Exercises For The Parkinson Patient

Just as running water does not freeze, so moving muscles do not freeze.

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Know the facts. The maintenance of normal muscle tone and function is an important aspect of the treatment of parkinsonism. In part, medication administered for your illness achieves this goal. However, to realize the full benefit of the medication daily exercise and activity are essential. This booklet outlines some of the exercises capable of maintaining muscle power and tone and preventing deformities of the limbs and spine. Their daily performance has proved most beneficial to patients with this illness.

TEN BASIC EXERCISES FOR THE PARKINSON PATIENT

1. Bring the toes up with every step you take. In Parkinson's disease, "you never make a move", without lifting the toes.

2. Spread the legs (10 inches) when walking or turning, to provide a wide base, a better stance, and to prevent falling. It may not look "beautiful," but neither does falling.

3. For greater safety in turning, use small steps, with feet widely separated. Never cross one leg over the other when turning. Practice walking a few yards and turn. Walk in the opposite direction and turn. Do so fifteen minutes a day.

4. Practice walking into tight corners of a room, to overcome fear of close places.

5. To insure good body balance, practice rapid excursions of the body. Backward, forward and to the right and left, five minutes, several times a day. Don't look for a wall when you think you are falling. It may not be there. Your body will always be there to protect you, if you will practice balance daily.

6. When the legs feel frozen or "glued" to the floor, a lift of the toes eliminates muscle spasm and the fear of falling. You are free to walk again.

7. Swing the arms freely when walking. It helps to take body weight off the legs, lessens fatigue, and loosens the arms and shoulders.

8. If getting out of a chair is difficult, rise with "lightning speed," to overcome the "pull of gravity." Sitting down should be done slow, with body bent sharply forward, until one touches the seat. Practice this at least a dozen times a day.

9. If the body lists to one side, carry a shopping bag loaded with books or other weights in the opposite hand to decrease the bend.

10. Any task that is difficult, such as buttoning a shirt. or getting out of bed, if practiced 20 times it day, becomes easier the 21st time.

FOR TIGHT MUSCLES AND POOR POSTURE

STANDING

1. Stand ln front of a wall, facing it about 8" away. Raise arms and reach as high as possible toward the top of the wall. Lean toward the wall and stretch.

2. With your back to the wall, alternate raising legs as high as possible by bending the knee as if marching in place.

3. Holding on to something secure, squat down as far as possible, bending knees; then come up.

SITTING

1. Sitting in straight-back chair, place your arms behind the chair and bring your shoulders back as far as possible; raise your head up and look at the ceiling.

2. Sitting In the same chair, grip the ends of a broom or mop stick with both hands, try to raise it over your head until you get it behind your head. Keep head and shoulders as erect as possible.

3. Sitting in same chair, place one leg at a time on another chair and press the knee straight. Keep it there 15 minutes. Try both legs together.

4. Sitting in a chair, raise legs up from the knee alternately, as if stamping your feet.

LYING ON A FIRM BED OR FLOOR

1. Lie on the floor or bed, flat on your back; try to press your body to the floor as flat as possible. Move your head from right to left as far as possible. Make sure your head, shoulders, back, and knees touch the surface.

2. Lie on the floor or bed on your abdomen. Do the following one by one:

1. Put your hands behind back and look up to ceiling, trying to raise your chest off the floor.
2. Kick your legs alternately, as if swimming.
3. Turn your head from right to left.

FOR BETTER BALANCE

1. Stand with hands on hips, feet spread apart:

1. Practice marching in place
2. Practice raising leg straight out to the rear.
3. Practice raising leg out to the side.
4. Practice drawing a circle with the leg.

2. Standing with hands at side, feet spread apart:

1. Lean forward and back
2. Lean to both sides
3. Lean in a circular motion and reverse the motion

FOR WALKING

1. When walking, REMEMBER:

1. Take as large a step as possible
2. Raise your toes as you step forward, hitting ground with your heels
3. Keep legs apart and posture straight
4. Swing arms and look straight ahead - your feet know where the floor is located.

2. Collect a dozen magazines; lay them out in a straight line. Space them so that you can take as long a step as possible. Practice walking over these magazines without stepping on them.

3. For a better swing to arms, walk holding a rolled magazine in each hand; keep elbows straight.

4. Practice walking sideways, backwards, and take big steps.

FOR TURNING

1. When practicing turning:

1. Keep feet spread-apart and head high
2. Use small steps; rock front side to side
3. Raise legs from the knees

2. If you feel glued to the floor:

1. Raise your head, relax back on your heels and raise your toes
2. Rock from side to side, bend knees slightly and straighten up and lift your toes
3. It sometimes helps if the arms are raised in a sudden short motion

FOR GETTING IN AND OUT OF A CHAIR

1. If you become glued a few steps before you reach the chair, try this: Don't aim for the chair but some object past it. Pass the chair as closely as possible and as you go by it sit down.

2. To sit down, bend forward as far as possible and sit down slowly. Get close to the chair. Do not fall into the chair.

3. To get up, move to the edge of the chair, bend forward and push up vigorously using your arms; try to count 1 2 3 GO! If you have a favorite armchair, raise the back legs with 4" blocks. This will help you to get up easily. Don't let people drag you up by your arms, but help you by pulling you under your arms, or with a slight push on your back.

FOR GETTING OUT OF BED

1. Place blocks under the legs of the head of the bed. This will elevate the head of the bed, & make it easier for you to sit up and swing the legs off the bed.

2. A knotted rope tied to the foot of the bed can help you to pull yourself up.

3. To get to a sitting position, shift the body down and rock yourself by vigorously, throwing your arms and legs toward the side of the bed.

FOR USING YOUR ARMS AND HANDS

1. Practice buttoning and unbuttoning your clothes; practice cutting food and writing. Squeeze a ball or work with "Silly Putty." Keep your fingers busy many times a day. Tear paper; take coins out of the pocket; play the piano.

2. Always try to dress yourself completely. Use shoehorns, elastic laces, or extra-long shoelaces to get a better grip. Dress in the most relaxed and comfortable position, sitting or standing, but make sure you are in a safe position.

3. To keep elbows straight and shoulders loose, install a pulley in doorway, place a chair under it or slightly in front. Stretch your arms and shoulders in all directions. By working the pulley when seated, you can get a more vigorous pull.

FOR GREATER SAFETY IN BATHTUB AND TOILET

If it is difficult to sit down in a bathtub, try the following:

1. Place a bench, stool or chair inside the tub; have the legs sawed off to tub height. Sit on the chair and soap yourself. Use shower to rinse, or rubber shower extension.

2. Bathtub grab bars are available. Purchase only those that attach securely.

3. Raised toilet seats are commercially available.

4. Toilet armrest for getting on and off the toilet are available.

FOR SPEECH, FACE AND CHEWING DIFFICULTIES

1. Practice singing and reading aloud with forceful lip movements. Talk into a tape recorder, if one is available.

2. Practice making faces in front of a mirror. Recite the alphabet and count numbers with exaggerated facial motions. Massage your face with vigor when washing and bathing.

3. When chewing food, chew hard and move the food around; avoid swallowing large lumps.

The previously outlined general exercises and suggestions are designed to help you. They are ancillary to medical treatment which should be carried out in consultation with your physician. In special instances where other diseases are associated with parkinsonism, your physician may wish to limit the intensity of your physical activity. Conversely, more intensive physical therapy may be indicated and in some instances should be done under the direction of a physical therapist.

All activities possible should be engaged in: work, walking, shopping, house chores, gardening, visiting, senior clubs, church organizations, travel, theater, swimming, sports, gymnasium, health clubs, "Y" activities, etc.

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Plantar Fasciitis

Introduction

Plantar fasciitis causes stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Signs and symptoms

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Watch for:

• Sharp pain in the inside part of the bottom of the heel, which may feel like a knife sticking in the bottom of foot
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain after, but not usually during, exercise
• Mild swelling in heel

Causes

Under normal circumstances, plantar fascia acts like a shock-absorbing bowstring, supporting the arch in the foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

• Physical activity overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
• Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
• Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.
• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're on your feet, putting added stress on the plantar fascia.
• Improper shoes. Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.

Risk factors

Your risk of developing plantar fasciitis increases if you are:

• Active in sports. Activities that place a lot of stress on your heel bone and attached tissue are most likely to cause plantar fasciitis. This includes running, ballet dancing and aerobics.
• Flat-footed or have high arches. People with flatfeet may have poor shock absorption, which increases the stretch and strain on the plantar fascia. People with highly arched feet have tighter plantar tissue, which also leads to poor shock absorption.
• Middle-aged or older. Heel pain tends to be more common with aging as the arch of your foot begins to sag, putting stress on the plantar fascia.
• Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.
• Pregnant. The weight gain and swelling that accompany pregnancy can cause ligaments in your body — including your feet — to relax. This can lead to mechanical problems and inflammatory conditions.
• Being on your feet. People with occupations that require a lot of walking or standing on hard surfaces, including factory workers, teachers and waitresses, can damage their plantar fascia.
• Wearing shoes with poor arch support or stiff soles. A closet of poorly designed pumps, loafers and boots can mean plantar problems.

Complications

Ignoring plantar fasciitis may result in a chronic condition that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking motion.

Treatment

If self-care techniques don't help, your doctor might suggest other treatments to heal your heel.

Conservative treatment
For most people, the condition improves within a year of beginning conservative treatment. Nonsurgical treatments that may promote healing include:

• Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.
• Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
• Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.

Medications and procedures
If conservative treatment doesn't provide relief, you might consider:

• Corticosteroids. When other treatments don't work, your doctor may suggest one or two injections of corticosteroid medication into the region of the plantar fascia attachment at the heel for temporary relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Another method for delivering corticosteroid medication is a technique known as iontophoresis (i-on-to-fuh-RE-sis), which uses gentle electric current to draw the medicine into the area of discomfort.
• Surgery. Only a small percentage of people need surgery to detach the plantar fascia from the heel bone (plantar fasciotomy). It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Prevention

You can take some simple steps now to prevent painful steps later:

• Maintain a healthy weight. This minimizes the stress on your plantar fascia.
• Choose supportive shoes. Give stilettos the boot. Also avoid shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces.
• Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 400 miles of use.
• Start sports activities slowly. Warm up before starting any athletic activity or sport, and start a new exercise program slowly.
• Wake up with a stretch. Before you get out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. This helps reverse the tightening of the plantar fascia that occurs overnight.

Self-care

By following these self-care tips, you may be able to eliminate heel pain without further treatment:

• Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
• Put your feet up. Stay off your feet for several days when the pain is severe.
• Decrease your miles. You probably won't have to permanently retire your running or walking shoes, but it's a good idea to cover shorter distances until pain subsides.
• Take up a no- or low-impact exercise. Swap swimming or bicycling for walking or jogging. You'll likely be able to return to your regular activities as heel pain gradually improves or disappears. However, some people find that the only way to avoid a recurring problem is to permanently modify their aerobic activities.
• Add arch supports to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock.
• Try acupressure techniques. Apply pressure to your heel by rolling a golf ball or tennis ball with the arch of your foot while you are standing and stabilized. This can help reduce pain and increase blood flow.
• Use over-the-counter pain medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), naproxen (Aleve) and others may ease pain and inflammation, although they won't treat the underlying problem. Use as directed, tapering off as your pain decreases.
• Stretch your arches. Simple exercises using household objects can stretch or strengthen your plantar fascia, Achilles tendon and calf muscles.

streching forPlantar Fasciitis Prevention

Hold each stretch for at least 30 seconds — don't bounce — and do one or two repetitions two to three times a day. Clockwise from upper left: 1. To strengthen arch muscles, place a towel on the floor, grab the towel with your toes and pull it toward you. 2. While sitting, grasp your toes and gently pull them toward you until you feel a stretch in the arch of your foot. Stretch one foot at a time. 3. Stand as shown, with your back leg straight and heel down. Move your hips forward until you feel a stretch in your calf. Switch legs and repeat. 4. Stand on a step near the bottom of your stairs, put your weight on the ball of one foot and slowly lower that heel until you feel your calf muscle stretching. Repeat on the other side.

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