Nutrition & Physical Activity

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St. John's wort

Dear M,

What’s the word on St. John’s wort? Also known by its botanical name, Hypericum perforatum, this supplement is derived from a yellow flowering plant. It has been used — with mixed results — as an herbal remedy for a wide range of ailments, including mild to moderate depression, menopausal symptoms, somatization disorder (when mental experiences are converted into physical symptoms in the body), and wound healing. Research suggests that St. John's wort raises levels of serotonin, norepinephrine, and dopamine (different neurotransmitters that help boost morale and mood), but the active ingredient that produces this effect is still unknown. More research is needed to better understand how St. John’s wort works and what beneficial effects it may have on health. You also asked about the recommended dosage for this supplement. How much of the supplement to take and the number of times you'll need to take it daily will vary depending upon the condition you wish to treat.

Although the evidence is mixed, there are a number of studies that suggest St. John’s wort can be effective in treating depression without the side effects common to traditional anti-depressant medications (It’s good to note that it’s not recommended for the treatment of severe depression). Unlike prescription anti-depressants, which can cause side effects such as lowered sex drive and delayed ejaculation and/or orgasm, the same sexual side effects have not been associated with the use of St. John's wort. However, this does not mean that the supplement is free from potential adverse side effects, some of which include:

  • Fatigue
  • Dry mouth
  • Dizziness
  • Vivid dreams
  • Headache
  • Skin rash
  • Gastrointestinal discomfort, such as diarrhea
  • Allergic reactions
  • Irritability
  • Restlessness
  • Increased sensitivity to sunlight
  • Confusion
  • Anxiety

Due to the lack of scientific evidence, it’s hard to know how taking St. John’s wort may affect different individuals. You may want to be especially wary of taking this supplement if you’re:

  • Taking prescription medications. Anti-depressant medications, monoamine oxidase inhibitors (MAOIs), and HIV/AIDS medications combined with St. John’s wort can lead to possibly dangerous interactions. Additionally, St. John’s wort can affect how the body metabolizes medicine, which may make certain medications less effective. If you’re using any other medications, prescription or otherwise, it’s best to let your health care provider know before taking this herbal supplement.
  • Pregnant or breastfeeding. Limited research has been done on women who are pregnant or breastfeeding. Until more is known, women who are pregnant or breastfeeding are advised not to take St. John's wort.
  • Have certain health conditions. Components of St. John's wort may raise blood pressure, possibly resulting in a stroke. Those who are already at risk of high blood pressure should be especially cautious.

As a rule, it’s helpful to remember that "natural" does not necessarily mean safe. Since St. John's wort is an herbal supplement and not regulated by the U.S. Food and Drug Administration (FDA), the quality of the supplement may vary. For more even more detailed information, check out the National Center for Complementary and Alternative Medicine website. Before trying St. John's wort, or any other natural supplement, it’s recommended that you talk with your health care provider. Doing so may help you gather all of the necessary information to decide wort the best course of action is for you.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Better to drink warm rather than cold water?

Dear J,

Staying well-hydrated is extremely important for an active athlete. It's great that you want to make staying hydrated as easy and healthy for your body as possible. In this case though, you're in luck — health and preference coincide!

In a happy coincidence of what feels good and what's good for you, it's actually cold water that's recommended when exercising vigorously. During intense physical activity, the body's core temperature rises above the normal 98.6°F (37°C). Drinking cool water lowers the body's temperature and helps it settle back to its normal range. Studies have also shown that cold water 41°F (5°C) is absorbed more quickly from the stomach than warm, abating dehydration and allowing you to play harder and enjoy your game of soccer even more. Sweating also helps to lower the body's temperature, but through sweating we lose a lot of water, so it's important to keep drinking.

The body is smart and often craves what it needs. That doesn't mean you should have an ice cream sundae every time you get a hankering, but in this case, cold water is what you want and cold water is what your body uses best. That said, if the only water around is warm, or if some prefer it warm, that's ok too. The main point is — listen to your body, stay hydrated, and have fun!

Alice

Iron, calcium, and constipation, oh my!

Dear Calcium and Iron Maiden,

It seems like you're approaching a supplement regimen with a healthy consideration of various factors like absorption and affects on your system — a great idea! You're right that there are certain foods that can inhibit iron absorption, like the oxalic acid in spinach, phosphates primarily in milk, other dairy products, and egg whites, phytates in beans, and tannins in tea and coffee. While it would take a lot of these foods to seriously impair your ability to absorb iron, you might want to consider going easy on them while trying to boost iron levels.

On the opposite side of the spectrum, there are many foods that are rich in iron, and it's usually preferable to get your essential nutrients from food rather than supplements. The body has an easier time digesting and absorbing nutrients like iron and calcium in the amounts and forms in which they occur naturally. You can check out Sources of Iron in Alice's Fitness & Nutrition archives for a list of these iron-boosting foods (sneak preview: meat, fish, dark leafy greens, dried beans, and nuts are all healthy iron-rich foods). Another dietary tactic to boost iron absorption is to eat a vitamin C rich food with your iron-rich food or supplement, as vitamin C aids in iron absorption. For example, eating citrus (oranges, grapefruits, lemons) along with your spinach salad will help unlock the iron in spinach. You can also cook your food in cast iron pots and pans to enrich your food with iron.

In terms of your sensitive GI system, the least constipating iron formula is hydrolyzed protein chelate, but again, diet can come into play here. In addition to looking for gentle and non-constipating types of iron supplements, you can also alleviate constipation by drinking plenty of water and by eating fibrous foods like whole grains, fresh fruits, fresh vegetables, and other foods as unprocessed as you can find them (whole grain bread instead of white, whole grain pasta instead of white, brown rice instead of white). It's a good idea to increase fiber intake slowly — too much too soon can cause gas and bloating. And to underscore again, when increasing fiber it's important to drink even more water than you think you need to make sure all that bulk moves through your system smoothly.

As for calcium, the two most common forms in supplements are calcium citrate and calcium carbonate. Studies show that calcium citrate is the most absorbable supplement form, and may be taken between or with meals. Vitamin D helps to assimilate calcium into bones. When exposed to sufficient sunlight, the human body synthesizes its own vitamin D. Fatty fish like salmon, tuna, and sardines are great food sources of vitamin D. If you want a D supplement, which might be a good idea for folks who live in northern climates and don't get adequate sun exposure during the winter, or for people who don't eat a lot of fish, look for supplements that contain vitamin D3 (cholecalciferol), rather than vitamin D2 (ergocalciferol) — vitamin D3 is more potent. You might also want to consider taking a magnesium supplement with your calcium at a ration of two-parts calcium to one part magnesium, as magnesium is needed to fully absorb and utilize calcium.

Finally, see if you can avoid taking your calcium and iron supplements together, as they compete for absorption. It may seem like a lot of juggling of different foods, supplements, and timing of the two, but hopefully this kind of careful consideration and knowledge will boost your iron and calcium levels to new heights.

Farewell, fair Iron (and calcium) Maiden,

Alice

I want a flat stomach!

Dear help,

This may seem like bad news, but it simply is not possible for every human being to have a stomach as flat as some of the models we see in magazine and newspaper ads, on the sides of buses, and, well, just about everywhere. The fact of the matter is that a really flat stomach may not be in your genes! Among many other physical traits, a person's genetic makeup determines the shape of internal organs (e.g., stomach, intestines, liver, kidneys). Depending on these organs' shapes and sizes, they may or may not contribute to a slight roundedness of our stomachs. Another aspect of body shape under genetic control is body fat distribution. Your body may naturally store more fat around your waist than in other areas of your body.

When done correctly, crunches can be a good way to strengthen abdominal muscles and the lower back. However, ab work alone will not burn fat of the stomach region specifically. It's a myth that a rigorous sit-up routine will guarantee a flat tummy. Instead of concentrating so much on your stomach, why not try an exercise program that works out a greater range of muscle groups and involves some cardiovascular fitness? If there really is fat to be lost around your stomach, running, swimming, or biking regularly will be more effective at burning it than only doing sit-ups.

You might also want to examine your eating plan; a healthy diet is a good idea for anybody (see the Related Q&As listed below for some nutrition tips). And finally, keep in mind that a flat stomach is not necessarily the essence of beauty or an indicator of good health. You may find that eating nutritiously, exercising regularly, and accepting your body's natural shape and size will help you feel good about yourself and your stomach.

Alice

March 20, 2012

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I wish "Alice" had pointed out that a lot of the sexy, flat stomachs we see in ads are photoshopped. It may look like everybody who's anybody has a flat, even muscular stomach, but that's only...
I wish "Alice" had pointed out that a lot of the sexy, flat stomachs we see in ads are photoshopped. It may look like everybody who's anybody has a flat, even muscular stomach, but that's only because of the magic of technology, not to mention the unhealthy standards of beauty that models are forced to aspire to if they want to continue working.

How to eat your veggies, even if you don't like them

Dear Reader,

Eating fruits and vegetables is an essential part of maintaining good health. In 2011, the USDA launched its most recent food guide called Choose My Plate. Most health professionals and health promotion organizations, including the USDA, recommend eating at least five servings of fruits and vegetables daily. Or, in the case of the Choose My Plate campaign, make half of your plate fruits and vegetables.

Since eating vegetables is not very appealing to you, let's start by discussing ways to incorporate some essential vitamins and minerals into your diet via fruit. Look to a wide variety of fruits to take in more vitamins, minerals, and phytochemicals, which are plant substances that may ward off heart disease and certain forms of cancer. For example, a fruit salad composed of oranges, assorted berries, grapes, kiwi, bananas, apples, and peaches with fresh lime juice squeezed over it can be enjoyed as a delicious part of any meal or on its own as a snack. A piece of fruit, such as an apple or a pear, is also an excellent dessert and can be paired with protein, such as nut butter or cheese, to make a well balanced snack.

Now let's move to the incorporation of vegetables in a positive way. Vegetables can taste bitter, particularly when eaten raw. A good place to begin may be experimenting with roasting a few different vegetables to see what you may like. Roasting vegetables brings out their sweetness via a process called caramelization, which reveals the sugars in vegetables, causing them to taste sweeter. This works particularly well with root vegetables, such as onions, potatoes, sweet potatoes, turnips, and carrots. To roast vegetables, simply cut them into one-inch squares, toss with olive oil, salt, and pepper, place on a baking sheet, and put in an oven at 450 degrees for 30 to 40 minutes, tossing and turning throughout cooking. You will know they are done when they are golden brown, slightly crispy on the outside, and soft on the inside. Broccoli and cauliflower are also delicious when roasted. Feel free to experiment by adding grated parmesan or other cheeses, herbs, and spices to the vegetables after roasting. You can also look to "sweeter" vegetables, such as corn, peas, tomatoes, and carrots and incorporate them into pasta or rice dishes or put them together to make a salad. The get balanced! nutrition initiative offers some recipes to get you started, such as the Cilantro Corn Tomato Salad.

It is also possible to disguise vegetables in your food, similar to the way some parents do when their children don't eat their veggies. This is typically done using vegetable purees, which can be made at home simply by microwaving a vegetable and then pureeing it, or can be found in the freezer section (most often found are pureed sweet potatoes or squash) or as jars of baby food in the children's section of your grocery store. Purees can be added to stew, soup, pasta sauce, baked goods, etc.; the options are endless. There are several good cookbooks available that offer recipes that incorporate vegetable purees. You can also sneak in an extra veggie by making fruit smoothies with spinach added in — all you'll taste is the fruit!

In addition to purees, you can also incorporate vegetables into other foods. Examples include:

  • Make omelets with tomatoes, peppers, and/or mushrooms — be sure to sauté the vegetables first before adding the eggs.
  • Add broccoli and/or olives to your pizza.
  • Add chopped spinach and/or grated carrots and onions to turkey burgers or meatloaf.
  • Mix chopped carrot and celery into tuna or chicken salad.
  • Choose soups rich in vegetables, such as Minestrone or Gumbo.
  • Add peas, carrots, and/or zucchini to rice pilaf.

It's difficult to "force" yourself into liking a specific food, especially if you are turned off by the taste. Luckily, you can choose from a variety of vegetable options and cooking methods. Keep an open mind (and mouth), and perhaps you will come to enjoy some of these foods!

For more tips about healthy eating, fruits, and vegetables, check out the Optimal Nutrition section of the Go Ask Alice! archive, learn more about the tools from Choosemyplate.gov.

Alice

Energy bars

Dear Power Me Up,

Sports bars, energy bars, power bars — call them what you like — a variety of these products are available at grocery stores and in vending machines. Marketing for these bars may have you believing that they can work wonders: some purported benefits include burning of fat, buildup of muscle, and improved athletic performance. In terms of nutritional benefits — well, that all depends on what benefits you are looking for.

All energy bars provide energy because energy — in the pure sense of the word — refers to calories. As a matter of fact, energy bars were first developed for endurance athletes who had difficulty taking in enough calories to sustain them during their athletic endeavors. True, they are a quick and convenient form of energy or calories. But will these bars energize you? Probably not. If you haven't eaten in a while and are feeling slightly fatigued, one of these bars may help take away that sluggishness, but so would a slice of whole wheat toast and a cup of skim milk or juice. However, if you're exhausted due to lack of sleep (for example), an energy bar won't give you any more pep.

On the nutrition tip, some energy bars contain over 400 calories (more than in many candy bars) and up to ten grams of fat. For many people, this may be more than they need or want to take in before exercising. Many energy bars do contain added vitamins, minerals, amino acids, and other important substances, but they are not meal replacements. They do not contain the natural fibers, phytochemicals, and high quality protein found in less-processed foods. For a fraction of the cost, and just as convenient to eat, consider some other snacking options:

  • Granola bars (read the labels, some granola bars have loads of added sugars)
  • Bananas
  • Oranges
  • Carrot sticks
  • Juice
  • Skim milk
  • Low-fat yogurt
  • Whole grain crackers
  • Graham crackers
  • Mini-bagels

Energy bars aren't a replacement for a healthy lifestyle; it's still important to eat a balanced diet, sleep, manage stress, and be physically active in order to achieve optimum performance. So rather than banking on bars, be a smart consumer: consider your caloric needs, choose to eat a balanced diet, read energy bar labels carefully (check for caloric, fat, and sugar content and think how they fit in with your overall diet), and don't be fooled by all the hype.

More power to ya,

Alice

Low protein diabetic (renal) diet

Dear Reader,

Great question! Diet is one of the most important ingredients for treating kidney, or renal, insufficiency. When a person has renal insufficiency, it means that some of the nephron function in the kidneys has been lost, and the fluid, protein, and electrolytes are not filtered as efficiently through the kidneys. In order to delay renal insufficiency and prevent it from worsening, it is important to limit the amount of electrolytes (i.e., sodium, potassium, phosphorus, and calcium), fluids, and protein that one ingests.

Diabetes is the main cause of kidney insufficiency, which can eventually result in kidney failure. The reason for this is that increased blood sugar damages the capillaries and nerves that support kidney function. In addition to your low protein diabetic diet, you should also be sure that you are testing your blood sugar daily, exercising, and following your health care provider’s instructions.

Depending on the degree of your renal insufficiency, various protein restrictions would be necessary. At this point, you could plan a diet that balances your intake of phosphorus, potassium, and calcium. If you have fluid retention, decreased urinary output, and/or hypertension, it could be necessary for you to have a sodium and fluid restriction as well. In this case, you should speak with to your health care provider about how to restrict these nutrients.

When you eat large amounts of protein, extra stress is placed upon the kidneys. This is because they excrete waste products derived from protein. Since someone in your situation needs to eat a reduced amount of protein, the protein you eat should come from sources that are easily assimilated into body tissue. This type of protein is termed High Biological Value (HBV for short). The highest HBV protein is from an egg — other sources with slightly lower HBV protein include fish, beef, and poultry. In renal insufficiency, about 70 to 80% of your protein should come from these sources.

Various health care providers, such as a registered dietitian, can formulate an eating plan designed to meet your specific needs. You can check out the American Dietetic Association to locate a Registered Dietitian in your area.

For more information on diabetes, you can try the following resources:

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Medical Services (CUMC)

Columbia Nutritional Services


Quick and healthy bag lunches

Dear S,

If you are what you eat, being healthy and time efficient sound like great qualities to have! Whether your motivations include saving time or money, improving your nutrition, maintaining or losing weight, or fostering your culinary skills, preparing your own lunch is a grand idea! Doing so can be a way to cater to your individual needs, nutritionally and conveniently, and to energize you through your busy days at school and beyond. With everything else that’s on your plate, preparing nutritious foods may seem like a challenge. However, with a few easy and balanced tips, you’ll be savoring a tasty lunch in no time.

First, a little review of the food groups may serve up some hot and cool lunch options. Main food groups include:

  • Fruits, naturally sweet and juicy, are great as salad ingredients, sides, or snacks. Grab a fruit that comes with its own wrapper (e.g. apples, oranges, bananas) or a small container of grapes or cut melon. Dried and canned fruits may also make for portable options.
  • Grains come as whole and refined grains. Whole grains use the entire kernel of the grain (e.g., whole wheat flour items, brown rice, oatmeal, popcorn). Refined grains have been milled to remove their bran and germ (e.g., white flour, white rice, white bread, pasta, noodles). They're great for sandwiches, wraps, noodle or rice dishes, and snacks.
  • Vegetables (raw, cooked, fresh, frozen, or canned) are easy to transport and are nutritious! Convenient versions include bite-sized vegetables (think baby carrots or cut celery sticks), salads, wrap fillers, soups, and potato dishes.
  • Meat and beans make great sandwiches or wraps with turkey, lean ham or roast beef, nut butter, fish (e.g., tuna, salmon), or hummus (chick pea spread/dip). They're hearty and complement most grains and vegetables.
  • Dairy products like milk, yogurt, and cheese (e.g., string cheese, cottage cheese) make for portable lunch items high in calcium. Try incorporating low-fat versions with less or no added sugar. Calcium-fortified non-dairy products may also be an option.
  • Oils and fats are part of a healthy diet, but use oils, fats, and their products (e.g., mayonnaise, butter, margarine, lard, animal fat, shortening) sparingly. Avoid trans-fat and limit the amount of food items high in oils and fats, such as some baked items (e.g., cookies, cakes), deep fried foods, and some packaged foods.

Suggestions for compiling easy and healthy lunches include:

  • Make it a combo meal! Try incorporating three or more food groups into a meal. Focus on fruit, vary your vegetables, consume calcium-rich foods, and make half of your grains whole ones. A sample menu may be a whole wheat pita stuffed with chicken breast, hummus, and spinach with a side of a low-fat yogurt cup and an apple.
  • Keep it simple. Whole, unprocessed ingredients make for easy preparation and high nutrition. Try having a sizeable stock of fruits, vegetables, nuts, beans, grains, and lean meats as basics for your lunch combinations.
  • Limit sweets and fats. Try to limit food items high in added sugar and fats, such as soda, cookies, candy, some snack bars, and deep fried items.
  • Make it up ahead of time. If you’re a top chef, make bigger batches of your famous dishes so that you can portion out meals for several days or freeze some for later use. Not a cook? No problem! Give wraps and salads a try.
  • Rotate your menu. Doing this will ensure that you won't get bored of eating the same thing each day, and this may help you incorporate a full range of food groups.
  • Remember: Safety first! Wash your hands while preparing and eating. Properly prepare your foods to appropriate temperatures before eating them. If you have access, store your lunch in appropriate temperatures to avoid having your food spoil. An insulated, reusable lunch bag with a reusable cold pack may help you keep your lunch safe and stay green!

For more information about creating a healthy lunch, check out ChooseMyPlate.gov for more tips and a personalized eating plan. You might also get your friends involved in the planning process. Ask them about their favorite quick and healthy lunches and trade ideas. These make for nutritious conversations and fruitful times with others. Bon appétit!

Alice

For more information, check out this recommended resource:

get balanced! Columbia University's Guide for Healthier Eating


Reduced fat and calorie diets: How low is too low?

Dear Fearing Fat,

Although you didn't mention your weight, 900 calories a day is considered a very low calorie diet (VLCD). VLCDs are usually diets designed for rapid weight loss that is medically supervised, and are reserved for adults with a body mass index (BMI) of 30 or higher. It is strongly recommended that people following such a diet be part of a doctor-supervised weight-loss program that includes behavioral therapy, nutrition counseling, physical activity, and formulas to ensure that they get enough essential vitamins and micronutrients. If not carried out properly, a VLCD can cause long-term nutritional deficiencies such as

  • Anemia
  • Bone loss
  • Decreased immune function
  • Amenorrhea (loss of menstrual periods)
  • Infertility
  • Decreased thyroid function
  • Increased susceptibility to colds and infections
  • Low energy levels
  • Poor concentration and cognitive development
  • Gum infections and poor dental health.

This isn't meant to frighten you, only to inform. All of these symptoms can be quickly remedied by eating a balanced diet sufficient in calories and essential nutrients.

In terms of your questions, your body won't store the calories you do consume as fat because you aren't taking in enough calories to for any of them to be stored. Our bodies use food and energy in a way that has evolved over thousands of years with the aim of our survival in mind. During times of very low calorie consumption, such as 900 calories per day, the body naturally slows its metabolism in order to conserve energy and attempt to keep your body functioning. A slowed metabolism can be reversed through balanced nutrition — your body will actually burn more energy if you take in more calories.

No matter what a person weighs, 900 calories and seven grams of fat a day severely deprives a person of the nutrients their body requires. The UN Food and Agriculture Organization recommends that fat be at least 15 percent of caloric intake, and for women of reproductive age it should be at least 20 percent. Body fat is crucial to the functioning of many systems of the body. It lines every cell membrane, is instrumental in production of many hormones, provides protection for the nerves, composes bone marrow, protects such organs as heart, liver, kidneys, and regulates blood pressure and body temperature. Fat is also essential in our diets for the absorption of certain fat-soluble vitamins, like A, D, E, and K. Without these vitamins, a person cannot properly absorb calcium (which leads to brittle bones), blood may not form or clot properly, nerves may malfunction, and hormone production may be affected.

Since fat is a concentrated source of energy, our bodies tend to preserve it and burn it slowly. Carbohydrates are the preferred source of energy for our bodies, and will burn first. We can also use protein for energy which means that even if a person eats enough protein, her or his body will burn the protein as energy if s/he is consuming too few calories. This leaves no protein for muscle and bone growth, repair of body tissues, and manufacture of hormones, enzymes, and antibodies. As a result, a person may feel fatigued and may get sick often. Additionally, the brain requires a certain level of glucose to maintain normal functioning. Without sufficient glucose (which comes from calories consumed) irritability, depression, dizziness, fainting, or hypoglycemia can become problems.

The big secret that many dieters and nutrition experts have been learning is that most restrictive diets don't work over the long run. Being on a diet often makes people hungry, tired, cranky, frustrated, depressed, deprived, annoyed, and anxious. Additionally, a VLCD can impair the body's hunger and satiety signals, which might cause a person to eat too much at some point down the road, leading to weight gain instead of loss.

So, what can you do to if you want to healthfully maintain a sleek figure? A well balanced diet and exercise are almost always good options for staying healthy, fit, and ensuring you have a healthy appetite that will provide you with all the nutrition you need to lead a full and active life. For a personalized eating plan to help meet healthy goals, a good source of assistance is a registered dietician. You can make an appointment with your health care provider to get a referral. Fear of fat, and consuming concerns about how we look, are common, and it might be helpful to talk through some of these concerns with a counselor.  To learn more about healthy weight maintenance or loss, you can check out Choose My Plate from the CDC. Choose My Plate will give you personalized recommendations for menu planning, calorie intake, and physical activity levels.

You can also check out the related Go Ask Alice! questions to learn about ways to healthfully lose and keep off weight. Big props to you for educating yourself on your body and how it works. 

Alice

Achilles tendon injury

Dear Reader,

The Achilles tendon attaches to the calf muscle and to the heel bone. The calf muscles and the muscles along the shin are needed to protect against shock in high-impact exercises. This muscle group is very strong and is used constantly. Because of this, your Achilles tendon is put under a lot of pressure. The Achilles tendon handles forces that range from two to three times the body weight in walking, to four to six times the body weight in running and jumping. When it is overused, or if you continue to use it when it is injured, inflammation of the Achilles tendon could lead to local degeneration and recurrent injury, which may result in a partial, or even a complete, rupture. It was very wise of you to take a break before gradually resuming exercise.

As you get back into an exercise routine, make sure that you follow up with your health care provider and/or a physical therapist to be certain that you are not doing any more damage to your Achilles tendon. If you are a Columbia Student on the Morningside campus, you can call 212-854-2284 or log into Open Communicator to schedule an appointment. For students on the Medical Center campus, contact the Student Health Service by calling 212-305-3400.

Stretching and strengthening exercises can certainly play a role in taking care of your body. Remember that all stretching should be slow and static and that you should listen to your body — feel your muscles stretching, but stop if you feel pain. Specific to the Achilles tendon and surrounding muscles, consider the following:  

Stretch #1 — Calf Stretch

  1. Stand about a foot from a wall, extend one leg behind you, keeping both feet flat on the floor, toes pointed straight ahead, and your rear knee straight and your front knee bent.
  2. Move your hips forward, keeping your lower back flat.
  3. Lean into the wall until you feel tension in the calf muscle of the extended leg.
  4. Hold for 10 seconds, then stretch the other leg.
  5. Repeat at least two more times.

Stretch #2 — Calf Stretch

  1. Stand arm's-length distance from a wall (or tree, or lamppost — whatever is handy and gives you support).
  2. Put your hands on the wall, keep your back and your legs straight, and make sure your heels are flat on the floor.
  3. Bend your arms and lean forward, trying to touch your chest to the wall.
  4. Feel the stretch in your calf muscles.
  5. Hold it for a few seconds.
  6. Relax and repeat at least two more times.

Stretch #3 — Achilles Tendon Stretch

  1. Stand with one leg in front of you, slightly bent, and the other leg extended back.
  2. Lower your hips downward as you slightly bend the knee of the extended leg.
  3. Keep both heels flat on the floor and toes straight ahead.
  4. Hold the stretch for 10 seconds, and then stretch the other leg.
  5. Repeat at least two more times.
    Note: This Achilles tendon stretch requires only a slight feeling of tension at the back of your ankle. Also, be sure that you do not bounce, and that you stretch gently and completely.

Besides jogging and running, the Achilles tendon can be injured from any activity that has an impact component. To help prevent injury to the Achilles tendon, consider exercises that put less stress on the Achilles tendon, such as bike riding and swimming. Also, abnormal pronation and muscle imbalances can be a problem for a recurring inflammation of the Achilles tendon. If you decide to get back into running, you need to have a physical therapist check out your running shoes to make sure they are not causing extra stress on your Achilles tendon and calf muscles. Be sure that you always wear running shoes that are not worn out, and try to avoid uneven or hard running surfaces. You may want to run on soft surfaces, such as running tracks, or soft trails without holes or ditches.

A reference to mythology seems unavoidable — stretch and allow your body to heal so your tendon doesn't become your Achilles heel. 

Alice

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