Tag Archives: physical therapy

Feet Matter! Correct Over Pronation Now and Avoid Problems Later

Karen Goeller, CSCS

Pronation is the action of the foot as it roles inward upon foot contact with the ground. This action acts as a shock absorber for the foot and rest of the body. Over pronation occurs when a person’s foot rolls inward and their arch flattens while performing weight bearing tasks. The foot may appear normal while sitting, with a noticeable arch under the foot, but over pronation becomes evident when a person stands or walks. Even people with normal foot structure can develop over pronation as a result of excessive foot stress and improper arch support.  

There are many possible causes for over pronation including walking on hard surfaces for extended periods of time – either barefoot or with flat shoes, heredity, obesity, an imbalance between the posterior and anterior leg muscles, or tight gastrocnemius and soleus muscles among other causes.

Since over pronation causes the person to walk along the inner portion of the foot, this poor alignment may lead to injury in the foot and ankle among many other areas of the body. Problems such as heel spurs, plantar fasciitis, shin splints, knee pain, back pain, and other medical issues can be the result of over pronation.

Gymnasts are at risk of over pronation because they train barefoot and often do not use proper landing mechanics. The over pronation becomes more of a problem when gymnasts either tumble or land with their feet in the over pronated position. If a gymnast is accustomed to standing or walking in the over pronated position, she will land from dismounts with the same poor foot alignment. The gymnast lands from some skills with a force of up to 16 times her body weight. Landing with such an immense force in an over pronated position, especially when it is on a daily basis, may cause severe damage to the gymnast’s body, ending her career.

There are various methods used to identify over pronation. One method is to look at a person’s shoes. If the shoes are more worn on the inside of the sole, then over pronation may be a problem. Another indicator would be to make a footprint by wetting the foot and stepping onto a towel or any surface where a print can clearly be seen. If there is no dry spot to specify the arch there may be a need for special foot care. The footprint may also be performed in a gymnastics facility by using chalk on the foot and stepping onto a clean mat.

One recommended form of treatment for over pronation is to wear supportive shoes, but the alignment problem should still be corrected for long term foot health. Because a gymnast trains barefoot, corrective exercises may be the best treatment besides wearing supportive shoes while not in the gym. There are many exercises that can help strengthen the foot and improve lower body alignment. Here is one simple conditioning exercise for the feet that can be performed with a towel.

Towel Pull: Place a towel flat on the floor. Keep the heels on the floor and place the toes on the edge of the towel. Next, pull the towel towards the body with the toes so that the towel gathers under the feet. Make sure the foot remains on floor as the toes pull the towel. This exercise may also be performed while sitting in a chair, but gymnasts will be able to relate the standing exercise to landing technique faster than the seated version of this exercise. Once the gymnast is able to perform several repetitions of this exercise, a small weight such as one pound may be placed on the towel.

It is imperative that coaches assign safe and effective exercises and teach proper landing mechanics in an attempt to prevent some injuries. Coaches must watch their gymnast’s feet, knees, hips, and posture closely during each landing performed, whether the landing is from a simple jump on floor or a dismount from bars. It is important to encourage gymnasts to keep their knees in line with their middle toes (where the shoe laces would be if they were wearing shoes) and hips upon foot contact with the mat.

One simple drill for landing mechanics and alignment involves the use of a mirror. The gymnast should stand in front of a mirror with her feet parallel to one another. The gymnast should then slightly shift her weight towards the inner and then outer portions of the feet while watching her knees shift laterally. This should only be a slight shift, but it will be the difference between a safe landing and an injury. This mirror drill will show the gymnast how the foot alignment greatly affects the entire lower body. The gymnast will see and feel the difference between proper and poor alignment. The ankles, knees, and hips must be in line with one another.

Another method of teaching proper alignment is a common exercise used in the fitness world, the Squat Exercise. The gymnast should perform the squat exercise without weights to learn the proper form before she uses light dumbbells. This exercise will help bring awareness of proper landing mechanics and once weights are used it will help her with lower body strength.

And finally, after the Squat Exercise is mastered, gymnasts should perform the “Stick Drill.” This drill involves dropping down from a spotting block or mat stack and landing in the proper squat position. Start with a low stack until gymnasts master the proper position. For best results, gymnasts should practice ¼, ½, and parallel squats. A gymnast must be able to stop the force somewhere between the ¼ and the parallel squat positions.

For safety and success, gymnasts must learn proper foot alignment and perform appropriate strength and sport specific conditioning exercises. And keep in mind that injuries are NOT necessarily part of the sport. Many aches, pains, and injuries may be prevented when the training program is carefully constructed and the athletes are carefully monitored.

One more important note: The gymnast should not perform these or any other drills, exercises, or skills if they feel pain, are ill or injured, or are being treated by a medical professional.

Karen Goeller, CSCS

More information on over-pronation at the below websites.

Education.Auburn.edu/news/2008/june/flipflop.html

Sportsinjuryclinic.net

PacificCollege.edu

Foot.com, DeerfieldFoot.com

Heel-that-pain.com

SportsMedicine.about.com

TheFreeLibrary.com

USAG Safety Manual Page 31

NSCA Performance Training Journal Volume 7, Issue 1 Landing Mechanics

Gymnastics Drills and Conditioning Exercises

Wikipedia.org Flip-flops, OurHealthNetwork.com Pronation

Lymphedema and Swimming

karen-lymph-book-2018

Karen holding her book, Lymphedema: Sentenced to Life in Bed, but I Escaped.

Swimming to reduce leg lymphedema….

For years I’ve been telling people with Leg Lymphedema that the best exercise to reduce the swelling is swimming. Why? There are a few reasons swimming is the best exercise.

One, because you are horizontal when swimming rather than vertical and your leg below your torso. This is similar to when you are lying down or elevating your leg to reduce the swelling.

Two, when swimming your bodily fluids are circulating. The movement of the limbs and muscles are creating a force to move the fluids throughout your body. The movement of kicking while swimming is helping to push the fluids out of your leg. Your blood and lymphatic fluid are being moved more rapidly when swimming rather than sitting or lying down.

Three, the water itself offers a gentle compression when in a pool. It is more gentle than a compression stocking, but it is still helpful for when you stand in the pool in between swimming. Swimming is great, but even standing and moving your leg through the water is helpful.

And four, swimming is non-impact. That means, your foot is not striking the floor with each step as it is with walking or running. Walking and running actually cause leg lymphedema to become worse because of all of the pounding/impact and gravity. Yes, they help circulation a little, but the impact causes the fluids to be packed down into the leg rather than pushing the fluids out of the leg. Your body is vertical and the fluids run down. Swimming is very gentle and effective for those of us with leg lymphedema compared to any other aerobic exercise.

I’ve been dealing with leg lymphedema since my 1991 cancer surgery. At the time, I already had a physical therapy degree, was a fitness trainer, and a gymnastics coach. I knew how the body functioned.

I had malignant melanoma in my right thigh. I was told that I would be bed-ridden for the rest of my life by many doctors after cancer surgery. The surgery was the only way to save my life. That was if it wasn’t already too late. The doctor was not sure if the cancer had already spread to my lymph nodes and throughout my body. If it had, it would have been too late. Going into the surgery I did not know whether I had weeks to live or a lifetime of being in bed.

The doctors removed the malignant tumor and the lymph nodes from my groin area during the surgery. It was two surgeries combined that lasted many hours. Immediately after the surgery, my leg was as wide as my waist. I had a tree trunk and a long way to go to reduce it to normal size. My life was saved, but my leg and life were forever changed. It took nearly one year to reduce my leg to almost normal size. I have maintained my leg lymphedema extremely well because I am so disciplined.

A few quick tips for reducing the swelling… elevate, compression, circulation/light exercise, and a very healthy diet of various fruits and vegetables – that’s the secret to reducing the swelling and keeping it down. Eat foods such as fruits and vegetables. Stay away from processed foods, fast-foods, junk foods, alcohol, soda, and other unhealthy foods.

I studied physical therapy in college and have been a CSCS for many years. I know how to maintain health and recover from illness and injury. I admit, my knowledge has made it easier for me to maintain my leg lymphedema, but you can do it too.

What prompted me to write this today? I go all winter long wishing I had access to a pool so I can maintain my lymphedema better. This week the pool opened and I paid for my pool pass. I’ll be able to keep my leg looking and feeling good, hardly any swelling on non-working days. YAY!!!

I swam for the first time this summer yesterday and my leg felt and looked great afterward. Elevating today and it feels good. Can’t wait to go to my ballroom dance social later this evening!me-swimsuit-xs

Anyone in NJ with leg lymphedema that wants to talk, meet for a quick swim, or needs a little bit of help just reach out to me. My schedule is very sporadic and constantly changing, but we will connect if you reach out.

Read about my journey with cancer surgery and lymphedema here, www.lymphedemabook.com

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