Q: I have become very active since coming to Portland and am now doing a lot of walking. The problem is that in the mornings after waking up the heel of my right foot is very painful when I take those first steps out of bed. It's not a sharp pain, more of a steady, dull and stiff kind of pain. What can cause this and is there anything I should be doing to help the situation?

A: I am glad your move to Portland has brought out the walker in you! It is common to have muscle pain and soreness with an increase in mileage. The onset of the pain the day after activity indicates more of a conditioning issue, and possibly that you’re wearing shoes that don’t support your feet correctly. Depending on your arch height — low, neutral, or high — a quality running and walking shoe store can fit you for an appropriate pair. The store can also check your current pair to make sure they are right for you. As far as the biomechanics of walking go, make sure your stride is shorter rather than longer, which reduces the force of your heel hitting the walking-surface. Also check that you do not add any extra, unneeded toe-off force. These are common problems in a stride that is too long. If you have a decrease of heel-fat-pad, the small, blue gel heel pads can be helpful as they cushion the heel-strike forces. Be sure to use them on both feet, even if one side hurts worse. A couple of other basic items are to be sure to stretch when you’re done walking before you sit down. In the morning, before getting out of bed, take a moment and spell the alphabet using your big toe, A to Z. This warms up the muscle tissue before you use it. On the foot itself, thumb-pressure or golf-ball trigger-point pressure is helpful to release some of the stiff tissue with a lighter force than standing produces.

I hope this helps you. Have a great 2005 walking season!
— Bryan Baisinger, DC

Q: I’m new to distance walking and have always seemed to experience significant low back pain when I exercise intensely. After X-rays and an MRI, my doctor told me it’s muscular and to build up my core. For a long time now I have used ice for pain and take a yoga class three times a week. I’ve read that abdominal crunch exercises will build a strong core and help prevent low back pain. Do you think this will help? Are there other things beyond strengthening my abdomen that I can do to increase my walking distance and avoid low back pain? Any advice is appreciated, thanks in advance.

A: A strong core is important to prevent injury with recreational exercise and high output sport performance. Muscular balance is the key here. Many people want a flat stomach and focus on the front half of their core and forget strengthening the back directly. This imbalance can actually create low back pain for people. Interestingly enough, the back pain often subsides after they stop the ab exercises and let the front “weaken” down to the level of the weak back!

Here are a couple things to help prevent low back pain and build a strong core: strengthen both abdomen and back proportionately. For each abdominal exercise you perform, do one for the low back. Which exercises can help do this? Simplicity is always best. I would suggest two basic hyperextension movements often referred to as “Supermans” and “Alternating Supermans.”

The Supermans start lying on the floor and pretending you’re flying like Superman (a cape is optional here). Try to flatten your abdomen and pull your belly button in towards your spine using your stomach musculature. At the same time, SLOWLY fully extend your head, arms, and legs upward off the floor. Then slowly return back to the ground. Count to 3 as you go up, hold everything up for a 3 count, then return to the ground with a 3 count. Be smooth and avoid any quick or jerky movements. Try a set of 10 repetitions, rest 30 seconds, and perform another 10.

Alternating Supermans are performed exactly the same way, only instead of raising both arms and legs at the same time, you raise one leg and the opposite arm at the same time. Try the same rep scheme as with the Supermans. Gradually, as you become more proficient, work up to 3 sets of 10 reps.

This motion patterning is one of those “walking and chewing gum” things — very tough at the beginning and easy once you get it. These cross-pattern movements mimic how your back controls itself as you walk. You’ll probably find that one side moves more smoothly and comfortably than the other. It is very common to even reproduce the low back discomfort you’ve been feeling. This is confirmation that the muscle groups are in trouble. If the discomfort is medium to high, I suggest you get some individualized professional help to put the “fire’’ out. Add these to your warm-up before heading out on your walks and you’ll start feeling the difference within a one- to six-week period, depending on the level of muscle weakness and imbalance.

Good luck and thanks for your question.
— Greg Lekas, LMT, ATC, CSCS

This issue’s experts:
Bryan Baisinger, DC, is owner of Clearwater Chiropractic & Massage. To contact Dr. Baisinger call 503-279-0205 or email bryan@clearh2o.org or visit www.clearh2o.org.

Greg Lekas, LMT, ATC, CSCS, is a graduate of Portland State University Sports Medicine/Athletic Training program and is currently on staff in the Physical Education Department as an instructor. Call to schedule your massage 503-279-0205.