Being Thankful

What are you  thankful for this year? Recently I met a woman who required more time and energy than usual and I mentioned this to a coworker who informed me the woman had a terminal illness. As I continued to help this woman I felt more compassion for her and more thankfulness for my own life. Taking time to reflect on the things that you are grateful for may be more important than you think. You already know the importance of exercise and nutrition. But you may be missing an even more important factor in your health. Here are five ways to lessen your chance of illness during the flu season, and all year round.

Start your day out right.  By starting your morning with a positive act, such as meditating on what you are thankful for, or by creating a grateful list, you'll be sending your body messages it will use to help you stay happy and healthy all day.

Music.  On your way to work, or school, listen to music that makes you feel good. Whether it's soothing, or fun, as long as it makes you smile, you'll be much better prepared to start your busy day. 

Breaks.  Whether you spend your day working with the public, on the computer, or at home, remember to stop and take a break. Use that time for positive thinking to counteract any of the negative stress that you've experienced. Breathe, meditate,  read a book, take a walk and get some fresh air, or just think about your favorite things in life.

Laughter.   Laughter is really the best medicine. It actually reduces stress hormones and even benefits your immune system. Finding the humor in the most difficult of situations is one of the best kept secrets of a happy, and healthy, life.

A hot bath and a good night's sleep.  Relaxing in a hot bath soothes sore muscles and joints, reducing stress and tension which helps you to get a good night's sleep. Getting enough sleep has a big impact on your immune function and disease resistance. This is the time your body uses to repair itself and your immune system, strive for 7-8 hours a night.  

Be thankful for the good things in your life.

Heart Healthy Diet and Lifestyle

Heart health is an important part of caring for our bodies. Unfortunately, we often are bombarded with poor food choices through the media and our lifestyle. Although you may know that its important to eat better,  it's often tough to change your eating habits. We have gathered a few tips to help you on your way to a more heart heathy diet.

1. Control your portion size How much you eat is just as important as what you eat! Overloading your plate, taking seconds and eating until you feel stuffed can lead to eating more calories, fat and cholesterol than you should. Portions served in restaurants are often more than anyone needs. Keep track of the number of servings you eat — and use proper serving sizes — to help control your portions. Eating more of low-calorie, nutrient-rich foods, such as fruits and vegetables, and less of high-calorie, high-sodium foods, such as refined, processed or fast foods, can shape up your diet as well as your heart and waistline. A serving size is a specific amount of food, defined by common measurements such as cups, ounces or pieces. For example, one serving of pasta is 1/2 cup, or about the size of a hockey puck. A serving of meat, fish or chicken is 2 to 3 ounces, or about the size and thickness of a deck of cards. Judging serving size is a learned skill. You may need to use measuring cups and spoons or a scale until you're comfortable with your judgment.

2. Eat more vegetables and fruits Vegetables and fruits are good sources of vitamins and minerals. Vegetables and fruits are also low in calories and rich in dietary fiber. Vegetables and fruits contain substances found in plants that may help prevent cardiovascular disease. Eating more fruits and vegetables may help you eat less high-fat foods, such as meat, cheese and snack foods. Featuring vegetables and fruits in your diet can be easy. Keep vegetables washed and cut in your refrigerator for quick snacks. Keep fruit in a bowl in your kitchen so that you'll remember to eat it.

3. Select whole grains Whole grains are good sources of fiber and other nutrients that play a role in regulating blood pressure and heart health. You can increase the amount of whole grains in a heart-healthy diet by making simple substitutions for refined grain (white flour)  products. Try a new whole grain, such as whole-grain couscous, quinoa or barley. Another easy way to add whole grains to your diet is ground flaxseed. Flaxseeds are small brown seeds that are high in fiber and omega-3 fatty acids, which can lower your total blood cholesterol.

4. Limit unhealthy fats and cholesterol Limiting how much saturated and trans fats you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease. A high blood cholesterol level can lead to a buildup of plaques in your arteries, called atherosclerosis, which can increase your risk of heart attack and stroke. The American Heart Association offers these guidelines for how much fat and cholesterol to include in a heart-healthy diet: Type of fat Recommendation Saturated fat Less than 7% of your total daily calories, or less than 14 g of saturated fat if you follow a 2,000-calorie-a-day diet Trans fat Less than 1% of your total daily calories, or less than 2 g of trans fat if you follow a 2,000-calorie-a-day diet Cholesterol Less than 300 mg a day for healthy adults; less than 200 mg a day for adults with high levels of LDL ("bad") cholesterol or those who are taking cholesterol-lowering medication The best way to reduce saturated and trans fats in your diet is to limit the amount of solid fats — butter, margarine and shortening — you add to food when cooking and serving. You can also reduce the amount of saturated fat in your diet by trimming fat off your meat or choosing lean meats with less than 10 percent fat. You can also use low-fat substitutions when possible for a heart-healthy diet. For example, top your baked potato with salsa or low-fat yogurt rather than butter. When you do use fats,choose ones such as olive oil or canola oil. Also the fats found in nuts and seeds,  are good choices for a heart-healthy diet.

5. Choose low-fat protein sources Lean meat, poultry and fish, low-fat dairy products, and egg whites or egg substitutes are some of your best sources of protein. But be careful to choose lower fat options, such as skim milk rather than whole milk and skinless chicken breasts rather than fried chicken patties. Fish is another good alternative to high-fat meats. And certain types of fish are rich in omega-3 fatty acids, which can lower blood fats called triglycerides. You'll find the highest amounts of omega-3 fatty acids in cold-water fish, such as salmon, mackerel and herring. Other sources are flaxseed, walnuts, soybeans and canola oil. Legumes — beans, peas and lentils — also are good sources of protein and contain less fat and no cholesterol, making them good substitutes for meat. Substituting plant protein for animal protein — for example, a soy or bean burger for a hamburger — will reduce your fat and cholesterol intake.

6. Reduce the sodium in your food Eating a lot of sodium can contribute to high blood pressure, a risk factor for cardiovascular disease. Reducing sodium is an important part of a heart-healthy diet. The Department of Agriculture recommends: Healthy adults have no more than 2,300 milligrams (mg) of sodium a day (about a teaspoon) People age 51 or older, African-Americans, and people who have been diagnosed with high blood pressure, diabetes or chronic kidney disease have no more than 1,500 mg of sodium a day.  Eating fresh foods and making your own soups and stews can reduce the amount of salt you eat. If you like the convenience of canned soups and prepared meals, look for ones with reduced sodium.

7. Plan ahead: Create daily menus You know what foods to feature in your heart-healthy diet and which ones to limit. Now it's time to put your plans into action. Create daily menus using the six strategies listed above. When selecting foods for each meal and snack, emphasize vegetables, fruits and whole grains. Choose lean protein sources and limit high-fat and salty foods. Watch your portion sizes and add variety to your menu choices. Variety also makes your meals and snacks more interesting.

8. Allow yourself an occasional treat.  Allow yourself an indulgence every now and then. Treat yourself to frozen yogurt or air popped popcorn sprinkled with cinnamon. This will keep your sweet tooth satisfied without completely derailing your new heart healthy lifestyle change. In addition try exercising at least 30 minutes a day to keep yourself feeling focused and to release some endorphins to keep you happy! If you slip up, don't berate yourself and also don't let it turn into an excuse for giving up on your healthy-eating plan. If overindulgence is the exception, rather than the rule, you'll balance things out over the long term. What's important is that you eat healthy foods most of the time. Incorporate these eight tips into your life, and you'll continue to find that heart-healthy eating is both doable and enjoyable. With planning and a few simple substitutions, you can eat with your heart in mind.

Tips for boosting Metabolism and a Healthier You

KEEP HYDRATED

The general population probably thinks this sounds like a broken record when it comes to the whole water thing, but it really is important. Drinking the recommended eight cups of water a day will help your body function at peak performance levels.

DESTRESS YOURSELF

Stress raises the amount of cortisol in your body. Cortisol is a hormone that tells the body to hold onto fat in case of a stressful situation (think more natural disaster-level stress, not a bad day at work-level). Experiment with yoga or meditation as ways to lower stress levels and clear your mind.

DECREASE DIET SODA

Although it's low in calories and seems like an easy swap for high calorie beverages, diet soda may actually have adverse effects on your metabolism. Water and seltzer are better options, but if you must drink diet soda, limit your consumption to two cans per week.

DON'T FORGET YOUR  ZZZ's

Getting a least seven to eight hours of sleep every night is crucial to a healthy metabolism. Anything less can adversely affect your body's ability to burn calories. Surprisingly, excess sleep may do the same thing. It's best to keep a consistent bedtime and wake up close to the same time every morning.

INCREASE WEIGHT BEARING EXERCISES

One pound of muscle burns 35 to 50 calories, while one pound of fat burns a measly 5 to 10 calories. Building more muscle can increase your body’s basal metabolic rate (BMR) by up to 40%. There's no need to hit the weights hard, either, simply using light weights at high repetition has been proven to tone muscle and burn fat.

TRY INTERVAL TRAINING

Aside from curing workout boredom, interval training allows you to burn more calories in less time. This is a great way for busy people with less time to get in a maximum workout.

INCORPORATE SPICY PEPPERS

Take your pick: Jalapenos, chili, cayenne, habanero, etc.. These fiery little guys contain capsaicin, which is why you get a burning sensation in your mouth when you eat them. This same effect is created internally, causing a calorie burn for about 30 minutes afterward.

 

Diabetes and You

Diabetes  is a disease in which the body does not produce enough or properly use insulin(a hormone that converts sugars, starches and other foods into energy).

There are 4 types of diabetes:

• Type I: the body does not produce insulin. 5-10% of Americans with Diabetes are type I. Most common in children and young adults.
  • Treatment: insulin.
• Type II: the body does not produce enough insulin or the cells ignore the insulin.
  • Treatment: diet, exercise and medication 
• Gestational Diabetes: 4% of all pregnant women have high blood glucose levels during pregnancy. One possible cause is pregnancy hormones block the action of the mother's insulin in her body. Left untreated, gestational diabetes can hurt the baby.
• Pre-Diabetes: glucose levels are higher than normal but not yet high enough to be considered diabetes. Damage to the body can already be occurring. Patients can take caution to mange this before it is too late.
  • Treatment: diet and exercise

Causes

There is a link between obesity and lack of exercise with developing Type II diabetes. Environmental factors (cold weather, viruses, diet) and genetics are also thought to contribute.

Symptoms

The early signs of diabetes are often missed because they are mild or attributed to other factors. If identified early, diabetes treatment can be started and the chance of developing complications can be decreased

Contact your doctor if you have more than one of the following symptoms:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

Current Treatment

• Diet:
  a well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets with a consistent number of calories will help control blood sugar (decrease calories if obesity is an issue).
• Exercise: 
  Regular exercise can help reduce the risk of developing diabetes. It can also reduce the risk of developing complications of diabetes (such as heart disease, stroke, kidney failure, blindness, skin disorders, neuropathy/nerve damage, gastroparesis, depression, foot problems and leg ulcers). Consult your health care provider before beginning an exercise program.
• Alcohol Use:
  Limit the amount of alcohol consumed. Excessive alcohol consumption is a known risk-factor for developing diabetes. Alcohol raises the glucose level in the blood.
• Smoking: 
  STOP! Smoking significantly increases the risk of developing complications of diabetes.
• Monitor blood glucose levels:
  self-check blood glucose levels frequently (at least before meals and at bedtime). A log of these levels allows your health care provider to determine if the current treatment is effective or if changes need to be made.
• Medication:
  your healthcare provider will determine the proper medication for you.

Keep it simple. Say you want to improve your physical fitness. The first week, add 10 minutes of activity a day. The next week, add 15 minutes to the weekend days. And track it. Walking during a lunch break is an easy fix to this simple formula. Add 10 minutes of stretching to your morning or after your regular workout. Squeeze in a 30-minute bicycle ride with your family this weekend. Easy.

Trying to lose weight? Take one thing at a time. A great first step is tracking your food intake – just the exercise of having to log each and every morsel and drink item will give you pause and cause you to pay attention to the excess calories you are taking in. If that is too much trouble, and you like social support – join the TOPS (Take Off Pounds Sensibly) group at your church or Weight Watchers at work.  Select one outlet and stick with it. Simple.

How Can Physical Therapy Help

Physical Therapy can help a patient with diabetes establish an exercise program to help lose weight, decrease blood pressure and regulate blood glucose levels. They can also provide education on the complications of diabetes and how to manage them (such as proper foot care). If a patient with diabetes develops an open sore, physical therapists are specially trained to help care for the wound. If complications develop and a patient with diabetes requires an amputation, a physical therapist can help with the recovery and return to function.

The good news is that the social norms are shifting. You won't have room for excuses. Healthcare reform is creating new health promoting policies and funding for safe and inviting spaces so you and your family have access to healthy foods and environments that support physical activity – for instance, more access to fresh produce, required nutrition information at restaurants, safe sidewalks, bike paths, and parks.

If you are looking for tools to help you set your goal, keep it simple and get back into the things you enjoy like golfing, swimming, tennis or dancing. Just start slow and watch your health improve.

Arthritis and Physical Therapy

Many people with arthritis have found substantial relief from their symptoms through physical therapy and exercise. In fact, exercise is thought to be the most effective non-drug treatment for reducing pain and improving movement for people with osteoarthritis. For those with osteoarthritis, the exercises need to be done correctly to avoid causing joint pain. Specific exercises help strengthen the muscles around the joints (removing some stress from the joints), improve joint mobility and reduce joint stiffness and pain.

Back and/or neck pain can inhibit muscle function, and due to this,  exercises should be focused on those particular muscles. Regular exercise also has a wide range of other benefits, as it may improve attitude, promote a healthy level of blood circulation, help individuals maintain an appropriate weight, promote endurance, provide more energy, improve sleep and can even decrease depression. The patient may be referred to a physical therapist or exercise trainer by his/her doctor in order to determine the appropriate amount and types of exercise. 

In general, a person with arthritis will benefit from all or some combination of the following categories of exercise:

• Neck and back exercises to build strength: These exercises can help keep the spine strong and limber. Increased muscle strength better supports arthritic joints and keeps undue stress off of them. Inexpensive devices that add resistance, such as exercise bands, can be used, in addition to resistance and weight machines.
• Low impact aerobic activities: These activities keep the lungs and circulation systems in shape, as well as helping control weight. Popular activities that do not place undue stress on the spine include walking, stationary cycling and exercising in the water (e.g. water therapy or pool therapy).
• Range of motion exercises: These exercises are focused on keeping the back joints limber, relieving stiffness and maintaining normal joint motion in the back. These may include bending sideways, forward and back  When patients are in pain, it may be necessary to use specific pain relieving techniques to help them tolerate exercises. For example, pain-relieving drugs (such as analgesics or anti-inflammatories) taken an hour before exercising may help, or applying local heat before exercise and cold packs after exercise can help make exercising easier and help relieve pain and inflammation.

Running on Empty: Breakfast

People who start their day on empty are 75 percent more likely to be overweight than regular morning eaters. Follow our guide to rethink your morning meal. Despite what your barista says, coffee, even with all that milk and sugar, isn't a meal. Your brain needs certain nutrients early on for all-day concentration and problem solving.  Shoot for getting 25 to 30 percent of your daily calories at breakfast: about 400 if you're trying to lose, 500 if you're maintaining or 625 if you're very active. Here's the ideal breakdown: 53 Percent of your morning meal should consist of carbohydrates-but simple carbs (muffins, doughnuts, sweetened cereal) are a no-go: They burn fast and trigger crashes and cravings. Instead, opt for complex ones (oatmeal and whole-wheat bread) that are high in hunger-fighting fiber, digest slowly, and give you sustained energy. Your goal = 35 to 65 g carbs; 6 g fiber. Go for the heart-healthy unsaturated fats found in nut butters or whole nuts, avocado and olive oil. Avoid the saturated fat in butter, bacon and full-fat cheese. Fat digests slowly, preventing those mid-morning munchie attacks. Your goal = 7 to 15 g fat. The final component to your morning meal is protein. You should aim for  20 percent Protein. Protein makes you feel full longer. You may need to combine multiple sources (e.g., egg whites, greek or nonfat yogurt or skim milk) to get enough. Your goal = 15 to 25 g protein.  Excuses? 30 percent of people said they skip breakfast at least once a week.  Cop-Out #1: You're on a diet. Friendly reminder: Shunning breakfast can lead to weight gain. It makes you more likely to snack impulsively later. But beginning your day with healthful foods helps steady your blood sugar level and regulate hunger hormones, which means you munch less and curb weight creep. Cop-Out #2: You have zero a.m. appetite. That's fine. Start small, then. Have a wedge of cheese or a piece of fruit, and build from there over time. It will reset your internal hunger clock and eventually train your body to want food in the morning. Cop-Out #3: You work out first thing. Worried about getting hit with stomach cramps? Split up your meal: Have a fast-digesting carb-rich snack such as a banana 30 minutes before the gym; afterward, finish up with some fat and protein to keep your metabolism stoked. Keeping your metabolism stoked with breakfast will help jumpstart your morning and can lead to better concentration and focus throughout the day. Keep your body healthy with a good breakfast.

Shin Splints: What every runner should know

Whether you jog daily or are a serious runner, you may have shin splints when you feel throbbing and aching in your shins. While they often heal on their own, severe shin splints can ruin your game.

Shin splints aren't really a single medical condition. Instead, they're just a symptom of an underlying problem. They might be caused by:

• Irritated and swollen muscles, often caused by overuse.
• Stress fractures, which are tiny, hairline breaks in the lower leg bones.
• Overpronation or ''flat feet" -- when the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons.

Shin splints are very common. They're the cause of 13% of all running injuries. Runners might get them after ramping up their workout intensity, or changing the surface they run on -- like shifting from a dirt path to asphalt. Shin splints are also common in dancers.

What Do Shin Splints Feel Like?

Shin splints cause dull, aching pain in the front of the lower leg. Some people feel it only during exercise; others, when they've stopped exercising. Sometimes, the pain is constant.

Depending on the exact cause, the pain may be located along either side of the shinbone or in the muscles. The area may be painful to the touch. Swollen muscles can sometimes irritate the nerves in the feet, causing them to feel weak or numb.

To diagnose shin splints, your doctor will give you a thorough physical exam. He or she may want to see you run to look for problems. You may also need X-rays or bone scans to look for fractures. Other tests are sometimes necessary.

What's the Treatment for Shin Splints?

Although shin splints may be caused by different problems, treatment is usually the same: Rest your body so the underlying issue heals. Here are some other things to try:

• Icing the shin to reduce pain and swelling. Do it for 20-30 minutes every three to four hours for two to three days, or until the pain is gone.
• Anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally unless your doctor specifically says otherwise.
• Physical therapy to strengthen the muscles in your shins. Your physical therapist may also recommend:
  • Arch supports for your shoes. These orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet.
  • Range of motion exercises, done at home or in the office
  • Neoprene sleeve to support and warm the leg.

In rare cases, surgery is needed for severe stress fractures and other problems that can cause shin splints.

How Can I Prevent Shin Splints?

To prevent shin splints, you should:

• Always wear shoes with good support and padding.
• Warm up before working out, making sure to stretch the muscles in your legs.
• Stop working out as soon as you feel pain in your shins.
• Don't run or play on hard surfaces like concrete.

While you heal, you could take up a new non-impact activity that won't aggravate your shin splints. For instance, runners might try swimming.

Your shin splints are fully healed when:

• Your injured leg is as flexible as your other leg.
• Your injured leg feels as strong as your other leg.
• Your can jog, sprint, and jump without pain.

Ankle Sprains

The most common type of ankle injury is a sprain. A sprain results from the stretching and tearing of small ligaments (fibrous bands connecting adjacent bones in a joint). There are many ligaments surrounding the ankle that can become damaged when the ankle is forced into an unnatural position. Although ligament damage frequently occurs during athletics or exercise, ankles are just as often injured stepping off a curb, into a pothole, or onto uneven ground.

The most frequent type of sprain occurs when weight is applied to the foot when it is on an uneven surface, causing the foot to "roll in" or "turn" (inversion). This places the sole of the foot in such a position that it points inward as force is applied, so the ligaments stabilizing the outside part of the ankle become stressed. Many people report hearing a "snap" or "pop" when an injury of this type occurs. Following such an incident, one experiences difficulty walking and, in a short time, the outside aspect of the injured ankle begins to cause pain and swells, sometimes so excessively that people believe it is broken.

Upon physical examination, the ankle will exhibit swelling and discoloration (black and blue) over the outside part of the joint. Touching of the area will result in a variable amount of discomfort. Range of motion (ROM) in the ankle can be limited due to pain and swelling, but strength is not usually affected. X-rays are essential, as the possibility of a fracture must be ruled out.

Degree of Severity of Ankle Sprains:

Grade I

• Mild sprain, mild pain, little swelling, and joint stiffness may be apparent
• Stretch and/or minor tear of the ligament without laxity (loosening)
• Usually affects the anterior talofibular ligament
• Minimum or no loss of function
• Can return to activity within a few days of the injury (with a brace or taping)

Grade II

• Moderate to severe pain, swelling, and joint stiffness are present
• Partial tear of the lateral ligament(s)
• Moderate loss of function with difficulty on toe raises and walking
• Takes up to 2-3 months before regaining close to full strength and stability in the joint

Grade III

• Severe pain may be present initially, followed by little or no pain due to total disruption of the nerve fibers
• Swelling may be profuse and joint becomes stiff some hours after the injury
• Complete rupture of the ligaments of the lateral complex (severe laxity)
• Usually requires some form of immobilization lasting several weeks
• Complete loss of function (functional disability) and necessity for crutches
• Usually managed conservatively with rehabilitation exercises, but a small percentage may require surgery
• Recovery can be as long as 4 months

Treatment and Rehabilitation:

Many problems resulting from sprains are due to blood and edema (swelling) in and around the ankle. Minimizing swelling helps the ankle heal faster. Most sprains heal completely within a few weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive. Chronic or recurrent lateral ankle sprains usually receive some type of strengthening program and training due to poor balance on the injured leg.

Phase I (Early Phase):

Goal:

Decrease post-injury swelling, bleeding, and pain. Protect the healing ligament(s).

Avoid the first 24 hours:

Hot showers

Heat rubs (e.g. Ben Gay)

Hot packs

Drinking alcohol

Aspirin–it prolongs the clotting time of blood and may cause increased bleeding into the ankle (Tylenol or ibuprofen (Advil) may be taken to help with pain, but will not speed up the healing process)

The PRICE regimen is the most important aspect of the initial management of a sprain:

Protection

Ligaments must be maintained in a stable position so healing can occur

Get off your feet if pain persists

Use an ankle stirrup or brace if necessary

Non-weight bear or partial weight bear with crutches to control other inhibitors of healing

Early walking is essential, since weight bearing inhibits contractures (tightness) of tendons, which may lead to tendonitis

Rest

Allow injured ankle to rest for approximately 24 hours after the injury

Caution should be taken against vigorous exercise

Exercise for the uninjured leg may be performed

Ice

Ice the ankle every 2 hours for 20 minutes to decrease pain, swelling, and spasticity for the first 48-72 hours

Do not place ice on the ankle for over 30 minutes

Compression

Done with ice

Place air or cold water within enclosed bag to provide pressure to decrease swelling

Ace wraps

To add more compression, a horseshoe-shaped felt pad may be inserted under the wrap over the area of maximum swelling

Elevation

Elevate as much as possible with ice and compression

Elevate foot higher than the waist to reduce swelling and pain

Keep the leg elevated while sleeping

Elevation allows gravity to work with lymphatic system rather than against it

Phase II (Rehabilitation Phase):

This phase begins when swelling stops increasing and pain lessens, so that the ligament(s) have reached a point in the healing process at which they are not in danger given minimal activity. Pain is the guide as to how much activity is enough.

Goal:

To increase motion and strength, which will aid in circulation and help eliminate residual inflammatory agents.

Stretching

Do stretches before and after activity

Vigorous heel cord/calf stretches initiated ASAP (hold stretches for 20 seconds each, performed every 2 hours) - moderate pull but no pain

All activities should be done slowly without pain 

Toe curls–place a towel on the floor and curl your toes to pick up the towel

Marble pickups–pick up marbles with your toes

Perform alphabet exercise–rest heel on floor and write the alphabet in the airwith your big toe, making the letters as large as you can

Stationary bike

Strength

Begin with isometric exercises with progression to isotonic exercises (with and without resistance) in a pain free motion

As the ligament heals further and ROM increases, strengthening exercises may begin in all planes of motion

Pain should be used as the basic guideline for deciding when to start Inv and Ev isotonic exercises

Obtain a strip (about 2 feet long) of elastic belting material, surgical tubing (from a medical supply store), or a bike tire inner tube and work your ankle in four directions. Pull the tubing taut, making sure that the tube is placed at the base of your toes, and do the exercises only with your foot and ankle, not the whole leg

Out and up:

sit on floor or chair, loop tubing over foot and around table leg, with heel on floor, work ankle out and up

In and up:

as above, but loop tubing to provide tension against an inward motion, with heel on floor, work ankle in and up

Straight up:

as above, but with heel on floor, work ankle straight up

Straight down:

hold tube loop against bottom of foot, with heel on floor, work ankle down

At the beginning of the rehabilitation process, use ankle weights for light resistance in the four directions described above (2-4 sets of 20)

Heel/toes raises–stand on a step with your heels slightly off the step and slowly rise up on your toes and equally slowly lower heel down; when this exercise becomes simple to perform, do the exercise using only the injured leg in a pain free motion

Single knee flexion exercises–stand on injured leg and bend that knee and straighten it

Phase III (Full Functional Level):

Goal:

Return to prior level; return to activity

• Must have full ROM
• Must have 80-90% strength in injured ankle compared to the uninjured ankle
• Strengthen the uninjured leg
• Run in a pool, using a floating device; swimming
• Tape the ankle if necessary
• High-topped footwear to stabilize the ankle
• Cleats should be outset along periphery of the shoe to provide stability
• Gradual progression of functional activities that slowly increase stress on ligaments
• Full weight bearing when you can walk without a limp
• Lunges forward, on a 45° angle, and sideways with injured and uninjured leg
• Pain-free hopping on affected side (start with hopping with both legs and progress to hopping with only injured leg)–four-square hopping drills
• Step up and over, forward and sideways, on high step in pain free motion
• Stand on your toes of the injured ankle for 20 seconds, and hop on your toes 10 times
• Begin stairmaster, treadmill, biking
• Running can be started as soon as you can walk in a fast pace without pain; initially, start jogging in a straight line, and progress to running from smooth, flat surface to uneven surfaces
• Cutting exercises: run in figure eights, cross-over walking
• Jump rope

Prevention:

• Wear the correct shoes for the event. Good walking shoes provide more comfort and better balance
• Wear hiking shoes or boots in rough terrain
• Different sports activities call for specific footwear to protect feet and ankles. Use the correct shoe for each sport. Don't wear any sports shoe beyond its useful life.
• Use steel toed shoes for occupations that threaten foot safety. Be certain they are fitted properly.
• Do not walk barefoot on paved streets or sidewalks.
• Watch out for slippery floors at home and at work
• Be aware of uneven terrain, potholes, and high curbs.
• If you get up during the night, turn on a light.
• Wear a brace or have ankle taped when doing activities that have a high incidence of ankle injuries (such as basketball, volleyball, soccer, tennis, and other sports requiring a lot of stopping, starting, and twisting motions)

When to Seek Medical Attention:

If the ankle is obviously fractured/dislocated or the injury is causing severe pain/disability, then medical attention should be sought immediately.

Put the Spring Back Into Your Step

This morning, you promised yourself that you'd head straight to the gym right after work. But by the end of the day, you were so beat that all you could think about is collapsing on the couch with takeout and the remote.

Why are you so tired all the time? Are you just not getting enough sleep or could something be medically wrong. If you're constantly plagued by exhaustion, there are a host of medical issues that could be wrong or you may also wonder if you're doing too much. But the most likely answer is just the opposite: You're not doing enough.

Fatigue Rx: Exercise! The biggest cause of tiredness these days, is the modern American lifestyle. Being overweight, eating too much fast food, and not exercising enough.

There are three key lifestyle changes that can make a big difference in your energy level, doctors say:

1. What you eat. Don't try for a quick-fix spurt of energy from caffeine and sugar; it will only leave you more fatigued as your blood sugar levels fluctuate wildly. Instead, go for a balanced, healthy diet replete with fruits, vegetables, and lean protein. 

2. How much you sleep. About 60% of women, according to the 2007 Sleep in America poll, say they only get a few good nights' sleep a week or less. To get more Zs, avoid caffeine and alcohol in the hours just before bedtime, and keep your sleep space quiet and restful.

3. How much you exercise. This is. the best prescription for ordinary, garden-variety tiredness, regular, vigorous exercise. The reality is that exercise breeds energy. Almost all the studies that have looked at this question have found the same thing: Sedentary people who start exercising feel much less fatigue than people who continue to slouch on the couch -- and exercise often boosts energy even more than medication.

So what's the prescription? How much exercise do you need, how often, and for how long, before you start noticing an end to your exhaustion? The recommended dosage is 40 minutes, at least four days a week, to get you going.

How soon should you see results?  Within a month, you should feel at least some improvement. Keep with it for three to six months more, and you should start feeling much better.

What Else Could Be Wrong? Chronic tiredness is associated with many different medical conditions. How can you figure out which one might be the culprit? The short answer is, you can't tell You'll need a doctor for that.

4. Anemia. This is a very common cause of fatigue and very easy to check with a simple blood test.  You can remedy anemia with an iron-rich diet, heavy in meats and dark, leafy greens, or supplements if you have a chronic iron deficiency.

5. Deficiencies in key nutrients, such as potassium. Again, this is easily checked with blood testing.

6. Thyroid problems . Over- and under-active thyroids both can cause fatigue. A blood test for your level of thyroid-stimulating hormone can help evaluate your thyroid function.

7. Diabetes. If you feel draggy and you're also having blurred vision or lots of urination, you should get that checked with a blood test.

8. Depression. If your feelings of exhaustion are accompanied by sadness and loss of appetite, and you just can't take any pleasure in things you once enjoyed, you may be experiencing depression.

9. Obstructive sleep apnea. If you never feel rested, ask the person you sleep with if you're bothering them with your snoring. If they say yes, look into testing at a sleep lab. Some other symptoms of obstructive sleep apnea include waking up each morning feeling unrefreshed and having morning headaches.

10. Undiagnosed heart disease. Tiredness can be a sign of heart trouble, particularly in women. If you have trouble with exercise you used to do easily, or if you start feeling worse when you exercise, this could be a red flag for heart trouble. If you have any doubts, see your doctor.

Healthy Relationships=Better Life

What better month is there than February to take time and evaluate the relationships in your life? Healthy relationships bring happiness and health to our lives. Studies show that people with healthy relationships really do have more happiness and less stress. There are basic ways to make relationships healthy, even though each one is different…spouses, children, co-workers, aging parents, difficult family members. Here are Ten Tips for Healthy Relationships.

1. Keep expectations realistic. No one can be everything we might want him or her to be. Sometimes people disappoint us. It’s not all-or-nothing, though. Healthy relationships mean accepting people as they are and not trying to change them!
2. Talk with each other. It can’t be said enough: communication is essential in healthy relationships! It means— Take the time. Really be there. Genuinely listen. Don’t plan what to say next while you’re trying to listen. Don’t interrupt. Listen with your ears and your heart. Sometimes people have emotional messages to share and weave it into their words. Ask questions. Ask if you think you may have missed the point. Ask friendly (and appropriate!) questions. Ask for opinions. Show your interest. Open the communication door. Share information. Studies show that sharing information especially helps relationships begin. Be generous in sharing yourself, but don’t overwhelm others with too much too soon.
3. Be flexible. Most of us try to keep people and situations just the way we like them to be. It’s natural to feel apprehensive, even sad or angry, when people or things change and we’re not ready for it. Healthy relationships mean change and growth are allowed!
4. Take care of you. You probably hope those around you like you so you may try to please them. Don’t forget to please yourself. Healthy relationships are mutual!
5. Be dependable. If you make plans with someone, follow through. If you have an assignment deadline, meet it. If you take on a responsibility, complete it. Healthy relationships are trustworthy!
6. Fight fair. Most relationships have some conflict. It only means you disagree about something, it doesn’t have to mean you don’t like each other! When you have a problem:
• Negotiate a time to talk about it. Don’t have difficult conversations when you are very angry or tired. Ask, "When is a good time to talk about something that is bothering me?" Healthy relationships are based on respect and have room for both.
• Don’t criticize. Attack the problem, not the other person.  Open sensitive conversations with "I" statements; talk about how you struggle with the problem. Don’t open with "you" statements; avoid blaming the other person for your thoughts and feelings. Healthy relationships don’t blame.
• Don’t assign feelings or motives. Let others speak for themselves.  Healthy relationships recognize each person’s right to explain themselves.
• Stay with the topic. Don’t use a current concern as a reason to jump into everything that bothers you. Healthy relationships don’t use ammunition from the past to fuel the present. Say, "I’m sorry" when you’re wrong. It goes a long way in making things right again.  Healthy relationships can admit mistakes.
• Don’t assume things. When we feel close to someone it’s easy to think we know how he or she thinks and feels. We can be very wrong! Healthy relationships check things out.
• Ask for help if you need it. Talk with someone who can help you find resolution—like a family therapist or ecclesiastical leader. Healthy relationships aren’t afraid to ask for help. There may not be a resolved ending. Be prepared to compromise or to disagree about some things. Healthy relationships don’t demand conformity or perfect agreement.
• Don’t hold grudges. You don’t have to accept anything and everything, but don’t hold grudges—they just drain your energy. Studies show that the more we see the best in others, the better healthy relationships get. Healthy relationships don’t hold on to past hurts and misunderstandings.
• The goal is for everyone to be a winner. Relationships with winners and losers don’t last. Healthy relationships are between winners who seek answers to problems together.
• You can leave a relationship. You can choose to move out of a relationship. Studies tell us that loyalty is very important in good relationships, but healthy relationships are NOW, not some hoped-for future development.
7. Show your warmth. Studies tell us warmth is highly valued by most people in their relationships. Healthy relationships show emotional warmth!
8. Keep your life balanced. Other people help make our lives satisfying but they can’t create that satisfaction for us. Only you can fill your life. Don’t overload on activities, but do try new things—clubs, volunteering, new hobbies or activities, projects. You’ll have more opportunities to meet people and more to share with them. Healthy relationships aren’t dependent!
9. It’s a process. Sometimes it looks like everyone else is confident and connected. Actually, most people feel just like you feel, wondering how to fit in and have good relationships. It takes time to meet people and get to know them…so, make "small talk"…respond to others…smile…keep trying. Healthy relationships can be learned and practiced and keep getting better!
10. Be yourself! It’s much easier and much more fun to be you than to pretend to be something or someone else. Sooner or later, it catches up anyway. Healthy relationships are made of real people, not images!