MUSCLE SORENESS v. JOINT PAIN

Many of our patients come into the clinic after a few sessions complaining that their joint pain has increased since their initial evaluation. This is not meant to whitewash those concerns, as an increase in joint pain due to a specific exercise is fairly common. However, typically the significant increases in joint pain will only come while performing that specific exercise, and subside significantly, if not entirely, a short time after. 

An increase in pain for longer periods of time, like 1-2 days, is more indicative of muscle soreness - not joint pain. While muscle soreness can be just as, if not more, debilitating compared to joint pain, muscle soreness is a good sign. 

Most of the time when patients come in with joint pain, they'll have been limiting activity that could increase that joint pain. For example: a patient comes in, chief complaint is knee pain, they'll likely have been avoiding stairs, bending down or squatting to pick something up or participate in hobbies, such as gardening, and moving slowly and cautiously. In physical therapy, to first lessen the pressure on the inflamed joint, we'll need to strengthen the muscles around the joint. To do so, patients will complete a number of exercises that don't necessarily aggravate those painful symptoms at the time, but can lead to soreness later. The soreness occurs because the muscles surrounding the joints are likely very out of practice - as your natural instinct to avoid an increase in pain is to minimize all causes of the pain. In turn, the muscle soreness will increase as they adapt to the newly added activities. 

Fortunately, muscle soreness doesn't last forever. It lasts a few days, maximum, and will decrease thereafter - usually leaving patients in less pain than they started. Patients need not worry that they'll reproduce that soreness each time, as each time they complete their Home Exercise Program, the muscles will continue to strengthen and therefore, adapt faster. Most of the time, patients will not be sore after a few visits to the clinic - given that they're doing their exercises as prescribed. Soreness from that point on will only increase as the intensity or difficulty of the exercises increase, but increases in difficulty means progression. 

Differences in joint pain versus muscle soreness include:

- Joint pain is sharp, stabbing, debilitating, while muscle soreness is dull, burning, achey

- Muscle soreness leads to problems you may not be used to: say your knee pain was below the kneecap, but now is above and on the sides of the kneecap

- Joint pain will increase during a specific movement, and decrease after the movement, whereas muscle soreness will decrease or become more manageable the more the movement is performed

- Muscle soreness only lasts 1-3 days, whereas joint pain will continue to hurt each time you do specific movements for an undefined amount of time, and can possibly even get worse

Still think it's joint pain? There are tests we can do here at CHAMPION Performance and Physical Therapy that can help us as professionals determine where the pain is stemming. It's our job as therapists to educate you on the circumstances of your pain.  Keep in mind, every patient is unique and your pain may continue to stem from the joint as we progress - and that's a bridge we'll cross when we get there. Our goal is to improve your quality of life back to functionality status at the very least, or in other words, give you the ability to do the things you love. 

TIPS FOR CAREGIVERS

For those of you who have loved ones living with or near you that you help on a daily basis, or for those of you who are medically trained caregivers, THIS IS FOR YOU. Caregivers have a significantly larger risk of injury that do most professions, and a larger incidence of stress-related medical complications, such as high blood pressure and cardiac dysrhythmias. We, here at Champion, understand the physical and emotional toll your job has on you - and we, with the help of the APTA, are here to help. Below is a link provided by the APTA to help people like you thrive in your career. 

http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/caregivers-caregiver-safety-tips 

Description: 

Lisa Leach, PT, DPT, demonstrates techniques to keep caregivers and those that they care for safe in a variety of environments.

For more information, please visit us at kcchampionperformance.com 

ARTHROSCOPY NOT RECOMMENDED FOR DEGENERATIVE KNEE DISEASE, PER NEW RESEARCH

A recent systematic review concluded that arthroscopic surgery for degenerative knee disease (including arthritis and meniscal tears) did not result in lasting pain relief or improved function. As a result, panelists strongly recommend against arthroscopy for patients with degenerative knee disease in most cases. 

The review (Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline- May 2017) was published in BMJ.

According to the review, about 25% of people older than 50 years of age experience pain from degenerative knee disease (the percentage rises with age), and costs for arthroscopies for this condition are in excess of $3 billion per year in the United States. Furthermore, only 15% of arthroscopy patients reported a small or very small improvement in pain or function at 3 months post surgery, and those benefits were not sustained at 1 year post surgery. 

In place of arthroscopy, panelists recommend effective alternatives including an individualized regimen combining rest, weight loss as needed, a variety of treatments provided by a physical therapist, exercise, and nonsteroidal anti-inflammatory drugs.

In an interview with the New York Times, Dr Reed A.C. Siemieniuk, a methodologist at McMaster University in Hamilton, Ontario, Canada, and chairman of the panel, said, "Arthroscopic surgery has a role, but not for arthritis and meniscal tears." The procedure, he elaborated, "became popular before there were studies to show that it works, and we now have high-quality evidence showing that it doesn't work."

TIPS TO RECOVER FROM A WORKOUT

Proper recovery following a workout is as essential as the workout itself. Whether you are beginning to work out for the first time or are altering your regimen, proper recovery is crucial to sustaining a long-term workout plan.

Why It's Important:

During exercise, the body undergoes a controlled amount of stress. Tissues in our bodies need this stress in order to improve their function and your performance. In fact, when you exercise, your muscles actually undergo “micro-trauma” due to the imposed demand of your activity. Recovery is your chance to build yourself back up stronger than before; it is the link between short-term, immediate benefit and long-term, lasting outcome.

The following tips can help you attain maximum benefit from your workout and reduce the risk of developing an injury.

Stretching

Stretching is an important part of recovery, but it rarely receives the time or attention it deserves. The purpose of stretching is to maintain the flexibility of tissues that are tight or stiff from an activity or prolonged position.

There are a variety of methods of stretching (using the hamstring muscle as an example):

• Static/Isolated Stretching: Static, or isolated stretching is holding a stretch position for a long period.  (Example: A static hamstring stretch would be when you sit on the ground with one leg pointing outward and you simply reach for your toes and hold for at least 30 seconds.)
• Dynamic stretching: Dynamic stretching is using movement to combine muscle groups. (Example: A dynamic stretch for the hamstring would be walking toe touches, as you bend down and grab your toe with every step for 2 to 3 seconds.)
• Foam Rolling: Foam rolling is a type of self-mobilization and massage. (Example: To foam-roll the hamstring muscle, you will simply put a foam roller under your legs and let your weight rest on top so the foam roller will push out any knots in your hamstring.)

A very general rule for stretching is dynamic stretching before exercise, static stretching after exercise, and foam rolling throughout. Utilizing various stretching strategies will allow you to maintain and improve your mobility.

Refueling (Hydration and Nutrition)

Proper fueling before exercise is important to optimize performance, but nutrition for recovery from exercise is often overlooked. Our bodies rely upon a well-balanced array of nutrients, vitamins, and minerals to aid in rebuilding the parts of our body that have been stressed during exercise. Refueling after a workout with a well-rounded set of carbohydrates, proteins, and healthy fats will help your body reap the most benefit from your hard effort

Water is also absolutely essential to overall health. In particular, following exercise, proper hydration is key to replace the fluids that you have lost during your activity. Water also helps regulate your temperature, maintain healthy joints, and eliminate wastes that build up in your system during activity. Pay special attention to your total water intake if you are exercising in extreme hot or cold climates or if you feel as though you may be getting sick. Make a habit of keeping a water bottle in your purse, gym bag, car, or workplace for easy, reliable access.

RICE

RICE stands for Rest, Ice, Compression, Elevation. If you find yourself having pain or swelling following exercise, particularly in a joint like your knee, ankle, or shoulder, you may consider using this four-part strategy to decrease inflammation and pain. If you continue to have symptoms several days following a workout, it may be important to seek the advice of a healthcare provider to further examine your complaints..

(See "The Difference between Soreness & Pain During Exercise" for more detailed information.)

Listen to Your Body

The only person who knows how your body feels after a workout is you. Allow yourself to listen to your body, and appropriately. This includes recognizing the signs of fatigue, pain or soreness and increasing recovery time between exercise bouts. This may also mean pushing yourself to work harder when you feel well. Don’t succumb to peer pressure at the gym. Trust yourself and what your body is telling you. When you are starting a new exercise program, don’t be afraid to ask your physical therapist for helpful hints on how your body may give you feedback after exercise, and how you should respond to that information.

Cross Training

Even if you love to run, your body may not like you running seven days a week. No matter what your exercise of choice may be (walking, running, swimming, cycling, weightlifting, yoga, recreational sports, etc.), you may considercan benefit from finding another form of exercise.

Cross training doesn't require a special shoe. It’s simply about challenging your body with different tasks so that certain tissues are not over-stressed, which often leads to overuse injuries. For example, a swimmer will benefit from strength training in addition to the hours spent in the pool in order to build different muscle groups and allow momentary rest for those that are used repetitively in the pool. Remember to do the exercises your body needs, not just the exercises you want to do. A physical therapist can help you determine where you have deficiencies or might be at risk for overuse injuries based on your workout regimen.

Planning Ahead

When life is busy, it’s hard to schedule enough time in your day to workout at all, let alone take care of yourself afterward. Try to plan your day or week so you have adequate time following each workout to implement the strategies above. This way you won't feel as rushed and cut out important recovery activities.

Sleeping

Often taken for granted, sleep is your body’s prime opportunity to recover.

When the body is at rest, the repair of our muscular, cardiovascular, skeletal, and immune systems can go to work. The CDC recommends that, in general, teens have 9-10 hours and adults 7-8 hours of sleep each day. These guidelines are especially important if you are demanding more of your body through regular exercise or stressful daily activities.

To get the most out of your shut-eye, strive for consistent bedtimes, avoid stimulating activities in bed (like TV and electronic devices), and a comfortable environment. You may find that you sleep better on days that you exercise, and will definitely notice a more effective, pleasant exercise experience if you are giving your body the rest it needs and deserves.

Fortunately, not only is your physical therapist trained to design an individualized exercise program for you, but she will also provide guidelines and strategies to ensure that you recover in the most effective way.

BRISK WALKING CAN REDUCE HIP FRACTURES IN MEN BY UP TO 62%

Long-term studies open our eyes to changes in the adult body as we age. As those studies get published, our knowledge of how to prevent injuries and maintain healthy bodies into old age increases significantly, and gives you the power to control your own life years before the risks increase. 

FOR EXAMPLE:

Hip fractures in older adults can be severely debilitating and can lead to significant medical expenses, but a study published in the American Journal of Public Health (“Physical Activity and Inactivity and Risk of Hip Fractures in Men” – April 2014) suggests that 4 hours of walking each week can significantly reduce hip fracture risk later in life.

Data from a study of nearly 36,000 men, conducted over a 24-year period, revealed that men who walked 4 or more hours a week at a brisk pace had a 62% lower risk of hip fracture than men who walked fewer than 4 hours a week, and that even men who walked 4 or more hours a week at a slower pace experienced a 43% lower risk of fracture than men who walked fewer than 4 hours a week.

VERTIGO + PHYSICAL THERAPY

Vertigo usually is described as a spinning sensation, whereas dizziness usually is described as "lightheadedness." Often, they have different causes and different treatments.

If you have vertigo accompanied by one or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:

• Double vision
• Difficulty speaking
• A change in alertness
• Arm or leg weakness
• Inability to walk

What Is Vertigo?

Vertigo is the sensation of spinning—even when you're perfectly still, you might feel like you're moving or that the room is moving around you. Most causes of vertigo involve the inner ear ("vestibular system"). A number of conditions can produce vertigo, such as:

• Inner ear infections or disorders
• Migraines
• Tumors, such as acoustic neuroma
• Surgery that removes or injures the inner ear or its nerves
• Head injury that results in injury to the inner ears
• A hole in the inner ear
• Stroke

You also might have:

• Nausea
• Vomiting
• Sweating
• Abnormal eye movements

One of the most common forms of vertigo is benign paroxysmal positional vertigo, an inner-ear problem that causes short periods of a spinning sensation when your head is moved in certain positions.

How Is It Diagnosed?

Your physical therapist will use your answers to the following questions to help identify the cause of your vertigo and to determine the best course of treatment:

• When did you first have vertigo (the sensation of spinning)?
• What are you doing when you have vertigo (turning your head, bending over, standing perfectly still, rolling in bed)?
• How long does the vertigo last(seconds, minutes, hours, days)?
• Have you had vertigo before?
• Do you have hearing loss, ringing, or fullness in your ears?
• Do you have nausea with the spinning?
• Have you had any changes in your heart rate or breathing?

Your physical therapist will perform tests to determine the causes of your vertigo and also to assess your risk of falling. Depending on the results of the tests, your therapist may recommend further testing or consultation with your physician.

How Can a Physical Therapist Help?

Based on your physical therapist's evaluation and your goals for recovery, the therapist will customize a treatment plan for you. The specific treatments will depend on the cause of your vertigo. Your therapist's main focus is to help you get moving again and manage the vertigo at the same time. Treatment may include specialized head and neck movements or other exercises to help eliminate your symptoms. Conditions such as benign paroxysmal positional vertigo have very specific tests and treatments.

If you have dizziness and balance problems after your vertigo has stopped, your physical therapist can develop a treatment plan that targets those problems. Your physical therapist will teach you strategies to help you cope with your symptoms:

• Do certain activities or chores around the house cause you to become dizzy? Your therapist will show you how to do those activities in a different way to help reduce the dizziness.
• Have simple activities become difficult and cause fatigue and more dizziness? Your therapist will help you work through these symptoms right away so you can get moving again and return to your roles at home and at work more quickly.

Physical therapy treatments for dizziness can take many forms. The type of exercise that your therapist designs for you will depend on your unique problems and might include:

• Exercises to improve your balance
• Exercises to help the brain "correct" differences between your inner ears
• Exercises to improve your ability to focus your eyes and vision

In addition, your physical therapist might prescribe exercises to improve your strength, your flexibility, and your heart health—with the goal of improving your overall physical health and well being.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people with dizziness. You may want to consider:

• A physical therapist who is experienced in treating people with neurological problems. Some physical therapists have a practice with a neurological vestibular rehabilitation focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurological physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with inner ear injury.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

IRREGULAR HEARTBEAT (ARRHYTHMIAS)

My child's heart seems to beat very fast. Does she have an irregular heartbeat?

Your child's heart rate normally will vary to some degree. Fever, crying, exercise, or other vigorous activity makes any heart beat faster. And the younger the child, the faster the normal heart rate will be. As your child gets older, her heart rate will slow down. A resting heart rate of 130 to 150 beats per minute is normal for a newborn infant, but it is too fast for a six-year-old child at rest. In a very athletic teenager, a resting heart rate of 50 to 60 beats per minute may be normal.

The heart’s regular rhythm or beat is maintained by a small electrical circuit that runs through nerves in the walls of the heart. When the circuit is working properly, the heartbeat is quite regular; but when there’s a problem in the circuit, an irregular heartbeat, or arrhythmia, can occur. Some children are born with abnormalities in this heart circuitry, but arrhythmias also can be caused by infections or chemical imbalances in the blood. Even in healthy children, there can be other variations in the rhythm of the heartbeat, including changes that occur just as a result of breathing. Such a fluctuation is called sinus arrhythmia, and requires no special evaluation or treatment because it is normal.

So-called premature heartbeats are another form of irregular rhythm that requires no treatment. If these occur in your child, she might say that her heart “skipped a beat” or did a “flip-flop.” Usually these symptoms do not indicate the presence of significant heart disease. 

If your pediatrician says that your child has a true arrhythmia, it could mean that her heart beats faster than normal (tachycardia), very fast (flutter), fast and with no regularity (fibrillation), slower than normal (bradycardia), or that it has isolated early beats (premature beats). While true arrhythmias are not very common, when they do occur they can be serious. On rare occasions they can cause fainting or even heart failure. Fortunately, they can be treated successfully so it’s important to detect arrhythmias as early as possible.

Signs and symptoms 

If your child has a true arrhythmia, your pediatrician probably will discover it during a routine visit. But should you notice any of the following warning signs between pediatric visits, notify your doctor immediately. 

• Your infant suddenly becomes pale and listless; her body feels limp. 

• Your child complains of her “heart beating fast,” when she’s not exercising. 

• She tells you she feels uncomfortable, weak, or dizzy.

• She blacks out or faints.

Diagnosis

It's unlikely that your child will ever experience any of these symptoms, but if she does, your pediatrician will perform additional tests and perhaps consult with a pediatric cardiologist. In the process the doctors may do an electrocardiogram (ECG), to better distinguish a normal sinus arrhythmia from a true arrhythmia. An ECG is a tape recording of the electrical impulses that make the heart beat, and it will allow the doctor to observe any irregularities more closely. 

Sometimes your child's unusual heartbeats may occur at unpredictable times, often not when the ECG is being taken. In that case the cardiologist may suggest that your child carry a small portable tape recorder that continuously records her heartbeat over a one- to two-day period. During this time you'll be asked to keep a log of your child's activities and symptoms. Correlating the ECG with your observations will permit a diagnosis to be made. For example, if your child feels her heart "flutter" and becomes dizzy at 2:15 P.M. and the ECG shows her heart suddenly beating faster at the same time, the diagnosis of tachycardia will probably be established.

Occasionally irregular heartbeats will occur only during exercise. If that's the case with your child, the cardiologist may have your youngster ride a stationary bicycle or run on a treadmill while her heartbeat is being recorded. When your child is old enough to participate in sports, ask your pediatrician if any special tests or restrictions are necessary.

Source - 11/21/2015

Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)

SCOLIOSIS

Our spine is naturally curved in order to distribute the weight of the body. A side-view X ray of a soldier standing rigidly at attention would show the cervical spine in his neck arched slightly forward. The twelve thoracic vertebrae curve gently to the rear. Then the lumbar spine, which bears most of our upper-body weight, arches forward as it nears the pelvis. 

About one in twenty-five adolescent girls and one in two hundred teenage boys develop scoliosis. Captured on an X-ray, their spines form, to varying degrees, a more pronounced S shape. When imaged from the back, a normal spine exhibits no curvature. A youngster is said to have scoliosis if her curvature is greater than ten degrees. 

The condition can occur as a complication of polio, muscular dystrophy and other central nervous system disorders, but four in five cases among teenage girls are idiopathic—that is, of unknown cause. Very often, though, a family member will also have had scoliosis. 

Symptoms Suggestive of Scoliosis May Include: 

• Conspicuous curving of the upper body 
• Uneven, rounded shoulders 
• Sunken chest 
• Leaning to one side 
• Back pain (rare) 

Scoliosis can develop quietly for months to years so it may only be picked up by the pediatrician during an examination of the teen’s back. Progression may occur quickly during the teen’s growth spurt. One in seven young people with scoliosis have such severe curvature that they require treatment. 

How Scoliosis Is Diagnosed 

• Physical examination and thorough medical history 
• X-rays 

How Scoliosis Is Treated 

• Bracing: Many such cases never progress to the point that treatment is necessary. Follow-up visits are scheduled approximately every six months for those diagnosed with curves between fifteen and twenty degrees. 

Curvature above twenty-five degrees may call for bracing. There are two main types of orthopedic back braces. The Milwaukee brace has a neck ring and can correct curves anywhere in the spine; the thoracolumbosacral orthosis (TLSO for short, thankfully) is for deformities involving the vertebrae of the thoracic spine and below. The device fits under the arm and wraps around the ribs, hips and lower back. 

Scoliosis patients can expect to wear the brace all but a few hours a day until their spinal bone growth is complete; usually that’s about ages seventeen to eighteen for girls, and eighteen to nineteen for boys. The braces are more cosmetically appealing than they used to be and can be hidden easily under clothing. Having to wear an orthopedic brace interferes only minimally with physical activity. Only contact sports and trampolining are off-limits for the time being. 

• Surgery: Posterior spinal fusion and instrumentation, the operation to surgically correct scoliosis, is typically recommended when the spine’s curvature is fifty degrees or more. The surgical procedure fuses the affected vertebrae using metal rods and screws to stabilize that part of the spine until it has fused together completely. On average, this takes about twelve months. Although teenagers who have the surgery still face some restrictions on physical activity, they can say good-bye to the brace. 

Helping Teens Help Themselves 

Only about 50 percent of young scoliosis patients wear their braces. Parents need to convey the importance of complying with the doctor’s instructions. At the same time, they should be sensitive to the tremendous impact the condition can inflict on a teenager’s body image, which at this age is inextricably entwined with self-identity and self-confidence. You might want to consider asking your pediatrician or orthopedist for a referral to a mental-health professional experienced in counseling children with chronic medical problems. A patient support group, like those run by the Scoliosis Association may also be helpful.

Source - 11/21/2015

Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)

EXERCISE COUNTERS COGNITIVE DECLINE

A recent study in the journal, Medicine Science in Sports & Exercise, adds to the ever-growing body of evidence supporting the benefits of exercise. In addition to the plethora of physical benefits, it was found that moderate-to-vigorous exercise can reduce the risk of cognitive decline by 36%, as reported in Time (Exercise Keeps the Brain Young: Study - December 29, 2016).

With an aging population and continued projected increases for age-related cognitive impairments such as Alzheimer’s disease and other forms of dementia, these findings give hope that older adults can help delay the onset of cognitive decline. 

The study provided 6,400 people aged 65 years and older with an activity tracker for a week, and assessed their cognitive abilities during tasks. After 3 years, people who performed moderate-to-vigorous levels of physical activity were significantly less likely to experience cognitive problems than those who were sedentary or did light physical activity. 

Other studies have shown that receiving physical therapy first for low back pain lowers costs, including basic education from a physical therapist prior to back surgery, and in instances when advanced imaging has been prescribed. 

As movement experts, physical therapists can design exercise programs for people with dementia or Alzheimer’s disease to include keeping them active and independent for as long as possible.

RUNNING INJURY PREVENTION

Running is a great form of exercise, recreation, and sport participation for adults, adolescents, and children. Whether alone or in a team environment, running, when done properly, can enhance physical fitness, coordination, sense of accomplishment and physical and emotional development. However, running under adverse conditions or with inadequate clothing and equipment can cause a variety of injuries and physical stress.
 

WHAT ARE THE SIGNS THAT I MIGHT HAVE A RUNNING INJURY?

Signs that you may be injured or need to alter or stop your running include:

•  Pain or discomfort while running
•  Pain at rest
•  Inability to sleep
•  Limping
•  Easily experiencing shortness of breath (exercise asthma)
•  Stiffness
•  Headaches during or after running
•  Dizziness or lightheaded feeling any time
   

WHAT ARE SOME COMMON RUNNING INJURIES?

Running injuries in kids are relatively common and may include:

•  Knee injuries — kneecap pain, tendonitis
•  Lower leg pain — shin splints, stress fractures, calf problems
•  Foot and ankle injuries — ankle sprain, heel pain, plantar fasciitis (bottom of foot pain), toe injuries
•  Pelvic and hip injuries — muscle pulls, growth plate stress injuries, tendonitis, groin pain, buttock pain
•  Heat injuries — sunburn, dehydration, heat exhaustion, stroke
•  Skin injuries — blisters or heat rash
   

WHY IS IT IMPORTANT TO STOP RUNNING IF I'M HURT?

Pushing through pain just makes the problem worse, which will keep you from running for a long time. Stopping when there is a problem and correcting it gets you back running again in the shortest, safest amount of time. Whenever there is a problem, contact your doctor immediately for proper diagnosis and treatment. Most of the time, problems are easily fixed if attended to quickly.
 

HOW CAN I PREVENT RUNNING INJURIES?

Planning Goals

• Talk about running with a coach, athletic trainer, knowledgeable adult runner, or running organization
• Children and parents should consistently discuss the goals of the running program
• Determine the reason (goal) you are running (e.g., fitness, recreation, training, competition)
• Develop a running plan and strategy that is compatible with your goal and your current level of fitness
• Set safe, achieveable goals and advance slowly and cautiously
   

  Preparing to Run

• Hydrate (drink water) well in advance
• Stretch for five minutes before beginning
• Speed up slowly
• Proper Running Attire
  
  The local running store is a good place to start and ask questions. It's important to remember the following:
   
• Lightweight, breathable clothing prevents perspiration buildup and allows for better body heat regulation
• Running hats, head covers, and ear covers shield the sun but allow temperature regulation — they are also excellent for cold weather to avoid frostbite
• Proper fitting and proper thickness of socks help avoid blisters and irritation
• Proper shoes with good support arches should fit well and be comfortable
• Inspect your shoes before running: if they have worn thin or are angled, purchase new shoes
• Orthotic shoe inserts (commercial off-the-shelf or custom-made) are especially valuable for people with flat feet, high-arched feet, unstable ankles, or foot problems
   

  Safe Locations and Times to Run



• Flat ground is more gentle on the body than hills
• Avoid steep hills
• All-purpose track surfaces (high school track) are ideal — especially for beginners
• Stay in well-lit areas (e.g., schools, public streets).
• Always run with a partner (preferably a teen or parent)
• A parent should always know:
   - where you are running
   - when you are running
   - how far you are running
   - with whom you are running
   - when you expect to be back
   - when you are finished
• Use a bag to carry a cell phone with you
• Avoid using headphones, especially if you are running on the street, so you can hear traffic and warning sounds
   

  Safe Weather Conditions

  
  Children and adolescents cannot tolerate the weather extremes that adults can, making them more susceptible to heat and cold injuries. Prevent heat illnesses (e.g., sunburn, dehydration, exhaustion) or cold injuries (frostbite) by monitoring the weather conditions.
  
  Avoid running if:
   
• Temperatures are over 90 degrees
• Humidity levels are high
• Temperatures are cold or freezing
  
   

  CONTRIBUTING EXPERTS

  
  The following expert consultants contributed to the tip sheet:
  Robert Burger, MD