Correcting Foot Pain and Maintaining Foot Health During Isolation
Most IFPA Certified Trainers around the World, and their clients alike, continue to experience Quarantines, Closed Gyms, and isolation.
For those clients, that have chosen not to engage with you through online training, their daily steps counts are dangerously low. Even if your clients are continuing their standard weekly sessions with you, through online training, their daily step counts are way down, due to the nature of being isolated at home.
Many of our Trainers are finding their older clients complaining of joint pain, especially in their feet. You may remember from the IFPA Book On Personal Training, “what you don’t use, you lose.” This is certainly true for the stability of joints that are not being exercised on a regular basis.
According to a 2018 Survey conducted by the American Pediatric Medical Association (APMA) 75% of people surveyed had some pain issues with their feet.
To my knowledge, no Personal Trainers are meeting the needs of these clients. This is a tremendous opportunity for each of you. I am going to provide you an Exercise Prescription and Program Design to meet this need.
Your Exercise Prescriptions must err on the conservative side for now. If it has been a while since your clients have exercised, start slow, and build slow. Getting people doing something is infinitely better than people doing nothing.
If your clients have some exercise equipment in their homes, great, use what they have available. If your clients do not have exercise equipment available, no worries, get them started with calisthenic exercises.
Even when they present with joint pain, you will still need gentle movements for their entire body, in order to get them healthy again. Teach your clients simple calisthenic exercises and the variations needed that will be appropriate for their current condition.
If they can do some aerobic exercise, pick a type that will be comfortable for them.
- Walking is a good starting point with a low impact. The feet land with 1.1-1.4 g’s.
- Jogging is a much higher impact of 4.4 g’s.
- Running, of course, is an even higher impact with the foot landing of 7.7g’s.
Depending on the pain threshold, even walking may be painful. In a gym, you have an excellent variety of bikes. The Recumbent Bike is the most gentle on the feet, for your Personal Training Clients experiencing joint discomfort. The Recumbent Bike not only takes the stress off the feet and somewhat the knees, but it is also very gentle on the back.
The solution for a client that cannot walk without pain, or a client that does not have access to a swimming pool, will require some creativity.
For the Warm-up select low-intensity movements, with little or no impact such as:
- Arm circles
- Chair squats
- Hip Circles
For the Strength Training portion of your Program Design, incorporate low-intensity exercises with low to no impact such as:
- Push-ups: choose a variation that meets your client’s fitness level
- Supermans: choose a variation that meets your client’s fitness level
- Squats: Bodyweight only, or Band/something available in their home
- Leg Curls: Preferably on a Stability Ball
- Hip Thrusts
- Heel Raises: Assisted if painful (use furniture for support)
- Toe Raises: Use Bands or household implements for resistance
- Shoulder Presses: Use Bands or household implements for resistance
- Bicep Curls: Use Bands or household implements for resistance
- Triceps Extensions: Use Bands or household implements for resistance
- Shrugs: Use Bands or household implements for resistance
For the Flexibility Training portion, include the same exercises you studied in The Book on Personal Training with emphasis on the feet, then add the following exercises:
- Big Toe Circles: Have your client make as big a circle as they can with their Big Toe, first clockwise for 15-20 Reps, then counterclockwise for 15-20 Reps, both feet
- Write the Alphabet: Have your client Write the Alphabet with their Big toe. First the Capital Letters, then the small letters, both feet.
- Marble Pickup: Have your client pick up an object using just their toes and then place the object in a bowl that is within easy range of your client’s foot. This exercise works with any small object such as small balls, sponges, or pebbles.
Make sure to review all your IFPA Rules for safe and effective stretching.
For the Cardiovascular Training portion, include large muscle, low-intensity activity, sustained for 20-45 minutes as described for the Warm-up above. And never forget the Cool-Down of the same type of cardio exercise and stretching.
Your clients must rehabilitate their feet to live. It may hurt to start, but it will get progressively more painful the longer they delay their Rehab program. If they get to the point where they cannot or will not move, they begin a physical deterioration of premature disease, disability, and death.
Depending on the level of pain, they should be referred to the appropriate doctor who may recommend more medical interventions.
Painful feet lead to poor balance. Poor balance leads to a fear of physical activity and movement. When we stop moving, we die an early death. Be cognizant of the fact that we must exercise to maintain balance. Even your younger clients would benefit greatly by doing many standard Dumbbell exercises by standing on one foot, or even better, standing on one foot and moving one dumbbell at a time.
For Example: perform a One-Arm Dumbbell Shoulder Press while standing on one foot. The better balance you build while you are younger, the better balance you will have when you get older.
Don’t forget joint issues are often the result of one side of the joint being Hypertonic (overly strong/overly tight) and the opposite side weak and stretched. Your exercise prescription should be adjusted to stretch the hypertonic side and strengthen the weak/stretched side.
Other Risk Factors for Foot Pain issues are:
- Rheumatoid arthritis
The ideal strength ratios between opposing muscles at a joint are as follows:
- Ankle: Plantar/Dorsi Flexion: 3:1
- Ankle: Inversion/Eversion: 1:1
- Leg: Extension/Flexion: 3:2
- Hip: Extension/Flexion: 1:1
- Shoulder: Flexion/Extension: 2:3
- Elbow: Flexion/Extension: 1:1
- Lumbar: Flexion/Extension: 1:1
- Shoulder: Internal/External Rotation: 3:2
Your Exercise Prescription should work toward getting your client to meet these strength ratios. You can accomplish this goal by doing 3 exercises for the weak side for every exercise you perform on the strong side.
Speaking of feet, new research regarding feet and the Coronavirus have been making headlines.
For reasons yet unknown, an early warning sign for the Coronavirus, may be your feet! People with the Covid-19, who were asymptomatic for the disease (they carry the virus, but do not have any symptoms of the virus), could be identified by small purple lesions on their feet that were very similar in appearance to chickenpox, measles or chilblains.
Usually, the lesions appear on the toes and usually heal without a mark. If you or your client presents with this condition, notify your doctor immediately and avoid contact with others for obvious reasons. If you experience this symptom, you could give it to others.
We are going to get through this. Never forget that we are the descendants of people that fought and killed tigers, lions and bears. We are descendants of those who survived the Bubonic Plague and every other disease nature has thrown at us. We have fought and won against all adversaries big and microscopic and we will defeat this opponent!
Stay safe, stay healthy, and keep fighting.
Dr. Jim Bell