Stretching the Calves

Q: I always feel like my lower legs and feet are stiff and inflexible. What exercises can I do to increase flexibility?

A: The dynamic action of the gait cycle is dependant on the flexibility of certain joints in the lower limbs and especially the foot. The foot needs to be able to flex, extend, supinate, and pronate as it adapts to the walking surface during ambulation. Normal range of motion in the ankle includes 20¼ of dorsi-flexion and 40¼ of plantar flexion. Another important joint for walking is the first metatarsophalangeal joint (MTP) that attaches the first big toe to the forefoot. This joint needs to be able to extend past 60¼ as the foot rolls forward into toe-off to assist in propulsion. Maintaining good flexibility in these joints is vital to preventing injuries and optimizing function.

Stretching out the calves and increasing dorsi-flexion range of motion in the ankle can be accomplished by standing on a curb or stair step with your forefoot and allowing your heels to hang out in space while using gravity to stretch the calves. To increase plantar flexion range of motion, sit on your heels with your knees bent and toes pointed back. This should allow the dorsum of your foot and shins to rest against the ground. The last position is to stretch the first MTP joint into extension and this is done by squatting down with the knees bent and heels off the ground so that your weight is resting on the ball of your foot and the toes. This brings the toes into maximum extension toward the shins. Stretches should be held for 20 seconds or longer.
— Dr. Jacob May

Childhood Obesity

Q: My husband and I have struggled with our weight since college, and with the rise in childhood obesity, what measures can we take to ensure our three children don’t have to struggle with their weight?

A: By being aware of the potential problem is an excellent first step. If any of your children are still breast feeding then I would encourage you to continue to do so, with each month of breast feeding there is an associated 4 % decrease in developing obesity. There is also an associated decrease in the development of diabetes.

As for toddlers there are many things to consider, food choices, what influences those food choices, activity level, television watching, and sleep habits. Intake patterns during infancy foreshadow shortcomings of children’s diets noted in later developmental periods and adulthood. Fruit and vegetable intake is notably low among toddlers aged one year and older, 18% to 23% consume no vegetables, and between 25% to 33% consume no fruit. By the age 15 months, french fries are the most commonly consumed vegetable and 44% of toddlers consume a sweetened beverage daily.

With both parents working today, most meals are taken outside the home. In fact, 36% to 38% of family food dollars are spent on going out. Parents are models for the majority of behavioral eating, and thus parents can control a child’s exposure to not only quality but quantity of food eaten. There is even evidence to suggest that the opportunity to foster healthy eating patterns are present during pregnancy and lactation. Children learn to prefer the familiar, so repeated exposure to healthy foods, at least 10 times is required to achieve acceptance. Thus it is important that you don’t come to a premature conclusion that your child dislikes certain foods, especially when we’re talking about healthy foods.

Today’s portion sizes are often two to eight times the recommended level. When you factor in activity level and television watching, we have too many children eating too much and doing very little. Just like you and your husband may have found, the only true way to lose and keep weight off is to cut calories and exercise. Toddlers should have 60 minutes of moderate to vigorous activity per day, and the recommended amount of television watching should be less than 2 hours per day. Fruits and vegetables should accompany every meal, toddlers should consume whole grains versus refined and overly processed foods, and lean protein should accompany every meal such as fish, poultry, tofu, and beans. Limit over-sweetened juices and colas; children should be drinking mainly water.

Strategies for healthy eating behaviors include offering or teaching age-appropriate portions, let children decide how much to consume, model healthful eating via family meals, and establish routines at those family meals. Have only healthy foods available for everyday consumption, this is especially true for snacks. As for activity, plan daily activities as a family, be a model and proponent of exercise, limit television time, and purchase toys that encourage physical activity.
— Dr. Lindsey Nelson

This Issue’s Experts
Jacob May, DC, brings careful thought and analytical thinking blended with a holistic approach to medicine. To contact Dr. May call 503-279-0205 or email jacob@clearh2o.org.

Lindsey Nelson, ND, is a naturopathic primary care physician and can be reached at 503-279-0205 or by email at lindsey@clearh2o.org.