Step-Up Exercise

How To Do Step Up


The concentric action is hip and knee extension. The primary muscles used during hip extension are the gluteus maximus  and hamstrings (semimembranosus, semitendinosus, and biceps femoris). During knee extension is quadriceps (vastus lateralis, vastus intermedius, vastus medialis and rectus femoris).

Starting Position

Begin the upward movement by stepping up with one leg. Keep trailing foot at start position and shift weight to the leg on the box. As the hip and knee extend on the box stand tall while simultaneously bring the opposite foot next to the starting foot.  The downward movement starts with shifting the body weight to the same start leg and stepping off the box with the opposite leg. Shift the body to the the opposite leg and the start leg will follow to starting position.


Training Tips

  • Keep torso erect and parallel to the tibia
  • Initial contact of lead foot with top of the box must be made by the entire foot
  • During upward extension push through the heels and squeeze the glutes
  • Maintain hip flexion, knee flexion, and dorsiflexion of ankle at top of movement

Warning Tips

  • Do not allow the heel to hang off the edge of the box

Charles DeFrancesco, NFPT, USAW, NASM
President & CEO of Pure Fitness Club, Owner of Fit and Functional

What do you expect

What Do You Expect?

Do you want to enjoy good health? It seems safe to say that the answer is most likely, “Yes”. Now, do you expect to enjoy good health? This answer may be quite different.

I recently heard an audio clip of a speech by a motivational speaker named Les Brown. He told a story about a conversation he had with his son in which Les asked if he wanted to be successful. Of course the answer was yes. He then asked if he expected to be successful based on his current behavior. His son fell silent and couldn’t answer. I found this simple conversation to be incredibly powerful and it really made me think.

The definition of “expect” according to Merriam-Webster’s Dictionary is, “to think or believe that something will probably or certainly happen.” If we want something that we don’t have, we must change our behavior in order to get it. When our behavior is in line with the results we want, we can then expect to have those results. When we have an expectation, our behavior should meet or even exceed the expectation. It is a very simple formula.

So I will ask again, do you expect to enjoy good health?

What are you feeding your body? How are you moving? How are you sleeping? How are you thinking? How are you feeling? How do you manage stress? What are you feeding your brain? What are you learning? Who and what are your influences? What are you reading? What are you watching? What are you listening to? What are you focused on? Are you focused on problems or solutions? Are you focused on what you want or what you don’t want? What are your dreams? What are you working towards? How are you spending money? How are you earning money? How are your relationships? What are you doing? What are you contributing? The list goes on, but I think you get the point. All of the above significantly affect our health. Taking a closer look at ourselves, it becomes evident that we have more control over our lives than we typically think we have.

I challenge you to take a look within and ask yourself some of these questions. Write them down. Write the answers. Then ask yourself what do you expect? This is a great step. If you don’t like the answer, then make a change. Take another step, then another, then another…

I’ll conclude with a great quote from one of my favorite Dr. Seuss books, “Oh, The Places You’ll Go”:

You have brains in your head.
You have feet in your shoes.
You can steer yourself any direction you choose.

Robert Inesta, DC, L.Ac, CCSP
Westchester Sports & Wellness

Summer Weight Loss

Getting in Shape for the Summer

By: Rick Weinstein, M.D., MBA

As the weather gets warmer, it is apparent who has been hibernating and not kept in shape in the colder months. This is the time of year where most people want to get into better shape. This should be a year-round activity, but the warmer days definitely afford you more opportunities to work out.
The journey to getting in shape always starts with the first step. This may mean starting with walking. It is best to have a good pair of sneakers or running shoes and a softer surface, such as grass or a track, which is better than the streets. You should be able to get a sweat going and get your heart rate up to get a real work out. Many phones can measure your heart rate using one of the work-out apps that are readily available. Try and get your heart rate up to 60% of your maximum heart rate. Maximum heart rate is approximated as 220-age.

It is important to do the work-out that you enjoy doing. If you like running or biking, then do that. If you prefer tennis or soccer, go out and play. You should be working out 6 days a week. If you do only 1-2 days a week, you will not get much benefit at all.

Before you get involved in working out and playing sports, warm up and stretch out. Do not push yourself too hard initially, but as you get into better shape, you do need to continue to push yourself. Give yourself short challenges and try to meet goals. Studies have shown that tracking your workouts on a calendar is more likely to keep you on the track to getting into better shape.

If you want to lose weight, working out can help, but the only way to lose weight is to burn more calories than you take in. Pick a reasonable diet that you can handle and stick to it. Don’t switch diets every few weeks or you will not lose any weight.

The goal of getting shape is to be healthier and feel better. Working out will give you a psychological boost and it is a cure for sadness and depression. The weather is warmer and the days are more pleasant, so get yourself outside and do something good for you.

Stop Picking the Scab

When treating painful conditions, an essential, and often ignored factor is removing the irritants causing the problem. The unhealthy world we live in provides an endless supply of irritants and causes of imbalances and pain that we are not always aware of. Some of these include sitting, workstations, cars, mattresses, computers and smart devices, shoes, sports, exercise, hobbies, foods, certain people – the list goes on and on.

Many of us, especially as children, have been told, “Don’t pick the scab,” after cutting or scraping our skin. The reason being that as the skin heals, we do not want to disrupt the process by picking at the scab. If we were to consistently pick at it, the wound would continue to open and would not heal. This is what happens in painful conditions where either the causative factor is not determined, or it is determined but patient does not make the necessary changes to remove it.

“Picking the scab” is a term used by Stuart McGill, Ph.D, one of the top lumbar spine researchers in the world. One of McGill’s main points in treating lower back pain is determining the causative factors and making changes in the patient’s lifestyle that will protect the spine and prevent further irritation. This is what is meant by not picking the scab.

This sounds like a very simple approach when compared to extensive treatments, drugs, surgeries, etc, but is often much easier said than done. When looking at all the possible causative factors for our pain, it may seem impossible to avoid them all. The first step is awareness – identifying the factors. Once identified, one can then make decisions on altering lifestyle. If the causes cannot be removed completely, it is important to try to create as much balance as possible in order to counteract the negative aspects as much as possible.

A common mistake in dealing with pain is making generalizations such as, “I just have to stretch more”, “I just have to exercise more”, “I have to do Pilates”, “I have to get adjusted more”, etc. While sometimes there is some truth to these generalizations, we must realize that every individual is unique and has different needs. What is true for one is not necessarily true for another. And it is often not about getting more, it is about getting what is right for the individual – quality instead of quantity.

Here are some examples of questions to ask your healthcare providers:

What types of exercise would be most appropriate?
What type of stretching would be most appropriate and when?
What movements or positions should I avoid?
How can I alter my workstation?
How can my diet affect my condition?
What else can I be doing on my own to help myself?
What types of treatments would be best for my situation so that I improve function and get the most out of life?

Keep in mind that the healthcare provider is not the healer. The patient is the true healer. It is their body that is changing, doing what it was naturally designed to do. The provider has an important role in helping to guide the patient on his or her journey, advising and providing services/products that allow the patient to heal more efficiently. Patients must take responsibility for their health, and healthcare providers must empower them to do so. By understanding the underlying causes of our conditions, we can take action to create a healthier lifestyle allowing our bodies to heal and thrive.

Plantar Plate

OPA!!! Did you “break” your plantar plate?

Plantar PlateMany patient’s present to my office complaining of “ball of foot pain”.  Many things can be occurring in the wonderfully complex forefoot, and many times, we are able to differentiate pa theologies based on the description of symptoms.  One particular issue which I am seeing more and more of is something that many people have never heard of; the plantar plate rupture.

The plantar plate is a cup like ligament that provides support to the plantar aspect of the metatarsophalangeal joint (or the bottom of the joint connecting the toe to the long metatarsal bone associated with it). This provides stability to the joint, and helps prevent dorsal dislocation when walking and running.

The plantar plate can sometimes suffer injury. This can be the result of a direct trauma, but I more often see it as a result of repetitive stress or “wear and tear”. These injuries are often associated with an elongated metatarsal. Over time, the ligament frays and weakens, eventually leading to attenuation or rupture. This will lead often lead to a toe deviating to the side. Most commonly, I see this occurring to the 2nd or 3rd metatarsophalangeal joint.  An MRI or detailed musculoskeletal ultrasound is often extremely helpful in evaluating the damage to the plantar plate, and in differentiating plantar plate pathology from other forefoot pain such as neuromas.

processed foods (1)

The Danger of Processed Foods

Processed foods are a staple in the American diet, and as a result, we are a heavier, sicker population overall. Processed foods are generally recognized as any food that comes in cans, bags, boxes, or jars, especially if they have a long list of ingredients on the label!  Processed foods are very easy and convenient; however, they contain many ingredients used to soften, preserve, color, emulsify, bleach, flavor, and hide odors.  These chemicals have been shown to cause cancer, obesity, and heart disease. Consequently, processed foods should be avoided as much as possible.

One reason processed foods have negative health effects is because they are usually very high in sugar or high fructose corn syrup. This sugar laden food is filled with empty calories and negatively affects metabolism.  Additionally, excessive sugar intake has been linked with high triglycerides, high cholesterol, and insulin resistance. Fructose is especially damaging and toxic to the liver, since that is where it is primarily metabolized. It also turns directly into fat and leads to obesity and issues with the mitochondria (the powerhouse of the cell), which also has a role in metabolism.

In addition to sugar, processed foods contain a large variety of artificial ingredients. These ingredients are not real food! They are chemicals used as preservatives, colorants, flavors, or texturants. Further, some of the chemicals in the food may not even be listed on the label and might be grouped in an all-encompassing term, such as “artificial flavors.” Supposedly, these chemicals have been tested for their safety, but how can all of these foreign chemicals actually be good for us?  A great deal of research shows that certain preservatives are linked to allergic reactions, cancer, and other health issues. For example, the preservative BHA affects the nervous system and has been shown to change behavior. Food colorings and flavorings also have negative health outcomes. In fact, nine food dyes are linked to hyperactivity and cancer, while a flavoring called diacetyl may be linked to Alzheimer’s disease.

Processed foods are also high in refined carbohydrates, which pass through the digestive system quickly and raise blood glucose levels and insulin levels. This has been associated with many chronic diseases and negative health effects. Additionally, these foods are generally low in fiber, because the fiber is lost during processing. Fiber is responsible for slowing the absorption of food, increasing satiety, normalizing bowel movements, and lowering cholesterol.  When foods pass through the digestive system quickly, we require less calories to digest them. Therefore, in a shorter period of time, we can eat more and burn less, a recipe for weight gain!  Overall, there is very little nutritional value in processed foods, even when vitamins and mineral are “added back” into the foods.

Many people complain that they can’t stop snacking on processed foods, and they have intense cravings for these items. Research shows that many of these foods have been engineered to be rewarding and desirable to the brain, which makes the food addicting and makes it difficult to stop eating.  Even though our bodies are designed to regulate how much we eat, food manufacturers have designed their foods to be “hyper-rewarding” and to bypass these intrinsic regulators. Additionally, since processed foods are missing important components like water, fiber, and nutrients, the hormones in your body do not know how to respond or digest these foods properly.

Today’s society is busy, stressed and overwhelmed, so processed foods may seem like an easy solution. However, in order to remain productive and healthy, it is important to eat real food. Real food with real nutrients will make us look better and feel better!

Sports Injury

The Mental Side of Sports Injury Rehabilitation

The physical demands required to practice a sport quite often lead to injuries. Last year, 1,5 million young athletes incurred in some kind of a serious injury. Strains and sprains, about 500,000, are the most common sport injuries, followed by fractures and contusions. Once an athlete suffers a sport injury, physical rehabilitation plays a positive and significant role in helping the athlete return to the field, track, or course. As the athlete commits to the rehabilitation process, he/she will notice physical improvements and, in due time, be back to practicing his/her favorite sport. However, injury rehabilitation is not just about addressing the physical pain. Injured athletes often experience a wide array of emotions that, unless properly managed, may impact not only in the rehabilitation process, but also the chances of successfully returning to completion.

Once an injury occurs, emotions invade the athlete’s mind. Regardless of the kind of injury, the athlete is suddenly forced to stop from participating in his/her favorite sport. The longer the rehabilitation process is, the stronger the emotions that are experienced. A sport injury can become an emotionally devastated moment for any athlete. Dreams of remaining in the varsity team, or hopes to receive a full scholarship ride to a top division school may have just become a gone possibility. At the time when education is running at exorbitant costs, parents may also experience a sudden emotional shock. The rehabilitation process is not just a physical demand, but equally important, a mental exercise that will demand focus, emotional determination, and positive reinforcement not only for the athlete, but also for the parents.

Addressing the emotional aspect in sport rehabilitation has many positive benefits. Setbacks, like an injury, is likely to challenge the mental makeup of the athlete. Chances are that the athlete will be able to come back and fully participate in his/her sport again. However, the athlete’s chosen mental approach to overcome this difficult moment can become a learned lesson for dealing with future sport and life challenges. It is in the athlete’s best interest to take full responsibility to embrace the mental side of sport rehabilitation as it will lead to developing a higher level of confidence knowing that he/she was able to successfully navigate the challenges and disappointments of a sport injury and return to play.

Injuries bring a wide array of emotions. An athlete will feel frustration, anger, sadness, depression, nervousness, and even hopelessness. All these emotions may be experienced one after another or some of them all at once. The athlete’s routine has just been broken and the sports goals need now to be temporarily put on a shelf. There is no worse experience for any athlete than sitting on a chair and thinking “why me?” The athlete will try to find answers and, in the process, become emotionally overtaken by the hopelessness of not being able to participate in his/her favorite sport. The longer the rehabilitation process, the more likely the athlete will go into an emotional tsunami of experiences.

Some of the emotions are related to the uncertainty of whether the athlete will be able to compete again, and how soon that will happen. Also, the athlete may fear being replaced by another athlete and losing his/her place in the team. Additionally, there is also the fear of not being able to achieve the top physical fitness prior to the injury or, even worse, the fear of being re-injured. Parents may directly or indirectly make this challenging experience even more difficult by undermining or short-cutting the rehabilitation process in hope of raising the athlete’s emotional state. Unfortunately, this approach often leads to not only increasing the chances for recurring injuries, but more importantly, to missing the opportunity to build a stronger emotional state that will help the athlete cope with future challenges.

There are important and useful mental approaches that positively impact injury rehabilitation for both, athletes and parents.


  • It is perfectly fine to have emotions concerning the injury. It is an unexpected set-back. However, the same mental fortitude that led he/she to succeed in sports can be applied toward the rehabilitation process. A positive mental attitude directed toward rehabilitation will promote quicker healing.
  • Set specific and realistic goals directed toward rehabilitation. Make sure you follow proper physical, dietitian and rest guidance. The athletes must commit to meeting those goals even when progress is not moving as fast as he/she wishes.
  • Surround yourself with encouraging people that will support the recovery process. There may be times when the athlete will feel down and discouraged. By maintaining contact with teammates, coach and/or even taking the role of mentoring other players will bring positive and fulfilling feelings.
  • Practice positive imagery. Athletes have successfully used this mental strategy to bring faster healing. The body has gone through a lot of stress, both physically and emotionally. To alleviate stress, mental imagery helps to lessen stress and facilitates rapid recovery.
  • Another strategy to lessen stress is to practice breathing relaxation. Athletes are encouraged to lie down on a coach and place a light object on the belly. With each inhale, push the object up and then exhale. Repeat this exercise for five minutes and bring attention to how the body begins to calm down.


  • Empathy goes a long way in the recovery process. The athletes need a secured presence for support, encourage, and understanding. It is also important for the parents to remain in contact with other sport parents and coaches for guidance and support, as well.
  • Take a pro-active approach to understand as much as you can about the injury, its potential outcome after surgery, the needed rehabilitation program while also maintaining contact with the athletic trainer, physical trainer and coaches. It is important to remain connected with these professionals in order to be truthful and supportive during the entire process.
  • It is normal that the athlete goes through emotional ups and downs. It will hard on them as it will on the parents. At this moment, it is important to remain positive and encourage the athlete to follow with professional recommendations and goals. It is detrimental for the athletes to minimize recovery time as it will only increase the chances of getting hurt, again.
  • If the athlete struggles with the recovery process and it is taking a big emotional toll, keep the professionals informed and consider seeking mental health sport counseling. As hard a recovery process is, the athlete may benefit by addressing his/her emotional struggles with a separate professional that will provide mental health support.

As unfortunate a sport injury is, there is a silver lining behind successfully addressing the recovery of a sport injury. The athlete will have gained the be more confident after having adhered to a set of goals, remain positive, be patient, seek help, and build mental toughness that will be useful to deal with future sport and life challenges.


Alex Diaz, PhD

Sports Mental Edge

Tennis Elbow

Tennis Elbow

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

One of the most common problems I see in the office is tennis elbow. Most people with this problem don’t even play tennis! Tennis elbow is damage to a tendon where it attaches to the elbow. The muscles that extend your wrist start as a tendon on the outside part of the elbow, and when this is injured, it results in tennis elbow pain. Repetitive motion of the wrist or excessive lifting with the arm and wrist is what causes the problem. I commonly see this in both athletes and non-athletes as well.

The pain is localized to the outside part of the elbow. It is worse with lifting with that arm and typically does not hurt when resting. Pain can be severe and is often felt when shaking someone else’s hand. If the pain is on the inside of the elbow, it is called golfer’s elbow and is due to an injury to the wrist flexors, not the extensors.

The best way to treat tennis elbow, like any other injury, is to prevent it. If you are going to play a sport you should be in shape before the season starts. This means cardio conditioning and strengthening legs and arms. Stretching is also key to preventing injury.

If you have tennis elbow, treatment for 95% of people is without surgery. I start my patients in physical therapy, but this should be with a good therapist who deals with this problem a lot. If you are having severe pain or have had symptoms for a long time, a cortisone shot can provide dramatic improvement. I do these under ultrasound guidance to ensure accurate placement. The few patients who don’t get better with therapy and injections will require surgery. The surgery takes me only about 20 minutes, and my patients go home the same day. The surgery is very successful, but again should only be performed if you really have done adequate therapy and injections. I also do PRP injections if the cortisone does not work.

Tennis elbow is very common, and if you suspect you have it, see an orthopedic sports specialist to get it checked. If your doctor tells you need surgery, and you have not done much therapy and injections, get a second opinion. Pain in the elbow or any other part of your body after working out or playing sports should be treated initially with ice and rest. If pain persists, call an orthopedic specialist.

Breathe Easily

Breathing is the most basic movement pattern and very often done incorrectly, having tremendous consequences in terms of our musculoskeletal health. If we think about how often we breathe (every moment of our lives), it is easy to see how incorrect patterns can lead to problems. Faulty breathing patterns and the impact they have are often overlooked because it is such a subtle and involuntary movement that we typically do not consciously think about.

Breathing is life. It is common to think of breathing only in terms of respiration, which is obviously essential to sustaining life. But the effects go beyond the basic respiratory function. There has been much research demonstrating a link between breathing pattern disorders and low back pain, neck pain, shoulder imbalances, TMJ pain, poor motor control and posture.

Posture and breathing are directly related. One cannot be addressed without the other. Breathing pattern disorders usually develop as we begin to develop poor postural patterns very early in life. Watching an infant is a great way to see proper breathing, as they have not yet learned to do it the wrong way.

The diaphragm, the main muscle responsible for breathing, can be seen as an essential component of the core function. If we think of the trunk as a cylinder or column, with muscles and fascia wrapping around as a belt, the diaphragm acts a lid, while the pelvic floor muscles make up the floor. Often when working the core, we often focus on the abdominal muscles and do not consider the importance of the diaphragm. If breathing is not correct, one cannot have full core stability.

An easy way to assess your breathing is to stand in front of a mirror placing one hand on the upper part of the chest and one hand over the abdomen. Take a deep breath and notice the movement of the hands. If the hand on the chest elevates, this indicates incorrect breathing, or thoracic breathing.

The correct pattern is when inhaling, the abdomen expands, pushing the hand over the abdomen forward, or outward. The hand on the chest should not move much. This is known as diaphragmatic breathing, and properly engages the diaphragm.

Thoracic breathing engages muscles of the chest, upper back and neck as the primary breathing muscles. Over time, these muscles will develop tension from overloading and doing more work than they are designed to do. While these muscles are overworking, the diaphragm is under-working, contributing to core weakness and the long list of consequences that result.

Awareness of breathing pattern disorders through the simple test above is an important step. To begin working on correcting the pattern, try the following. Lay supine (on your back) and prop your legs up on a cushion, or support, so that the hips and knees are both at 90 degree angles. If you cannot do that, simply laying on the back with knees bent will also work. Place one hand on the abdomen and the other on the chest and breathe normally trying pull the breath into the abdomen. With each inhalation, the goal is expand the abdomen lifting the hand. The ribcage will also expand a bit laterally, but should not elevate. Try to stay as relaxed as possible while doing this and don’t worry about taking deep breaths. Breathe easily and normally. Do this for a few minutes three to four times a day.

This will start to groove the movement pattern and reprogram the system. Gradually you will begin notice when breathing incorrectly and will more easily be able switch to diaphragmatic breathing. It is more difficult to do this while upright, which is why the supine position is the best way to start the training process. It is very important to work on posture simultaneously in order to achieve the best, long lasting results. It is very difficult to breathe correctly with poor posture.

Also keep in mind that this is a process. It will not change overnight. It takes a lot of work and consistency to retrain a system that has been in place for so long. Remember how often you breathe, and for how long it has been done incorrectly! Do not get frustrated if you feel like you are getting nowhere. Keep working on it. If you feel you need more help, consider seeking the help of a professional who has experience with this. Many chiropractors, acupuncturists, trainers, physical therapists, massage therapists and other types of body workers can be very helpful.

There are many other health benefits to proper breathing in addition to musculoskeletal health. One can write volumes on breathing in terms of musculoskeletal, biochemical, respiratory, mental/emotional, endocrine, neurological and spiritual health. Many types of meditation and relaxation exercise focus on the breath. It is synonymous with life. So contribute a few easy minutes a day to your breathing, and ultimately your health. It is a worthy cause.

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.