Ankle Pain

As summer gives way to fall, we may find ourselves hitting the hiking trails. Many times, these uneven surfaces can lead to foot and ankle issues. Many people have sprained their ankle in the past, and are aware what this feels like. A lateral ankle sprain is an acute twisting of the ankle (often an inversion injury or an inward twisting of the foot and heel as compared to the leg). However, there is another condition which can cause pain on the lateral (outside) part of the foot, which many people will incorrectly refer to as “ankle pain”. I am referring to a pathology know as sinus tarsi syndrome.

The ankle joint consists of three bones, the Tibia, the Fibula, and a bone called the Talus. There are several ligaments working to help support the ankle which are very commonly sprained or ruptured with inversion sprains. However, sometimes there is only a small trauma, or repetitive micro-trauma from uneven surfaces that can affect another joint. The Sinus Tarsi (sometimes referred to as the “eye of the foot due to its appearance on an x-ray) is a very specific part of a joint called the subtalar joint.

Ankle Pain

This is the joint between a bone called the talus and the heel bone (known as the calcaneus). This portion of the joint contains many ligamentous attachments between the talus and calcaneus themselves, and between these two bones and the other bones of the mid-foot. When this joint is injured, there is often nagging pain along the lateral foot or across the ankle joint. Patients will often complain of pain in the morning or after periods of rest. They may find themselves hurting at the beginning or a run or hike, with the pain actually subsiding after getting warmed up. Certain motions like stepping off a curb, or walking up and down steps may cause sharp sudden pain.

Two tendons know as the peroneal tendons border the outside foot and ankle and help invert and evert the foot. When the sinus tarsi of the subtalar joint is painful, these tendons often over act, leading to a tendinitis which can even extend all the way to the lateral calf. Patients may complain of a pulling or stretching pain which extends to the outside calf. Often, when people complain of an “ankle pain” but have a difficult time expressing just how they hurt, direct palpation of the sinus tarsi will recreate the symptoms.

Treatments often include the standard RICE therapy (rest, ice compression, elevation), range of motion exercises (often pretending the big toe is the tip of a pen and tracing the letters of the alphabet in broad motions), oral anti-inflammatory medications, or steroid injections into the sinus tarsi itself. Also, many times supporting the foot with an orthotic is extremely beneficial and/or wearing supportive shoe gear with increased shock absorption.

So the next time you have a lingering “ankle pain” that just doesn’t seem to be getting better, ask your foot care professional about a possible sinus tarsi syndrome.

Lower Back Pain

There is a price that we pay for walking upright, and that is namely lower back pain. About 80% of the adult population has back pain at some point in their lives. The pain varies from mild achiness to disabling, tear-drawing, searing pain. The cause of back pain is often due to weakness of the core musculature and tightness of the muscles along the spine. Also, tightness of the hamstrings can cause back pain or exacerbate the pain. It is very important to keep your abdominal muscles strong and your hamstrings stretched to prevent and even to treat back pain.

Besides the pain, it is important to treat nerve symptoms. If you are having back pain that shoots down your leg, that could be a sign of something much more serious. A herniated disc can actually put pressure on one of your nerves, which will not only cause tremendous pain, but can lead to irreparable damage to the nerve. If you have weakness or tingling down your leg, immediately call an orthopedic specialist and get it checked. Fortunately, most people with a herniated disc do not need surgery. Therapy, anti-inflammatory medication, and walking can often relieve the symptoms. Do not sit or lie down in one position too long as the muscle spasm will just get worse and cause more pain when you try to move.

As with most medical problems, getting the correct diagnosis is important. Back pain has many causes and I have diagnosed people with fractures and cancer who present with just with lower back pain. There are signs on physical exam that help identify where the pain is coming from. An MRI is a great test for identifying herniated discs. Simple x-rays will show fractures and arthritis. CT scans may be helpful as well, but we try and avoid getting them, as there is much higher radiation from this test.

If you have mild back pain, stretch out and walk around. Take Advil or another anti-inflammatory medications and give it a few days. If you don’t get better, the pain gets worse, or you have any nerve symptoms going down your leg, go see you orthopedic specialist.

Rick Weinstein, MD, MBA
Director of Orthopedic Surgery
Westchester Health Associates

Beware! Low Fat May Mean High Sugar

Many of us are constantly searching for the “best” foods to eat. Our grocery stores are filled with hundreds of products “designed” to help us eat healthier. Foods are labeled as low fat, reduced fat, low calorie, low sugar, sugar free, etc. to presumably aid us on our weight loss or healthy eating quests.

Many Americans choose low and reduced fat items thinking these products are good dietary choices that are lower in calories and therefore, healthier than their full fat counterparts. However, research has shown that low fat foods are not necessarily better for you, because many products that are low in fat or reduced in fat are often very high in sugar. In fact, some studies show that these so-called diet foods sometimes have as much as 40% more sugar than the regular versions and can have the same amount or even a higher number of calories! This is because fat supplies the flavor in many foods, and when fat is eliminated, sugar is often substituted to make the food taste good. Salt and other additives are also usually added to enhance flavor, which makes the food even unhealthier and causes additional health risks.

When people eat lower fat foods, they often wind up overeating. Part of this is psychological – people believe they can eat more of a “healthier” food. There is also a scientific basis for overeating products high in sugar. Sugar is a simple carbohydrate and is easily digested and absorbed. This can lead to blood sugar fluctuations and food cravings, which may make it difficult to control caloric intake. Overeating causes fat storage and weight gain. Additionally, sugar causes inflammation in the body and increases the risk of diabetes, heart disease, and high cholesterol.

It is extremely important to decrease the amount of sugar we consume. Last year, The World Health Organization changed its sugar intake recommendations from 10 percent of daily calorie intake to 5 percent, which is about 6 teaspoons, or 25 g, of sugar per day. Sugar is hidden in many processed foods, so it is important to read food labels so that you are aware of what you are eating. Be on the lookout for sucrose, corn syrup, dextrose, high fructose corn syrup, molasses, honey, and malt syrup to name a few.

Consumers should pay careful attention to the amount of calories per serving and the amount of sugar per serving before assuming that low fat or light is synonymous with healthy. The best way to ensure you eat a healthy diet that is low in fat and calories is to avoid processed foods as much as possible. Eat a diet filled with fruits, vegetables, lean protein, and drink plenty of water. This will ensure you receive all the nutrients that you need in a healthy way.

Can’t Control Your Hunger or Cravings?

It Could Be Your “Hunger Hormones!”

Do you find that you’re always thinking about food? Do you have an insatiable appetite? Are you having trouble losing weight despite cutting your calories way down? If so, you may be realizing that successfully achieving weight loss is not as simple as following the classic “calories in-calories out” model. Instead, you need to focus on the hormonal imbalances that affect metabolism and hunger.

At NY Health & Wellness, we’ve created a proven, science-based program that works with your hormones to control your hunger, appetite and cravings. Our new Balance 3H+ program resets the hormones that are making you feel sick, bloated, and unusually hungry! We specialize in hormonal weight loss programs and metabolic hormone balancing wellness plans that are designed to balance your hormones both naturally and effectively. All of our weight loss programs are predicated on a proven, integrative medical approach that has helped thousands of women nationwide achieve significant weight loss, look younger, and restore their energy at the fastest and safest pace possible. Our programs prove that “It’s not your fault, It’s your hormones!“

Balance 3H+ — What’s the “3H” and How Does It Affect Your Hunger and Weight?
Hormones are the body’s chemical messengers, and they travel through the bloodstream, delivering messages to tissues and organs throughout the body. Leptin, ghrelin and cortisol are the three most common hormones involved in the regulation of weight and weight-related senses like hunger and satiety. They need to be balanced in order for effective weight loss to take place.

Leptin
Leptin, which produced in fat cells, plays a significant role in the regulation of body weight. Through the effect that it has on the brain, leptin controls the feelings of hunger and satiety. Because it is secreted by adipose (fat) tissue, people who are overweight or obese tend to have higher levels of leptin, causing a vicious cycle that makes weight loss all but impossible.

Gherlin
Gherlin, also known as the “hunger hormone,” is produced by specialized cells that live in the lining of the stomach and the pancreas. When levels of ghrelin are high, the hormone works in conjunction with the brain to stimulate hunger, slow metabolism, and decrease the body’s ability to burn fat.

Cortisol
Cortisol is known as the “stress hormone.” It is produced in the adrenal glands in response to stress. When cortisol levels are high, the body will believe that it needs to store extra fat, making it impossible to lose weight. In this scenario, fat tends to accumulate in the abdominal region, which contains large quantities of cortisol receptors.

Learn about the revolutionary weight loss program that has helped thousands of women across the nation look and feel their very best. Call NY Health & Wellness at 914-703-4811 now to schedule a complimentary one hour medical weight loss consultation.

The Dangers of Stress

Stress is your body’s way of responding to any kind of physical, emotional, or mental demand. It is a real or perceived threat to your mind and body which can wreak havoc both physically and mentally. When the body perceives stress, it commands the sympathetic nervous system to slow down. This results in increased hunger, decreased metabolism, and fat storage.

When your body perceives any kind of demand or threat –whether life threatening or not – it reacts as if you are actually in a life or death situation. It releases chemicals to give you added strength and energy to protect yourself. This is widely known as the “fight or flight” response. In the proper situation, this response can help your body meet challenges by staying more alert, energetic, and focused. However, if you experience the fight or flight response on a daily basis, the heightened stress can damage your quality of life by suppressing the immune system, increasing the risk of heart attack and stroke, enhancing the aging process, and promoting mental and emotional issues.

In order to reduce the harmful effects of stress, it is important to recognize the signs of stress overload. Some of the major external causes of stress are work, school, relationship problems, financial issues, children, family, major life events/changes, and an overly busy schedule. Common internal causes of stress are pessimism, chronic worry, lack of flexibility, unrealistic expectations, and an all-or-nothing attitude.

Everyone tolerate stress differently. Stress management is dependent on many factors including the quality of your relationships, your life experiences, your genetics, and your emotional intelligence. Individuals with strong support networks of friends and family often deal with stress better than those who are lonely and isolated. People who have a sense of control and confidence seem to persevere through life’s challenges better than those who are all over the place. Those who are optimistic and capable of dealing with their emotions tend to manage their stress better than those who get overwhelmed easily and cannot calm and sooth themselves. Stressful situations are easier to cope with when a person is more knowledgeable and realistic about the specific event.

It is important to learn how to manage stress and cope with stressors. Many people cope by drinking too much, eating excessively, taking pills, or lashing out at others. This is unhealthy and unproductive. To take care of oneself, one must learn how to rest and relax. Exercise is extremely effective in managing stress. Additionally, yoga, meditation, prayer, hypnosis, saunas, steam baths, massage, acupuncture, and breathing techniques are all proven relaxation methods. It is also important to get plenty of sleep and eat a healthy diet. Some dietary changes to help alleviate stress are to avoid refined sugars, increase fiber intake, and increase omega 3 fatty acids. Supplements shown to decrease stress levels are B complex vitamins, magnesium, zinc, Vitamin C, Coenzyme Q10, lipoic acid, ginseng, licorice, rhodiola, and aswagandha.

Don’t let stress overwhelm you and take over your life. Learn to manage it so you can live every day with a glass half full attitude!

Time to Start a Yoga Practice

Do you want to do something good for both your mind and body at the same time?

Try yoga.

Yoga is a mental, physical and spiritual practice which originated in India. The term yoga comes from the Sankskrit word “yuj,” which is defined as “to unite or integrate.” The practice of yoga focuses on the idea that the body, mind, and spirit must all be integrated in order for a person to be in harmony both with himself and his environment. To achieve this integration, emotions, actions, and intelligence all need to be in balance, and this can be achieved through exercise, breathing, and meditation – the three main yoga structures.

There are many different types of yoga. The most common type of yoga in the US is hatha yoga, which is a generic term that refers to any type of yoga that teaches physical postures. Hatha yoga is the foundation for many other types of yoga. In hatha yoga, physical poses, called asanas, are used in conjunction with breathing techniques and meditation. Often, classes labeled as hatha are gentle and move at an easy pace.

Other types of yoga include ashtanga, bikram, hot, iyengar, vinyasa, anusara, and restorative. In ashtanga yoga, the poses are always performed in the same order and are linked to the breath. It is physically demanding. Bikram yoga is practiced in a hot room and is a series of 26 poses that always follow the same sequence. It is also very physically demanding. Hot yoga is any type of yoga that is practiced in a heated room, so you should be prepared to sweat! Iyengar yoga focuses on finding proper alignment in a pose and uses a variety of props such as blankets, straps, and blocks to do so. It is physically and mentally challenging, but it will not increase your heart rate too much. Vinyasa yoga is known for its “flow” and the transition from pose to pose in fluid movements. It is intense and will increase your heart rate. Anusara yoga is a new form of yoga that strives to open your heart and connect with yourself and others through alignment. Restorative yoga is used to relax and rejuvenate. It uses props to help the body experience the pose without too much effort.

Yoga has been shown to have many benefits. It is not just about stretching! In fact, it is really about creating balance through increased strength and flexibility. Almost every yoga pose helps build core strength as well as strength in other muscles of the body. Yoga can help improve posture, since you become stronger and more flexible through your practice. Yogis also notice improved body awareness so that they are more aware when they are crouched or slouching. Other physical benefits are improved circulation, decreased stress, increased relaxation, decreased heart rate and blood pressure, and lower cholesterol and triglyceride levels. Additionally, those who practice yoga seem to lessen chronic pain and reduce insomnia.

Anyone can start a yoga practice as there are many different kinds of yoga and modifications for every type of pose. It is individual, and you can go at your own pace and explore your limits. It is a great way to get in tune with both your physical and mental self and engage

Are You Really What You Eat?

There is an old popular adage that states, “You are what you eat,” implying that in order to be fit and healthy you need to eat good food. While this notion is certainly true, it is complicated by our modern food supply. It is no longer enough to eat a balanced diet full of whole grains, lean meats, and fresh fruits and vegetables and expect to have adequate nutrition. Data collected by the US government shows that there has been a decline in the nutritional content of our fruits and vegetables. The USDA has proven that store-bought fruits and vegetables have far less vitamins, minerals, and nutrients than they did 40-50 years ago. One study shows we would have to eat 8 oranges today to get the same amount of vitamin A our grandparents would have gotten from one orange!
The past five decades have been known as the “Green Revolution” which is demonstrated by the increased production and yield of the fastest growing and greatest producing plants. The decline of the nutrients in our crops is due to soil depletion during this mass agricultural phenomenon. The soil that most of our crops is grown on is so deficient in mineral content that our produce contains only about 10% of the vitamins and minerals they should have! Our soil quality has decreased because of the modern intensive agricultural methods that are used to improve size, growth and pest resistance.
Most plants require nitrogen, phosphorus and water in order to grow. However, if they are grown in soil without other nutrients present, the plants will be devoid of any nutrition, even though they will look good to the naked eye. The absence of nutrients in the soil creates plants that are less able to defend themselves against natural predators, and thus they require pesticides in order to protect themselves from damage. These chemicals sprayed on our fruits and vegetables are poisonous and have not been properly tested to determine their effects on humans.
Even though fruits and vegetables are not as healthy as they used to be, we should not avoid eating them. They still have beneficial nutrients, fiber, and phytochemicals, and they are much healthier than processed foods and other snacks. Buying organic and local fruits and vegetables helps preserve the nutrient content in our produce and helps us avoid damaging chemicals and pesticides.
So, continue to eat the rainbow of foods in front of you, but also realize that it might not be enough. You may need to replace the missing vitamins and minerals in your diet with nutritional supplements. A good multivitamin might go a long way in helping to ensure optimal health and nutrition and to make sure that you are, in fact, what you eat.

The Importance of Being Flexible

Flexibility is often under-used and under-rated in both the fitness industry and in life in general. Physically, a person’s flexibility refers to the ability of a joint to move through its full range of motion. It is important to attain a full range of motion to perform activities of daily living and to reduce the stress on muscles, which in turn decreases injury rates.

Flexibility is joint-specific, since each joint has a potential range of motion. Static flexibility refers to the range of motion that can be attained while not in motion; dynamic flexibility refers to the range of motion that can be attained during movement. Dynamic flexibility is important to athletes because range of motion is limited by the amount of time it takes for a muscle to lengthen, which affects athletic ability. The more a joint can flex, the better the athlete can improve sport specific skills.

Greater flexibility of the muscle around the joint translates into better posture, reduced risk of injury, and less muscle tension and soreness. We need to be flexible to perform every day activities, from sitting to standing, and from lifting items to turning the body in different directions. Joints become stiffer as people age, and it is crucial to achieve a full range of motion to perform simple tasks, like tying shoelaces. When our muscles are sedentary and inflexible, our bodies create poor posture habits and movements that reduce the mobility of joints and compromise body positions. Flexibility helps prevent this loss of mobility.

Stretching helps to reduce soreness after exercise and gradually elongates the muscle through its full range of motion, which improves muscular balance and resting posture. Additionally, stretching promotes muscular relaxation, which increases flexibility in the hamstrings, hip flexors, and quads. This decreases the likelihood of both sporadic and chronic back pain. Stretching also increases blood flow and nutrients to soft tissue, increasing joint synovial fluid, which lubricates the joints and improves greater range of motion and decreased joint pain and degeneration.

Stretching can be part of a workout or a workout all by itself. As a rule of thumb, before a workout, stretching should be dynamic. Static stretching should be reserved for after a workout. When stretching, always be gentle and never jerk the muscle into position. Instead, smoothly move the muscle into position to safely lengthen the muscle tissue. Mild discomfort is normal during stretching, but there should never be any pain. Pain is an indication that the muscle is being overstretched or has been excessively stretched. Find 5-10 minutes per day to stretch to reduce stress and improve your health. Your body will thank you for it!

Keep On Spinning

Spinning has become all the rage, with spin studios like Soul Cycle and Fly Wheel opening up exponentially. Indoor cycling is a great low impact cardiovascular workout that increases both strength and endurance. However, as with any exercise program, it is important for the cycling enthusiast to make sure she/he is burning calories efficiently while simultaneously decreasing the risk for injury. And, as with many other routines, it can be too much of a good thing.

Proper alignment and biomechanics are the most important part of spinning effectively. Form starts with ensuring that the bike is set up correctly. First, make sure the seat height is correct by clipping your feet into the pedals (or putting your feet in the toe cages) and rotating your feet until one leg reaches the bottom. You should have a 25-35 degree bend in that leg when your foot is at the bottom of the pedal stroke.  It is common for people to sit too low, which can be dangerous for ligaments and joints. After adjusting the height of the seat, the seat needs to be adjusted fore-aft. The idea is to have your kneecap directly above the center of the pedal or when both pedals are level with each other, so that the front of your knee is right in line with the ball of your foot when the pedal is farthest forward. Lastly, the handlebars should be set so it is comfortable for your back and neck. A new cyclist should raise the handlebars to take the stress off his/her back or neck. However, those with a stronger core and lower back can lower the handlebars.

Form on the bike is also extremely important to avoid injury. Because cycling is a non-impact exercise, it might take longer for injuries to present themselves, and our goal is to prevent recurrent stress to the body. Make sure the balls of your feet are directly over the pedal and do not lock out your knees. In fact, your knees should be slightly bent towards the center of the bike.  Also, try to pull up with your legs instead of only pushing down.

Keep your head high and look in front of you at the road ahead to keep your neck aligned. Further, if you keep your abs tight, you can strengthen your core and help maintain your hips in proper alignment over the pedals. Additionally, it is important to keep your upper body relaxed; the handlebars are meant for balance and you should not be leaning too far forward or using your upper body to support your weight. You do not want to feel sore or tight in the forearms or triceps. As far as upper body movements on the bike, keep in mind that leaning while clipped in puts a lot of stress on the hip and knee joints and increases the risk for injury.

When biking out of the saddle, be sure to add resistance to the wheel to maintain balance from seated to standing. Also, your hips should be back on the saddle so your butt is only 1-2 inches above the nose of your saddle to ensure you are using your legs. Also, keep your upper body as still as possible with as little swinging or bouncing on the pedal to focus on core and leg muscles. You don’t want to pedal too fast or too slow; if you pedal too fast without the proper resistance, you will start bouncing in your seat and if you pedal too slowly you will be inefficient. It is more important to focus on intensity than on leg speed.

To maximize your workout, what you do off the bike is just as important and what you do on the bike. Resistance training to strengthen your core, hamstrings, quads, glutes, and back is extremely important to maintain proper form on the bike. The goal is to use exercises with a similar motion to cycling with lower and upper body while simultaneously increasing muscular endurance and core strength. Lack of glute strength is a major cause of muscle injury. Planks, lunges, deadlifts, kettlebell swings, and rows are all good exercises to utilize to improve your spinning experience.

Don’t forget to stretch! Don’t rush out of the studio after class; the two to three minutes of stretching is the bare minimum necessary to prevent injury. Spin classes can leave you feeling tight and sore, and stretching helps prevent muscle soreness by increasing blood and nutrient supply to the muscle and improving flexibility. Concentrate on the hip flexors, quads, hamstrings, calves and hips. Spinning  causes a tight psoas, which causes back pain and discomfort.

Moderation and diversity are key to any exercise program. Spinning 5-7 days a week will undoubtedly lead to repetitive stress on the same muscles and joints since your body is in the  same position doing the same motions. Injuries caused from spinning range from lower back pain due to tight hip flexors and knee pain due to imbalances in surrounding muscles.

Spinning can be a fun and effective part of any exercise program. If you do choose to spin, be sure to complement it with other exercises, especially those that strengthen the core and glutes. To be truly fit and functional, remember proper form on the bike, muscle strengthening, stretching, and changing up your exercise routine.

 

The Skinny on Stress

Have you ever tried to lose weight and found it impossible….even when your diet was perfect and you were exercising like a madman? Well, that’s because weight is not always all about the calories. Sometimes, other factors in our lives, like stress and sleep, affect our ability to lose weight and stay fit.

Stress is defined as your body’s way of responding to any kind of physical, emotional, or mental demand.  It is any real or perceived threat to your mind or body.  When our bodies are stressed, our sympathetic nervous system slows everything down. Our metabolism decreases, which increases our hunger and increases fat storage Further, blood sugar levels increases and because food isn’t moving properly, we may experience reflux or
constipation

Stress also causes hormonal imbalances that affect weight status. It decreases testosterone, which is related to muscle loss and fat increase. Additionally, it increases cortisol, otherwise known as the “stress hormone.”  Cortisol is responsible for stimulating insulin and effecting blood sugar levels,  which affects fat and carbohydrate metabolism.  Levels of cortisol vary at different times of the day. It is usually highest in the morning to increase appetite and energy levels and lowest at midnight to help sleep and repair.  During psychological and physical stress, the normal amount of cortisol in the blood is disrupted and may promote weight gain, especially around the abdomen. This fat around the midsection is typically linked to increased diabetes and heart disease. Increased cortisol is also responsible for increasing cravings for unhealthy food, especially carbohydrates. Increased carbohydrate intake increases insulin, which then stores fat. Additionally, cortisol may decrease sensitivity to leptin, a hormone that makes you feel full. Therefore, increased cortisol is dangerous in 2 ways: it decreases metabolism and increases hunger…both contributing to weight gain.

The most important thing you can do to decrease your stress levels is learn to relax! Relaxing increases your metabolism, increases your insulin sensitivity and helps you lose weight.  You can train your body to relax through yoga, meditation, prayer, hypnosis, deep breathing, mindfulness, acupuncture and saunas or steam baths.  Adequate sleep is necessary to decrease stress level as a lack of sleep is linked to an increase in cortisol levels. Exercise is also great for stress because it helps the body relax while burning calories. Physical activity helps to keep insulin and blood sugar in control.

Diet is another key factor to controlling stress and weight.  In order to decrease insulin production and eventually reduce cortisol levels, it is important to keep your blood sugar levels steady by eating a balanced diet.  Never skip breakfast and try to consume six small meals a days with a variety of foods.   Avoid refined sugars and simple carbohydrates, which increase insulin and contribute to stress inside the body. There are many supplements you can add to your diet which have been shown to help the stress response. These include B vitamins, magnesium, zinc, vitamin c, vitamin E, lipoic acid, coenzyme Q10, ginseng, rhodiola, aswaganha, licorice, and passion flower extract.

Don’t get frustrated if you are having trouble reaching your ideal weight.  Take a closer look at how stress may be affecting you. If you use the above tips to help mange your stress levels, you may soon find yourself closer to reaching your weight loss goals.