to correct a fallen or dropped arched.
The last of our six S’s is structure. No one does structure better than the doctor of chiropractic. Because of our education, philosophy and the art of the adjustment, we continue to be the leading profession that the consumer seeks for manipulative therapy. We must continue to keep it that way. The use of individually-designed orthotics can be essential to help stabilize the kinetic chain to allow the chiropractic adjustment to hold longer in correcting or stabilizing our patients’ neuro-musculoskeletal conditions that result from the different types of subluxation. We must also consider posture of our patient when we recommend rehabilitative procedures to help with strengthening muscle imbalances. The right nutrition is key in assisting to reduce inflammation and improve healing. All of these are important aspects to think about when giving exercise recommendations to our patients.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.