As ACL tears pile up, doctors and coaches worry that kids are playing too much basketball

Long before high school basketball star Anthony Harris tore his ACL in December, his father was doing his best to prevent his son from suffering the serious knee injury.

Anthony Harris Sr. visited multiple doctors and trainers and asked what workouts were best for strengthening the knee. He had them run tests to see how vulnerable his son — a senior at Paul VI High School in Fairfax, Va., who is signed to play at the University of North Carolina next season — was to getting hurt. He built rest time into his training schedule.

“There was a lot of things we tried to do to prevent him getting injured,” Harris Sr. said.

However, the precautionary approach wasn’t able to keep Harris from tearing his ACL during a December game, when a defender collided with his knee as he went up for a layup. Harris was one of three elite Washington-area basketball players to suffer the injury during a six-month span, along with Paul VI teammate and Duke commit Jeremy Roach and Azzi Fudd, a sophomore at St. John’s who was recently named girls’ national player of the year.

The injuries have prompted a question about youth basketball: Amid a demanding, year-round schedule that includes high school games, AAU tournaments and all-star competitions, are kids being asked to play too much?

“We are pushing our kids to the limit where they are playing 365, 24/7,” said John Klimkiewicz, an orthopedic surgeon specializing in sports medicine and joint replacements in the D.C. area. “As you increase the number of exposures, I don’t care. If you go down the ski slope enough you’re going to hurt yourself. It’s kind of a little bit of a time bomb.”

Paul VI guard Anthony Harris is committed to play at the University of North Carolina next season. (Jonathan Newton/The Washington Post)

Though medical experts and coaches stress that every injury is unique and stop short of connecting all ACL tears to overuse, they agree that top teenagersare being made susceptible to injuries, wear and tear, and burnout.

Families such as the Harrises are aware of the risks facing players who compete year-round, but the nature of the sport’s schedule doesn’t leave them with many alternatives. The workload question is being asked all the way up to the professional level, and many acknowledge that the typical pressures and motivational tactics that come with competitive sports don’t always make it easy for parents or the athletes to allow time for rest.

“People put stuff out like, ‘While you’re resting, so and so is in the gym.’ Or, ‘while you are doing this and resting, so and so is doing this and you’re getting left behind,’ stuff like that,” said Kesha Walton, the girls’ basketball coach at Bishop Ireton. “Maybe make a quiet time across the board, I don’t know. … Football, baseball, basketball, whatever. After the season is over, everyone sit down.”

Physical therapist Angela Gordon performs dry needle therapy to help break up adhesions and increase range of motion for Harris, while therapist Kait Donovan looks on. (Doug Kapustin/For The Washington Post)

‘No one is really listening’

Part of the problem, medical professionals say, is that early specialization in basketball or any sport can leave children more vulnerable to injury as they grow up.

Neha Raukar, a senior associate professor in the department of emergency medicine at the Mayo Clinic College of Medicine and Science in Minnesota, said early sports specialization is “an American public health disaster.” Raukar equates repetitive stress to fatiguing of the muscles, with hundreds of microtears occurring every day through strenuous activities.

She uses a paper clip to explain the process: If you bend a paper clip back and forth long enough, eventually it breaks.

ACL tears are of particular concern. They have long been a common injury, Klimkiewicz said, and girls’ basketball players are especially vulnerable. He said girls ages 15 to 25 are five to eight times more likely to tear their ACLs playing basketball than boys.

“It [usually] isn’t someone landing on you, it usually is, you are coming down kind of . . . mid-stride instead of the beginning or end of the stride,” Klimkiewicz said. “The muscle shuts down and you expose the ACL. When everything fatigues and shuts down and you are putting more stress on the ACL . . . that is when you are more likely to see it.”

Klimkiewicz said overuse over time and, in some cases, being poorly conditioned can lead to fatigue. Klimkiewicz stressed the importance of ACL prevention programs, which are mostly carried out by physicians or sports medicine doctors. However, doctors are struggling to get the program in front of young participants. Klimkiewicz said if kids start at age 14 or 15, “it is too late,” and ideally they should be introduced as young as age 6.

More research has come out about the concerning effects of sport specialization, Raukar said, and it has included recommendations for kids to rest and cross-train. But the information is failing to get beyond medical circles and out to the general population.

“No one is really listening,” Raukar said.

St. John’s star Azzi Fudd (35) tore her ACL and MCL at a USA Basketball event shortly after the conclusion of her 38-game high school season. (Katherine Frey/The Washington Post)

Fudd, — who in two high school seasons has won two All-Met Player of the Year awards, played for Team USA and was named the 2018-19 Gatorade national player of the year — was aware of the risks of serious knee injuries before tearing the ACL and medial collateral ligament (MCL) in her right knee in mid-April. The injury occurred after she absorbed contact during a 3-on-3 tournament with USA Basketball.

It was the type of injury that could happen to any player in any game, but it also came after a 38-game high school schedule — the same number of games played by college national champion Baylor — that included league and state championships in addition to a run to the title game of a national tournament.

The Fudds say they have always made a concerted effort to monitor Azzi’s workload, limiting the amount of “exposure camps” and clinics she attends because they deemed it “unnecessary and doing too much.” They also had her compete in sports other than basketball when she was younger, aware of the concerns over sport specialization.

“Over the years, we have been very conscientious about doing preventive exercises and strengthening areas that are commonly know to be weaker in females,” said Tim Fudd, Azzi’s father. “Azzi has a strong foundation, and that was proven to not matter as much due to her particular situation.”

Similar to the Fudds, Harris Sr. said his son’s ACL tear appeared to be unavoidable, although he did acknowledge that fatigue could have been a factor, given that it wasn’t a “massive hit” to the knee. Regardless of the causes, however, the injuries force athletes into a significant recovery period, with ACL tears keeping athletes from the court for a minimum of nine months.

“It’s not a small problem,” Klimkiewicz said. “I say to the kids that come in [with ACL tears], ‘Listen, I’ll get you back, but you can’t do it again.’ And if you look at the incidents, they are at more risk of tearing their other [ACL] a year later.”

Anthony Harris Sr., said his son’s ACL tear appeared to be unavoidable, but added that fatigue could have been a factor, given that it wasn’t a “massive hit” to the knee. (Doug Kapustin/For The Washington Post)

What can be done?

Many within the basketball community acknowledge that kids are playing too much, but few have been able to come up with solutions. In the race to land college scholarships, kids are specializing in the sport and playing it year-round at increasingly younger ages, juggling participation on middle or high school teams with playing on AAU teams and attending all-star camps.

The issue of overuse is relevant all the way up to the NBA. At an event in Washington in mid-May, Commissioner Adam Silver addressed the topic of “load management” that had sparked conversation throughout the season, after stars such as LeBron James and Kawhi Leonard sat out games to rest.

“In the modern NBA we’ve had an 82-game season for roughly 50 years,” Silver said. “And maybe it’s too many games on the players’ bodies.” He also said that if “legitimate resting of [NBA] players resulted in them being healthier in the playoffs, healthier longer, able to continue their careers longer, I think we’d be in favor of it.”

Harris receives treatment during a physical therapy session. (Doug Kapustin/For The Washington Post)

This question of “how much is too much?” tracks back to the youth level, and in 2016, USA Basketball and the NBA partnered to create a set of recommended guidelines to “enhance the playing experience for young athletes.” These included delaying single-sport specialization in basketball until age 14 or older and suggestions for the number of games kids should play in a day or week — taking into consideration practice length, rest time and sleep.

“This started with a concern not only for potential injury, but burnout and mental health,” said Jay Demings, USA Basketball’s youth and sport development director. “Putting less of a focus on the competitive aspect of basketball and more the fun of the sport, which is the number one reason kids play sports.”

Harris Sr. said he believes the basketball community is becoming more adept to change. Shoe-sponsored AAU circuits have teams playing only four to five games over a three-day weekend, compared with the multiple per day young athletes would play in past years. More coaches are aware of their role in trying to manage workloads and look for fatigue in their players. Parents such as Harris are taking preventive measures.

But there is still risk any time a player steps onto the court, Tim Fudd said, no matter what precautions are taken.

“I don’t know how we could’ve prevented Azzi’s other than not be in the place at that time,” he said. “Given the physicality that occurred at the moment, any player would’ve been vulnerable to injury.”

Our Journey So Far…

By Renee’ Fulkerson

I ask that you please consider the vulnerability that goes along with sharing a personal story like this and why I believe in The YogAlign Method.  Thank you

Joaquin Fulkerson our miracle was born in December of 2003 a healthy happy baby boy.  Peter (my husband) and myself were over the moon happy as all new parents are. We did notice at birth Joaquin had a tiny curve in his sacrum area between his gluteal muscles but did not think much of it. The years past by in our then mountain home of Big Bear Lake California where we lead a very family active lifestyle. Peter and myself owned and operated a backpacking outfitting store and next door a yoga studio. Joaquin spent his first seven years of life hiking, skateboarding, rock climbing, skiing, downhill mountain biking, snowshoeing, BMX racing,snowboarding, zip lining, slack lining  and of course guiding groups with dad in the great outdoors or practicing in one of mom’s yoga classes. Joaquin born and raised vegetarian, with perfect annual health exams was again the picture of health (not even a cavity to this day)

Fast forward to the end of 2011 when the Fulkerson tribe arrived on the island of Kauai. Where as a family we continued to remain very physically active biking, hiking, swimming, golfing,boogie boarding, outrigger canoeing ,snorkeling, surfing and Joaquin continued his BMX racing on Oahu on the weekends. In 2017 Peter Joaquin’s dad started to notice Joaquin’s posture changing and not in a positive way. We both noticed a curve in his spine and a very forward head carriage. Joaquin is of the generation of Screenagers meaning his generation is spending a great deal of time in front of a computer screen. With my anatomy knowledge, YogAlign training and common sense I assumed the postural issues where coming from the amount of time Joaquin was spending sitting in a chair in front of his computer. Peter and myself became the posture police and tried reminding him to change his bad posture habits and to shift his body when we saw him out of alignment. In 2018 Joaquin was scheduled to get his annual physical exam before starting school and I had alerted his primary care physician about our concerns with Joaquin’s posture, curve in his spine and now what looked like a collapse in the left side of his chest.

This was the beginning of many Dr. visits on and off island between Kauai and Oahu. On that day at Joaquin’s routine exam he was diagnosed with Pectus Excavatum and sent for a spine x ray for Scoliosis. Then seen by both a pediatric surgeon and spine surgeon on Oahu where we was then diagnosed with Scheuermann’s Disease of the Thoracic and Lumbar Spine.
Joaquin had many forms of x rays on his chest and spine and the results being his spine is healthy in regard to no cysts, tumors or abnormalities for concern however he will continue to struggle with the above mentioned Scheuermann’s Disease of the Thoracic and Lumbar Spine. The Scoliosis is still within mild concern and the Pectus Excavatum is a surgical procedure fix which we would like to avoid however, this does not seem possible and surgery is on the horizon.

Meanwhile during this roller coaster ride I consulted with my teacher and creator of YogAlign Michaelle Edwards here on Kauai and we together came up with a course of action plan for Joaquin. Joaquin’s first YogAlign session with Michaelle took place at her home studio on January 14, 2019. The session was two hours long, began with pictures of his posture, a breathing tool to help him get the fullness in his diaphragm and a few specific YogAlign postures. Our goal was and is to continue to shift his current posture as he is fifteen and his body is pliable, wake up the left side of his pectus muscles, re wire his brain with new positive posture habits and create space in his short and tight front line. Joaquin has had three more YogAlign sessions with Michaelle once a month up until now including before and after pictures. In between those YogAlign sessions with Michaelle Joaquin and myself practiced YogAlign for one to two hours 4 times weekly with great enthusiasm (well most of the time).

Fast forward to today May 30 Th Joaquin and myself continue to practice YogAlign four times a week (mostly). He is even willing to now participate in one of my public YogAlign classes. He has practiced the YogAlign method once on his own with the support of his dad – proud mama moment. Joaquin has become very in tune with his anatomy, posture good and bad and how his body feels when in it is in good or bad alignment not to mention the self confidence it has given him. He will always need to be very physically active and practice YogAlign in order to maintain a happy healthy body able to do all of the things he enjoys in life well into his senior years. I am proud of his commitment and grateful for the YogAlign Method as well as Peter and myself for being proactive in a challenging situation.
Joaquin will need in the near future to have the Nuss procedure to fix his Pectus Excavatum but until then anything is possible – the proof is in the pictures (4 months of YogAlign practice).
Much love, respect and gratitude for all the love and support now and as the journey continues.

What Kind of Exercise is Healthiest?

By Todd Hargrove

Physical activity is now considered one of the “big four” lifestyle factors (along with smoking, nutrition and drug abuse) that have major effects on health. In 2015, the Academy of Medical Royal Colleges put out a report summarizing the benefits of exercise, calling it both a “miracle cure” and a “wonder drug.” [1] The report observes that regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions — reducing the risk of each by at least 30%. This is better than many drugs.

A recent analysis of data from more than 60,000 respondents found that people exercising 1-2 times per week had a 30% reduction in all-cause mortality compared to those who got no exercise. There was a 35% reduction for people who exercised 3-5 times. [2] Similar studies have concluded that a sedentary lifestyle is a primary cause of 36 diseases, and that exercise is an effective treatment to prevent them. [3, 4] Numerous experts have observed that if exercise came in a pill, it would be the most effective and widely prescribed medicine ever developed.

While the evidence supporting the health benefits of exercise is undeniable, I don’t find the metaphor of it being “medicine” totally appealing. First, medicine is something most people would rather not take, so the marketing is not very good. Second, the term medicine suggests cure of a particular disease, which is misleading. Physical activity can improve your health in many different ways, just as light, water and soil will nurture a plant. But it’s not a targeted intervention that “fixes” a specific problem.


I think a better metaphor for the benefits of physical activity is one recommended by Katy Bowman and Nick Tuminello: movement is like food. This analogy works on many different levels. First, nutrients in food are beneficial when consumed in some goldilocks amount — not too much and not too little. For example, you need a minimum dose of iron to avoid anemia, but too much is toxic. Many kinds of inputs to the body follow this pattern, even water. With physical activity, some minimum amount is essential, too much is toxic, and there is a broad range of happy mediums.

Another analogy between food and movement is that you need a well-balanced diet of many different nutrients, all of which have a different optimum dose. If you have a deficiency in Vitamin A, it won’t help to double up on the Vitamin B. The same is true of physical activity. The bench press is a fine exercise, but if that’s all you ever did, you would become deficient in other areas of physical function.

If movement is like food, how do you eat a balanced diet? Part of the answer is that … it depends. A twenty-year-old athlete will need a different diet of movement than a 65-year-old with knee pain. In fact, two 65-year-olds with knee pain might benefit from completely different programs. To find what works best for an individual, you will need to explore a wide landscape of different options. The good news is that some parts of the landscape are more worth exploring than others. To get a rough idea where they are, we can look to two sources of data: (1) formal recommendations from government health groups; and (2) research analyzing the physical activity of hunter-gatherers living in natural environments. I think of these guidelines as major landmarks for orientation on the movement landscape. Fortunately, they both point in the same basic direction.

Recommendations from Health Groups

Numerous governmental agencies, including the World Health Organization, the U.S. Department of Health Services, and the National Health Service in the U.K., have published physical activity guidelines. [5, 6] They are based on expert analysis of the voluminous research looking at physical activity, fitness and health. Here is a brief summary of their advice, which is almost the same for each source.

The amount

The guidelines suggest at least 150 minutes per week of “moderate” physical activity, or half as much “vigorous” activity. (See below for definitions.) But this is just the minimum, and a better goal would be 300 minutes of moderate activity per week. Adding more exercise may continue to reduce mortality until as much as 750 minutes per week, after which point the health benefits of physical activity seem to flatline. [7]

“Moderate” activity defined

Moderate activities are usually light aerobic exercise — continuous cyclic movements done at an easy pace. Examples include:

  • brisk walking

  • hiking

  • gardening or yard work

  • jogging, cycling or swimming at an easy pace

Moderate exertion feels like you are working, but not in a way that is unpleasant or difficult to continue. Heart rate is about 60-80% of maximum, and breathing rate is elevated to a point where it would be difficult to sing, but easy to talk. You may break a light sweat but will not become significantly overheated. After finishing a session of moderate physical activity, you could probably complete another one if necessary.

“Vigorous” activity defined

Vigorous activity is higher intensity work that can be either continuous or intermittent. Examples include:

  • resistance training with weights, machines, bands, or bodyweight

  • sprinting or high intensity interval training on a cycle or rowing machine

  • continuous running, cycling, swimming, or rowing at a challenging pace

  • heavy manual labor

During continuous vigorous activity such as running or cycling, you are approaching the fastest pace you can sustain for twenty or more minutes. Your breathing rate is high enough that you cannot have a conversation. Intermittent activities like weight lifting, sports or sprint- ing cannot be performed continuously, but only in intervals. Vigorous physical activity feels hard and requires willpower to continue. When you are finished, you will probably want to rest at least a day before completing a similarly tough workout.

Movements that challenge strength

Most guidelines recommend that the above weekly totals should include at least two sessions that maintain or build strength in all major muscle groups. Although the majority of research on physical activity relates to aerobic exercise, there is a large and growing number of studies showing equally impressive health gains from strength training. Some of these benefits are not available with aerobic exercise, especially preservation of muscle mass, which declines with age, often to a point where function is significantly compromised. [8]

Movements that challenge mobility and basic coordination

Some popular guidelines, but not all, recommend inclusion of movements that maintain functional ranges of motion, and basic movement skills like squatting or single leg balance. This doesn’t mean you need exercises specifically devoted to this purpose, such as stretching or corrective exercise. Many common activities challenge mobility and functional movement skills, including dancing, swimming, martial arts, gymnastics, climbing, calisthenics, or classic compound strength exercises like pushups, pull-ups, rows, presses, squats and lunges. On the other hand, if all you do is bike or run, you will not be challenging your mobility or coordination very much.

Physical Activity Levels of Hunter-Gatherers

Another way to approach the question of how to move is to consider the physical activity levels of humans living in more natural environments. This is the same logic you would apply to analyzing the health needs of any other animal. If you had a pet cheetah and wanted to know how much running she should do to maintain good health, you would try to learn something about how much cheetahs run in the wild. If you had a pet chimp, you would take him to the climbing gym, not the swimming pool.

Anthropologists who study hunter-gatherer cultures observe that they generally enjoy excellent health and fitness, and have low to non-existent rates of chronic diseases associated with a sedentary lifestyle. [9] They engage in high levels of physical activity, but certainly do not consider it to be exercise or medicine. [10] Movement is simply inseparable from almost every meaningful event in their lives. Although each hunter-gatherer culture has a different lifestyle, there are some general patterns and averages that are informative.


Men usually spend the day hunting, which requires lots of walking, occasional jogging, and the odd sprint. They sometimes climb trees, dig to find tubers, and carry food back to camp, which must be butchered. Women generally spend their days gathering plants, and also caring for young children, who often must be carried. Back at camp, men and women engage in toolmaking, and food preparation. Down time is spent sitting on the ground in positions like squats that challenge lower body mobility. [9]

Although they are moving all day, the pace is not grueling. Recent studies on the Hadza tribe in Tanzania show that they do about 135 minutes per day of moderate to vigorous physical activity. [11] That’s about 900 minutes of activity a week, just a bit past the point at which recent studies have found that adding more exercise stops providing any significant additional health benefits in terms of reduced mortality.

Some days involve hard work, but they are usually followed by easy days. Presumably some days will involve maximum intensity effort, such as sprinting or carrying a heavy load. Interestingly, activity levels do not decline much with age. The 65-year-old elders keep up just fine with the young adults. A good percentage of the total workload is walking 5-10 miles per day. If you think in terms of steps, this is about 10 to 20,000.

How does this organic, all-natural program for fitness compare to the standard issue government cheese? There are some obvious similarities. The majority of the work is moderate continuous movement like brisk walking. Vigorous activity is a smaller percentage of the whole, and includes work that challenges strength (climbing, digging, carrying, butchering) or power (sprinting). Many of the activities require mobility, coordination, and balance, such as walking over uneven terrain, climbing and scrambling, digging, lifting and carrying odd-shaped items, throwing, and sitting on the ground. One major difference is that hunter-gatherers do a higher volume of low intensity work, even compared to highly active modern humans. They are not doing more bench presses, but they are getting in more steps.

Interestingly, walking is exactly the type of physical activity that modern humans would probably like to do quite a bit more, if only they had the time. Paddy Ekkekakis studies motivation to exercise, and observes that although high intensity exercise is quite effective at delivering health benefits quickly, most people don’t do it because … (prepare to be shocked) … they don’t like it. But people tend to enjoy walking. Under the right circumstances, say being with a friend in a nice environment, they do not consider it to be exercise at all, but an enjoyable and invigorating experience that delivers immediate rewards.

Another notable feature of walking is that it provides health benefits with only a minimal risk of injury. More intense exercise (e.g., a set of barbell squats) offers a relatively narrow window between too much and not enough. The difference between a good workout and an injury might be just a few extra reps or plates on the bar. But the margin of error with walking is huge. After a healthy dose of walking, most people could double it and recover easily.

It makes sense that walking delivers the highest bang for your buck, because this is the movement we are best adapted to perform. Like any other animal, our primary physical function is locomotion, and walking is the most energetically efficient way to get the job done. If you did nothing else but walk a lot, you’d be in better shape than most Americans.

A Quick Summary

If you want to “play” with fitness as a way to improve general health, here are some “rules of the game” to keep in mind. Have as much fun as possible within these basic constraints:

  • Aim for at least half an hour and up to two hours of physical activity almost every day.

  • Movement should be varied in terms of volume, intensity and type. Most activity can be fairly light. Walking is the most natural and beneficial movement for human beings.

  • Every few days, include some high intensity work that significantly challenges your strength, power, and/or capacity to sustain high energy output for a short period of time. Climbing, running and resistance training are logical choices.

  • Include movements that challenge coordination, balance, and range of motion.

Or to put this in even simpler terms:

  • Move around a lot at a slow easy pace.

  • Frequently move with some urgency or pick up something heavy.

  • Every once in a while, move like your life depends on it.

And have fun!

Physical activity activity isn’t like taking medicine, you know.


Karen Salmansohn, 58 years young

Senior cohousing is now trending – and for good reason. Below I share 5 reasons you might prefer senior cohousing with friends to nursing homes and assisted living.

Last week I got punched by the guy who came to fix my internet connection. And I was happy about it.

You see I was blaming my age for NOT being confident in technology – like the “younger generation.”

The technician told me I looked young – and asked me my age.  When I told him I was 58, he punched me in the arm – Elaine-from-Seinfeld style. He claimed he didn’t believe me.

Note: If you don’t know who Elaine is from Seinfeld – then I am old enough to be your mother – or even grandmother.

It’s not by accident that I’m (perhaps) a younger-looking and (definitely) younger-feeling almost 60 year old. 

I’m proactively taking care of my health and longevity.

My father passed away about ten years ago – in a challenging way– so I’m highly aware of my mortality.

For many reasons, I’ve been researching longevity – for a while now.

In my research I discovered that “Senior Cohousing” is trending right now – which I’m very excited about – for later on in my life, when I am older.

“Senior Cohousing” is when you live in an “intentional neighborhood” – surrounded by your friends – and you share in things like the same dining area, library, fitness center, garden, TV room etc.

Longevity research states that staying social with friends and family helps to keep you living longer.

It’s thereby no surprise to read that seniors who cohouse live at least ten years longer than they might otherwise live in traditional senior housing (Note: According to the Canadian Cohousing Network).

“Senior Cohousing” is a great concept for older people like myself, who are part of what I call the “Wellderly.”

“Wellderly” means that we’re older, but don’t feel old or act our age! 

With the help of the longevity tools tools I’m using I plan to remain “wellderly” for a long time to come.  And so I’m very interested in exploring this cohousing concept.

Cohousing sounds like a blast. Plus cohousing with fellow Wellderly friends is more affordable than nursing homes and/or living alone. After all, sharing resources saves money. When you’re a group paying for community meals it costs less than paying for groceries for one.

Plus it’s cheaper to maintain a yard, garden,  library, fitness center when you’re sharing in the costs with your friends.

It is estimated that by 2050, the number of people over 60 years old will triple from what it is now. 

I will soon be one of those people in that huge group – who’s looking for the most comfortable and enjoyable way to spend their senior years!

I love the idea of living in cohousing surrounded by friends – where I only need to walk a few feet to meet up with a someone for coffee or enjoy a walk in a shared garden.

If you’re seeking a more fun and rewarding way to spend your senior years,  here are…

5 reasons you might prefer senior cohousing:

1. A True Community

You get to enjoy having your friends close by so you can share time and activities. In contrast, seniors who live alone often feel loneliness.

2. Lots Of Privacy

In assisted living seniors live in very close quarters with one another. But with senior cohousing you get your own private apartment or house!

3. Less Money

Living in a nursing home or assisted living usually costs a lot more. But with senior cohousing, you’re sharing resources with friends, so you save money.

4. Lots of Mental & Emotional Wellbeing Perks

Let’s be real. Living in a Nursing home or in Assisted Living can feel a lot more depressing than living in a shared senior cohousing community.

5. Safety

In a cohousing neighborhood, you have neighbors around who expect to see you daily. They will notice if you’re not around. Hence if you fall,  then don’t show up for a meet up, your neighbors will check in on you.

Golf injuries: Play it safe with these tips

Golf injuries are common but avoidable. Learn how to protect yourself.

By Mayo Clinic Staff

Although golf is a low-impact sport, it’s associated with a significant number of injuries. Many golfing-related injuries are a result of poor mechanics or overuse. The most commonly injured area is the lower back, followed by the elbow, wrist and hand, and shoulder.

Follow these tips to stay in shape on the course.

Adjust your swing

The entire body is used to execute a golf swing in a complex and coordinated movement. When this movement is repeated frequently, significant stress is placed on the same muscles, tendons and joints. Over time, this can result in injury.

Understanding the mechanics behind your golf swing can help you prevent golf injuries. Try to:

  • Use proper posture. Stand with your feet shoulder-width apart and rotated slightly outward, and with your knees slightly bent. Hold your spine relatively straight; your trunk should be tilted forward, but most of that movement should come from your hips. Avoid hunching over the ball, which may contribute to neck and back strain.
  • Stay smooth. The power of a golf swing comes from force transferred smoothly through all the muscle groups, from your ankles to your wrists. If you depend on one part of your body for your hitting power, you may be more prone to injuries. For example, overemphasizing your wrists during your swing can lead to golfer’s elbow — a strain of the muscles on the inside of the forearm.
  • Don’t overswing. If you swing the club too hard or too fast, you may stress your joints. Relax and take a nice, easy swing at the ball. The best golfers have consistent — not necessarily fast — swing tempos.

If you want to reduce the risk of golf injuries, consider taking lessons. What you learn about your golf swing may even help you shave strokes from your score.

Other tips to keep you on the course

There’s more to golf than your golf swing. Consider other ways to lower your risk of golf injuries:

  • Warm up. Before you practice your swing or play a round of golf, warm up for at least 10 minutes with a brisk walk or a set of jumping jacks. Stretch your hands, wrists, forearms, elbows, shoulders, spine and pelvis. Swing your golf club a few times, gradually increasing your range of motion.
  • Start slowly. You might start out by practicing your swing for hours, believing it’s helping your game. But if your body isn’t conditioned for the strain, repetitively practicing your golf swing may do more harm than good. Work up to your desired level of activity instead.
  • Strengthen your muscles. You don’t need bulging muscles to hit a long drive — but the stronger your muscles, the greater your club speed. Stronger muscles are also less prone to injury. For best results, do strength training exercises year-round.
  • Focus on flexibility. Regular stretching can improve your range of motion and lead to a more fluid golf swing.
  • Build up your endurance. Regular aerobic activity can give you staying power on the course. Try walking, jogging, bicycling or swimming.
  • Lift and carry clubs carefully. Golfers who carry their own bags have higher rates of shoulder and back injuries than do other golfers. If you jerk heavy clubs out of the trunk of your car, you could injure yourself before you reach the first tee. Use proper lifting technique: Keep your back straight and use the strength of your legs to lift.
  • Try to avoid hitting objects other than the ball. Elbow and wrist injuries are often the result of hitting the ground or the rough.
  • Choose proper footwear. Dress for comfort and protection from the elements. Wear golf shoes with short cleats. Long cleats dig into the sod and hold your feet planted as you swing, which may strain your knees or ankles.

Watch out for hazards on the course

Be careful to limit your sun exposure while golfing. Remember to:

  • Use sunscreen.
  • Wear sunglasses to filter out UVA and UVB rays.
  • Wear a hat with a visor to shade your eyes and face.

Watch for signs and symptoms of dehydration, heat exhaustion and heatstroke. Drink plenty of water, whether you feel thirsty or not, and cut your game short if necessary. Red flags for heat-related injury might include:

  • Headache
  • Weakness
  • Dizziness
  • Nausea
  • Muscle cramps
  • Rapid heartbeat
  • Confusion

When riding in a golf cart, keep your feet inside the cart. Golfers have suffered broken ankles when their feet have been caught in the moving parts of golf carts.

Keep an eye out for storms. Call it quits at the first sign of threatening skies or lightning.

Play smart

Whether golf is a new interest or a lifelong passion, make the most of your time on the course by protecting yourself from golf injuries. Consider it all part of the game.

What are the best foot exercises for healthy feet?

Reviewed by 

Many people experience foot or ankle pain at some point. By keeping the feet strong, a person can alleviate soreness, and improve overall health and flexibility.

Regularly exercising and stretching the feet and ankles can help to ensure that muscles are providing the best support. These exercises may also increase the range of motion in the feet, keeping a person active for as long as possible.

Most foot exercises are simple and require no complicated equipment. They can be done at home or in the gym as part of a regular exercise routine.

Exercises for flexibility and mobility

The following exercises have been developed to improve flexibility and mobility in the feet.

1. Toe raise, point, and curl

Image of toe raise, point, and curl foot exercise

There are three stages to the toe raise, point, and curl.

This exercise has three stages and will help to strengthen all parts of the feet and toes.

To do this exercise:

  • Sit up straight in a chair, with the feet flat on the floor.
  • Keeping the toes on the floor, raise the heels. Stop when only the balls of the feet remain on the ground.
  • Hold this position for 5 seconds before lowering the heels.
  • For the second stage, raise the heel and point the toes so that only the tips of the big and second toes are touching the floor.
  • Hold for 5 seconds before lowering.
  • For the third stage, raise the heel and curl the toes inward, so that only the tips of the toes are touching the floor. Hold this position for 5 seconds.
  • Build flexibility and mobility by repeating each stage 10 times.

2. Big toe stretch

Keeping a wide range of motion in the big toe is important. The following exercise also has three stages, and it was designed to stretch and relieve pain in toes that have been squashed in shoes.

  • Sit up straight in a chair, with the feet flat on the floor.
  • Bring the left foot to rest on the right thigh.
  • Using the fingers, gently stretch the big toe up, down, and to the side.
  • Remain in this position for 5 seconds.
  • Repeat this 10 times before switching to the other foot.

Exercises for strength

The following exercises can help to enhance the strength of the feet.

3. Toe splay

Toe splay foot exercises

The toe splay helps with control over toe muscles.

The toe splay was developed to improve control over the toe muscles. It can be done on both feet at once, or on alternate feet, depending on comfort.

To do this exercise:

  • Sit in a straight-backed chair with the feet gently resting on the floor.
  • Spread the toes apart as far as possible without straining. Hold the position for 5 seconds.
  • Repeat this motion 10 times.
  • Once some strength has been built up, try looping a rubber band around the toes. This will provide resistance and make the exercise more challenging.

4. Toe curls

Toe curls build up the flexor muscles of the toes and feet, improving overall strength.

To do this exercise:

  • Sit up straight in a chair, with the feet flat on the floor.
  • Lay a small towel on the floor in front of oneself, with the short side facing the feet.
  • Place the toes of one foot on the short side of the towel. Try to grasp the towel between the toes and pull it toward oneself. Repeat the exercise five times, before switching to the other foot.
  • To make this exercise more challenging, weigh down the opposite end of the towel with an object.

5. Marble pickup

The marble pickup was designed to increase strength in the muscles on the underside of the feet and toes.

To do this exercise:

  • Sit up straight in a chair, with the feet flat on the floor.
  • Place an empty bowl and a bowl of marbles (20 is good to start with) on the floor in front of the feet.
  • Using only the toes of one foot, pick up each marble and place it in the empty bowl.
  • Repeat, using the other foot.

6. Sand walking

Walking barefoot on sand is a great way to stretch and strengthen the feet and calves. This is a good exercise in general because sand’s soft texture makes walking more physically demanding.

To do this exercise:

  • Head to a beach, desert, or even a volleyball court.
  • Remove shoes and socks.
  • Walk for as long as possible. Increase these distances slowly over time, to avoid overexerting muscles in the feet and calves.

Exercises for pain

The following exercises can provide pain relief.

7. Toe extension

The toe extension is useful in preventing or treating plantar fasciitis — a condition that causes pain in the heel when walking, as well as difficulty in raising the toes.

To do this exercise:

  • Sit up straight in a chair, with the feet flat on the floor.
  • Place the left foot on the right thigh.
  • Pull the toes up, toward the ankle. A stretching feeling should be felt along the bottom of the foot and heel cord.
  • Hold for 10 seconds.
  • Massaging the arch of the foot while stretching will help ease tension and pain.
  • Repeat this exercise 10 times on each foot.

8. Golf ball roll

Golf ball roll foot exercise

A golf ball rolled under the foot may help to relieve discomfort.

Rolling a golf ball under the feet can help to relieve discomfort in the arches and ease pain associated with plantar fasciitis.

To do this exercise:

  • Sit up straight in a chair, with the feet flat on the floor.
  • Place a golf ball — or another hard, small ball — on the floor next to the feet.
  • Lay one foot on the ball and move it around, pressing down as hard as is comfortable. The ball should be massaging the bottom of the foot.
  • Continue for 2 minutes, then repeat on the other foot
  • A frozen bottle of water can be a soothing alternative if no suitable balls are available.

9. Achilles stretch

The Achilles tendon is a cord connecting the heel to the calf muscles. It can strain easily, and keeping it strong may help with foot, ankle, or leg pains.

To do this exercise:

  • Face a wall and raise the arms, so that the palms rest flat against the wall.
  • Place one foot back, keeping the knee straight. Then bend the knee of the opposite leg.
  • Keep both heels flat on the floor.
  • Push the hips forward, until the Achilles tendon and calf muscles can be felt stretching.
  • Hold for 30 seconds before switching sides. Repeat three times on each side.
  • For a slightly different stretch, bend the back knee and push the hips forward.

Foot health and safety tips

To keep feet strong and healthy:

  • Complete a thorough warm up routine before exercising.
  • Wear supportive footwear for day-to-day activities and sports.
  • Replace shoes when they are worn down.
  • Build up strength and flexibility slowly, to condition feet and ankles.
  • Avoid uneven surfaces, especially when running. Try not to run uphill too often.
  • Listen to the body and do not overdo activities.
  • Prevent any recurrence of injury by resting and receiving appropriate treatment.

Keeping the feet and ankles healthy is always a good idea. The exercises above can help to ease existing pain, prevent discomfort, and reduce chances of injury.

Stilettos…A Pain In The ???


The biomechanical effect of heels in everything from running shoes to stilettos has puzzled researchers and fired controversy for almost a century. In a highly functioning body, the neuro-myo-skeletal system ‘hangs’ in dynamic equilibrium, each part balancing the other. But when a woman wears high heels, a new dynamic equilibrium occurs (Fig. 1) If one body part becomes ‘fixed,’ the whole system must compensate with altered movement patterns resulting in kinetic chain ‘kinks.’ Here’s an interesting experiment that’ll help you get a feel for biomechanical adjustments high-heel wearers deal with every day: • Stand barefoot with the back against a wall. Observe how your ‘upright’ body column forms a perpendicular line (ninety degree angle) with the floor (Fig. 2A).

* Slide a two inch wedge of some kind (phone book, etc.) under both heels and notice that by keeping your body column rigid, you’re forced to tilt forward from ninety to about seventy degrees (Fig. 2B).

* Now replace with a three inch heel wedge and straighten up so you’re touching the wall again and feel the dramatic myo-skeletal adaptations that take place. Can you feel your ankles shift from dorsi to plantar-flexion? In this standing posture, the knees are buckled, hips flexed, low back swayed, and the shoulder girdle retracted (Fig. 2C).

The brain, guided by foot, ankle and visual proprioceptors, must instantaneously make a whole series of myofascial and joint adjustments (ankle, knee, hip, spine, and head) to regain and retain erect stance and equilibrium (Fig 3). But high-heeled posturo-functional faults are not confined to the external milieu; they may also inflict compressional damage on the internal viscera…particularly pelvic bowl contents. According to research conducted by Diane Lee, excessive lumbar lordosis causes the pelvic bowl to dip anteriorly which raises the body’s center of gravity leading to reduced proprioceptive stability.1

Not only are we more unstable on our feet, but the increased anterior pelvic tilt squashes our poor organs. For example, when standing barefoot, the anterior angle (pelvic tilt) of the female pelvis is twenty-five degrees; on low, one-inch heels it increases to thirty degrees; on two-inch heels to forty-five degrees and on three-inch heels to sixty degrees. You don’t have to be a physicist to envision how increased heel height causes gravity to compress and distort abdominal organs (Fig. 4). Hopefully one day we’ll see a well-designed study testing the relationship of long-term high-heel wearing and ‘gut’ problems such as prolapsed colons, distended bladders, hemorrhoids, etc.

Many women love to wear high heels, and I might add many men like women in high heels. However, it’s true that some women suffer for their vanities. In young women, this is accommodated fairly well by ankle and hip mobility and low back stability. But, many high-heel wearing women find that as they age and the hip joints stiffen, shock waves shoot through the lumbar spine causing disc compression, ligamentous laxity and facet joint spurring. Women should be cautious about wearing heels constantly, or over long periods of time.

Clearly, the human foot was not designed to walk in stilettos… or cowboy boots for that matter. The foot is specifically constructed to land in a heel to toe ‘rolling’ motion whereby the arch, ankle, and knee absorb shock (stored energy) and release the ground reaction force up the kinetic chain to counter-rotate the torso and pelvis. The heeled shoe steals this propulsive power from tendons, ligaments and leg muscles. Not only do heels place the foot and leg under greater stress to achieve the demands of propulsion, but the borrowed power must be ‘leeched” from higher structures in the kinetic chain, i.e., knees, thigh muscles, hips, and trunk. As a small army of anatomical reinforcements are recruited to rescue the handicapped fascial tissues, the body continues to lose energy to the ground. Shoe heels of any height set in motion a series of gait-negative consequences, making natural gait — meaning the barefoot form — impossible. Don’t let your clients be a slave to fashion; fix their feet and give them back the natural spring in their step.

Somerset teen helping peers banish stress with yoga

By Deborah Allard

SOMERSET — As teens make the transition from children to adults, there’s lots to think about – and stress over.

Driving. Homework. Grades. Fitting in. Biological changes. Dating. Work. College. The list goes on.

Catie Ledwidge, a Somerset-Berkley Regional High School senior, found her own stress-busting cure and has shared it with her peers.


“It’s a natural remedy people can use instead of turning to medication,” Ledwidge said.

Ledwidge felt so strongly about the healing benefits of yoga, and the mediation that is often combined with the practice, that she chose it as the subject of her senior capstone project, designed her own yoga session and taught it to her peers recently at Blend Café & Yoga.

“They asked us to pick something we were passionate about. That’s when yoga came to mind,” Ledwidge said.

Ledwidge, 18, said she wanted to share the “focus and balance” found in yoga that can be incorporated into “everything” in life. “It allows you to be in your head. It calms the central nervous system and lowers blood pressure.”

Ledwidge has been practicing yoga for several years after taking her first class with her mom.

“It’s a way for me to relieve my own stress and let go of judgments around me,” Ledwidge said. “I fell in love with it.”

She said teens face a lot of stress, and some can turn to harmful means, such as alcohol and drugs, to deal with their feelings.

She listed peer pressure, fitting in with other students, having the right clothing, working after school, and having a busy extracurricular schedule all as stressors.

“That stress keeps on building,” Ledwidge said. It can become “exhausting” and “emotionally disruptive.”

Ledwidge, working with her mentor, yoga instructor Meagan Mulready, developed a 90-minute yoga routine for the class.

“I put together the poses that I like to do,” Ledwidge said. “She helped me to tweak it.”

After lots of practice, she said that when it came time to teach, she was “super prepared.”

Ledwidge taught her peers to focus on their breathing, get into each pose, and feel only the moment.

Before and after class, she asked students to fill out a survey about their current stress levels. Before yoga, many registered a 7 to 8 – with 10 representing the most stressful feelings. After yoga, they reported that their stress levels dropped to a 1 or 2.

Yoga helps teens, and all ages, be in the “present moment and let go of everything,” she said.

Ledwidge said she’d like to become a certified yoga instructor – but probably not until she graduates from college. Ledwidge has been accepted to Emmanuel College in Boston, where she plans to double-major in math and education starting in the fall.

When it’s time to pack for dorm living, her yoga pants and mat won’t be far behind.

“I definitely highly recommend (yoga),” Ledwidge said. “I think it’s really something you can use for the rest of your life.”

Low Backs, Glutes & Lats


The gluteus maximus was probably the muscle most responsible for pulling us up onto two legs and now look what’s happened to it. Our flexion-addicted lame-ass (no pun intended) society had forced it to be neurologically bullied about by tight hip flexors. If reciprocal inhibition doesn’t completely rob its massive power, injured SI joints and low backs certainly will. It attaches and is continuous with the biceps femoris, long dorsal SI ligaments, thoracolumbar fascia and crosses over to form the posterior spring system with latissimus dorsi (Fig 1).

The g-max and lat dorsi are not only dynamic lumbar spine stabilizers, but when working in conjunction with other spring systems, play a major role in coordinated cross-patterned gait (Fig 2).

It’s easy to spot those with weak glutes. Due to reciprocal weakness, these folks tend to stand with the pelvis tilted one way or another with their butt kinda “hanging off” the hip capsules and lumbopelvic ligaments. If the muscles, tendons, and fascia are relatively weak in relation to the demands of a particular sport or repetitive activity, the vertebral joints (usually beginning with the disc) will deteriorate (Fig 3). When deterioration becomes severe it can be difficult to carry out the functions of daily living, let alone any high performance athletic endeavor. Any attempt to manually lengthen or stretch weak intrinsic and extrinsic spinal stabilizers causes greater forces to converge on the spinal discs and facets resulting in premature degeneration.

Spindle-Stim Technique

OK, so the glutes are typically weak….whadda we do about em? Even though the clients love it, the last thing we want to do is start massaging and digging around creating more stretch weakness. We could always send them to the gym for squats, leg presses, lunges, or…we could try to tonify them during the therapy session using fast-paced spindle-stimulating techniques.

Try this Spindle-Stim ‘test & treat’ routine:

• With client prone, ask them to lift their left leg as high as comfortably possible and get a sense of how high the extended leg comes off the table…then test the right.
• Place the left foot against the right knee forming a “Figure 4” position with the leg. This places g-max on the stretch.
• With arms extended, use soft fists and begin bouncing on the left hip..
• Now, drop your body weight so all the energy is coming from your legs.
• Working the tissue in all directions, begin to gradually pick up speed until you see the entire body rocking & rolling. (This is not tapotement folks…use your body weight)
• The goal is to kick in a mild stretch reflex via muscle spindle’s dynamic gamma motoneuron system..
• After two minutes of rapid spindle-stim stop and retest their degree of hip extension.
• Results are often dramatic depending on your use of the technique and the degree of weakness the client presents with.
• Repeat on the opposite side and take notes on the degree of improvement so you can test them next session to see which g-max needs more work.

What about the tight lats?

Gotta love these guys. Considered a lower quadrant muscle, lat dorsi is innervated by the cervical ganglia and instrumental in all shoulder and arm movements, i.e., chopping with an axe. Two major structural/functional problems can occur in the presence of lat hypertonicity:

• Due to their attachment at the lesser tubercle of humerus, they work with teres major and the clavicular fibers of pec major to internally rotate the humeral head leading to upper cross syndrome patterns, forward head postures and rotator cuff injuries.
• Optimal functioning of the posterior spring system during cross-patterned gait demands there be precise length/strength balance between g-max and lat dorsi. In the presence of tight lats and weak glutes, the posterior spring system fails to participate with the other spring systems to wind up the lumbar spine and propel the legs forward in the gait cycle.

Try this ‘lat-lengthening’ technique:

• The client is left sidelying, knees flexed with his/her right hand grasping the top of the therapy table.
• With your left hand behind your back, grasp the client’s right ilium and lean against your arm to brace the hip.
• Place a soft right forearm along the lateral border of the lat fascia and get a good fascial hook.
• Establish a counter-force by anchoring with your left hand and slowly hooking and gliding up the lats with your right forearm. The goal is to lift the rib cage off the pelvic girdle and open up the lateral side of the body.
• After a few strokes, stop and this time ask the client to inhale to a count of 5 while gently pulling up on the top of the therapy table.
• As they relax and exhale, hook the deeper fascia so you can really decompress lat adhesions and activate the posterior spring system.
• Repeat on opposite side.

GOAL: Help your clients maintain a strong, mobile spine and spinal spring system to minimize injuries and maximize sports performance. Advise against overexertion during competitive or recreational activities to avoid microfailure (fatigue) and eventual spinal degeneration. Remember, the spine cannot support itself without help and that’s where these spinal engine spring system routines come in handy. Restoration of optimal range of motion, length/strength balance and proper firing order are essential components of the Myoskeletal Alignment Techniques(TM).


For the past several years Australian world champion and Olympic medalist Mitch Larkin has been incorporating yoga into his training in several ways. Larkin has been working with physiotherapist and yoga teacher Tom Barton to develop a program that improves both performance and prevents injury.One of the ways he uses yoga on a regular basis is as part of his dry land preparation before heading into the water. Larkin has taken several of the movements and poses that he has worked on with Barton to create his own yoga inspired pre-swim routine.There are five main focuses in this routine:

  • Alignment
  • Cross body connection
  • Body rotation
  • Shoulder activation
  • Creating length through the front and the back of the body


Almost all of the movements and poses incorporate a focus on the alignment of the head, ribcage and hips. This creates length through spine as well as activating the core, which are foundations of strong posture both in and out of the water.

Poses that highlight this include the halfway lift and single leg back bridge.



The cross body connection is the link between opposite arm and leg through the core. By bringing awareness to this connection through the activation of the core is an effective way to prepare for freestyle and backstroke.

Two of the ways that this done is through the two-point plank as well as movements from a three legged dog.



Body rotation in this routine is another aspect that is very applicable to swimming both freestyle and backstroke. It is also important in developing spinal mobility, which is an aspect that influences healthy movement through the shoulder joint.

This is highlighted in aspects of the advanced dead bug pose as well as side angle with arms overhead with a twist.



The activation of the shoulders focuses on the posterior aspects of the joint including posterior deltoids, rhomboids and trapezius. This is accomplished by the extension of the shoulders and retraction of the shoulder blades (bringing the shoulder blades towards the spine).

These movements are done with the arms in three different positions:

  1. Hands by hips
  2. Arms straight from shoulders (T position)
  3. And arms overhead in a Y positioning



Activating the spine by moving through flexion and extension creates length in the front and the back of the body. This allows for greater freedom of movement in the spine.

The movements that highlight this are cat cow as well as both the forward fold and sphinx, which are part of Sun Salute A.