October 2011 - Advanced Physical Medicine
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Ankle Sprains

You twisted your ankle and are experiencing pain and swelling in and around the joint. What could be happening? Why is it not going away?


The ankle is a complicated structure, with three bones and several tendons and ligaments surrounding it. There are many structures that can be injured when the ankle is twisted or rapidly moved in an awkward position, through a fall or abnormal step. Ankle injuries are common injuries for those who are live an active lifestyle.  Furthermore, sporting events, wet or snowy weather, people who always wear flip flops or high healed shoes, those who are constantly walking on irregular surfaces are suseptible to further injury as well.


The most common parts of the ankle to be injured when it is turned incorrectly are the ankle ligaments on the outside of the ankle: the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. Early onset may include pain, swelling, and instability . Typically, the best initial treatment for this injury includes RICE: rest, ice, compression (ace wrap, soft cast, splint, or walking boot), and elevation. X-Rays are typically ordered to make sure the bones are not broken, but injured ligaments are not visible on regular X-Rays, and therfore, more extensive studies, such as MRI may be necessary.  MRIs look at soft tissue structures that cannot be visualized on X-Rays. Medication and physical therapy may also be initiated to reduce the inflammation in the area. If there are tears in the ligaments, more rigorous immobilization or surgery may be indicated.


You can prevent ankle injuries by wearing supportive shoegear and avoiding flip flops or high healed shoes. It is important to take extra care when walking on irregular surfaces or in wet or snowy conditions, as it is easier to twist the ankle.

If you think you have sprained your ankle, please call Dr. Bender at Advanced Physical Medicine for your appointment. Dr. Bender has been practicing in the Chicagoland area for the last ten years and is a clinical instructor for William Scholl College of Podiatric Medicine.


- Presented by Dr. Mary Ann Bender, Advanced Physical Medicine

You may have noticed a bump on the inside of your foot, near the big toe joint.  What is this?  Often, the bump is a bunion. A bunion is caused by shifting of bones in the foot.  The first metatarsal bone and phalanges of the big toe move out of position, and this leads to a bump which can become red, swollen, and painful.  Bunions can be aggravated by certain shoes (especially tight ones) and certain activities.

There are many causes of bunions, but the most common causes include the following: flat feet, genetics, arthritis, gout (also a type of arthritis), and injury or trauma to the foot.

Bunions can be treated either conservatively or surgically, depending on the severity of the condition.  The only way to completely correct the deformity is through surgery to realign the bones and remove the bump.  Surgery is indicated for creating a less painful foot but will not create a perfect foot.  Some patients are not good candidates for healing, and your doctor will discuss with you whether this is the best option for you.  Initial healing for bunion surgery takes 6-8 weeks, but there is often discomfort and swelling from time to time for a year after the procedure (depending on activity level).  During the initial healing period, patients often must be off work, unless they have a desk job, as prolonged standing and walking are not permitted (for correct healing).  If surgery is not an option or in an effort to delay surgery, there are a variety of conservative options for treatment: medication, injections, padding, shoe changes, and orthotics (or shoe inserts).  Orthotic devices are particularly helpful in trying to make the patient more comfortable and delaying the progression of the bunion.

If you have this condition and would like to discuss your options, please schedule an appointment with Dr. Bender at Advanced Physical Medicine Oak Park or Chicago.

Mary Ann Bender, DPM
Foot and Ankle Specialist
Advanced Physical Medicine
6931 W. North Ave.
Oak Park, IL 60302

What is a Detox Diet?

Importance of detox diet for health

Detox is a shortened form of the word detoxification. Detoxification is the natural process of the body. This is an ongoing process that helps to neutralize or even remove the toxins from the body. Toxins are things that can be harmful to body tissue. When your body detoxifies, it actually transforms toxins into less harmful compounds which are then excreted out of the body.

Our body actually produces some of those toxins during normal functions. A detox diet is normally recommended for people who are suffering from either a drug or alcohol problem. However a detox diet also refers to the use of various methods, involving herbs and diets to remove the toxins in our body. This ensures that our body enjoys good health. You will find that there are different types of detox diets. However, there are some common factors that you will notice in all these diets. For one thing a detox diet is a brief diet.

A detox diet actually helps to minimize the amount of chemicals that we would normally take in. A detox diet works in a positive way by stressing on the need to eat food that can actually help your body detoxify. These would be vitamins, nutrients and the antioxidants which is what the body would require in order to remove the toxins from the body. A detox diet stresses the need to take in food that contains high fiber content, and food that is high in water content. These types of food types have the ability to draw out and get rid of the toxins. A fiber rich diet and an increased intake of water ensure that your bowel movements are regular and your urination is more frequent. This way the toxins are naturally removed from our body. People go on a detox diet to increase their sense of well being since a body that contains toxins can be prone to illness.

The presence of excess toxins has also been linked to other problems like hormonal imbalance, ineffective metabolism, nutritional deficiency and other such problems. This can be seen from fatigue, bad skin and bad breath. Anyone who wants to start a detox diet should consult their doctor before they do so. Pregnant women or children should certainly not go on a detox diet. People with eating disorders, diabetes and other disease too should not consider this diet.

When people go on a detox diet they have to make changes to their diet. They will have to eat a special diet. Their diet will include special food items, herbs, and other supplements. In addition to this they will also have to follow an exercise regime, do some breathing exercises and even follow some sauna therapy.

Achilles Tendonitis

presented by Dr. Mary Ann Bender, Advanced Physical Medicine

Why do I have pain in the back of my heel?
The Achilles tendon is a very powerful structure which extends from the knee to the heel bone, and it plays a very important function in normal walking.  It controls the movement of our ankles. 
What are the causes? 

Occasionally, the Achilles tendon can develop inflammation and can become painful and sore.  There are many reasons why it can become inflamed:  overuse, twisting or some other abnormal motion, improper shoes, obesity, and flat foot structure.
How is Achilles Tendonitis treated? 

There are a variety of treatment options that can be used, depending on the severity of the case:  Icing, antiinflammatory medications, wrapping or bracing, walking boots, physical therapy, and rest are some of the most common remedies.
What if it is not getting better? 

If the Achilles Tendonitis is not improving with these treatment modalities, a diagnostic ultrasound or MRI may be ordered.  These tests allow for better visualization of the Achilles tendon, as it is not adequately visualized on X-Rays.  Occasionally, the Achilles tendon has a tear in it and will require more aggressive treatment.
How do I prevent this type of injury? 

1. It is important to wear supportive shoe gear, such as athletic shoes, when exercising or standing and walking for prolonged periods.  The heel of the shoe should be firm and there should be support in the arch.  Additionally, it is important that the shoe cannot be twisted. 
2.  Stretching the Achilles tendon before exercising or prolonged walking is essential to preventing this condition. 
3.  Reducing excess body weight is also very important.  Elevated body weight puts extra pressure on the lower extremity and can aggravate this condition.
If you feel that you have this condition, or have any other foot or ankle condition, please call for an appointment with Dr. Bender.
Oak Park 708-763-0580
Chicago 63rd 773-776-3166
Chicago Drexel 773-994-0417

Could Your Allergies be Making You Tired?

Sneezing and itchy, watery eyes are the most obvious

symptoms that spring to mind when talking about

allergies, but daytime sleepiness and poor nighttime

sleep also commonly plague allergy sufferers. An

ongoing lack of restorative sleep reduces the quality

of life for those with allergies and makes it harder to cope

with the other physical symptoms.


There are steps that you can take to improve the quality of your sleep and reduce daytime

sleepiness and fatigue.


Talk to Your Doctor and/or Pharmacist

Drowsiness and grogginess are common side affects of common allergy medications.

Talk to your doctor and pharmacist about other medications you can try. Sometimes

it can be helpful to alter the times that you take your medication, for example taking

a 24 hour pill before bed instead of first thing in the morning.


If you’re not taking any medications at all and experiencing snoring and frequent

night-waking talk to your doctor. If your allergies are causing these symptoms, taking

a prescription or over the counter medication or performing nasal irrigation before bed

could help.


Make Your Bedroom as much of an Allergen Free Zone as Possible

Most of us spend 6 to 9 hours at a stretch in bed asleep. It only makes sense to do our

best improve the air quality in our bedrooms. Here are some tips to help with that:


●     Remove all carpeting and rugs from your bedroom. If you’d like to keep one for

decor or warmth, choose a small one that can be frequently

machine-washed in hot water.

●     Use a high-quality vacuum with a HEPA filter to clean floors and remove

dust from blinds and other window treatments.

●     Wash all bedding once a week in hot water.

●     Use special pillow cases and mattress covers to keep dust mites from

inhabiting your bed.

●     Keep your bedroom as clutter-free as possible. Put all clothes away in

closets and dressers. Keep shoes and dirty clothes outside of your

bedroom as they may track in allergens.

●     If you have pets, ban them from your bedroom.

●     Use an air purifier to trap dust, pollen and dander.

●     An air dehumidifier can help prevent mold growth and keep the air

comfortable for those suffering from allergy symptoms or asthma.

●     If you have extremely dry air, an air humidifier can help you breathe easier

and avoid dry, cracked nasal passages and a sore throat. Use a gauge to ensure

that you don’t over-humidify your room and encourage mold growth.


Other Helpful Tips

Keeping your allergies well-controlled during the day can make it easier for you to rest

at night. Stay indoors on days when the pollen count is high and treat symptoms before

they make you completely miserable. If you’re not crazy about the idea of allergy

medication, look for natural remedies and foods that can help mitigate your body’s

response to allergens. Try showering in the evening instead of in the morning. Your hair

and skin can be covered in allergens by the end of the day. You’ll rest easier without all

of those allergy triggers so near your mouth, nose and eyes.


Scented products such as soaps, lotions and detergents can often trigger an allergic

reaction. Try using unscented versions of these products and using gentle cleaners

like baking soda and vinegar to see if they help your allergy symptoms so that you

can sleep well at night. Pay careful attention to the detergents and fabric softeners

you use on your bedding and pajamas as you’ll be breathing in those scents all night.


Jacob Maslow is a blogger working for Allergy Be Gone, a site that sells allergy control products including air purifiers, dehumidifers,  and humdifiers.

Vitamin C in Building Muscle

Every year thousands of dollars are pumped into

the health supplement industry.  A new product

constantly hits the market with astonishing claims

that it will help to build muscle. However, it is

amazing how silent everyone is about the muscle

building benefits of eating something as simple as

an orange. Vitamin C is an under appreciated

vitamin in the process of muscle growth.


Taking Vitamin C speeds up muscle recovery.  During

weightlifting muscle tissue is broken down and it takes time to rebuild.  Vitamin C

speeds up this process so that you can head back into the gym sooner.  You

will have greater energy when doing workouts and be able to put out more effort.


Vitamin C reduces cortisol production.  Cortisol is a catabolic hormone that serves to break

down muscle tissue.  It is released in the body in times of stress and contributes to body

fat especially around the waist.  Therefore, after a workout (when cortisol production is

usually high) would be a great time to take Vitamin C. As an antioxidant Vitamin C destroys

the presence of free radicals that can cause damage tocells and make us sick.

Free radicals are as a result of waste products and occurs after stressful situations on the

body like weightlifting.  Vitamin C also keeps your immune system healthy so that you

become sick less often.  As a result, less time would be spent away from the gym due to


Anabolic Growth

The production of anabolic or growth hormones is probably the greatest muscle building

benefit of taking Vitamin C.  It also helps with the efficient transport of nutrients to your

muscles so that they can grow.

Water Soluble

Vitamin C is a water soluble vitamin which means excess is eliminated through sweat and

urine.  However, it is best not to exceed the recommended dosage.


It is obtained from strawberries, oranges, grapefruit, tomatoes, papaya, spinach,

watermelon, cranberry and many other fruits and vegetables.  So I hope you have

a totally different perspective of Vitamin C now.  It may not be as hyped as other

muscle building supplements but it's benefits in the muscle building process in undeniable.


Author: Chris Brown "I am a 24 year old fitness enthusiast who believes in being the

healthiest person I can be."  Chris Brown blogs at www.gainbuildmuscle.com.

Top 7 Stretches Every Runner Must Do

Summer is over, but for those avid runners among us, it’s still running season:  time to hit the road with your properly fitted shoes, and moisture-wicking sportswear.  Follow each run with these 7 stretches and you will assure that you’re able to enjoy your jogs, injury free.

Standing Calf Stretch

The calf muscle runs along the back of your lower leg. In runners, this muscle is prone to a calf pull or strain.

  • Stand about an arm's-length from the wall.
  • Lean forward and place both hands on the wall about shoulder width apart.
  • Extend one foot (the side to be stretched) behind you with one heel on the ground and one foot closer to the wall.
  • Lean into the wall with your hips until you feel a stretch in the calf of the extended leg.
  • Hold this stretch for about 30 seconds and change sides.
  • For a deeper stretch, move your foot farther back.

Standing IT Band Stretch

The IT band is a tough group of fibers that run along the outside of the thigh. IT band syndrome is a common running injury that is generally due to inflammation and irritation of this band. Here is a simple stretch you can do while standing.

  • Stand with your left leg crossed in front of your right leg.
  • With your right arm extending overhead, reach to the left.
  • Put your left hand on your hip.
  • Push slightly on your left hip until you feel a slight stretch along the right side of your torso, hip, upper thigh and knee.
  • Hold 20 to 30 seconds and change sides.
  • For a deeper stretch, keep your feet farther apart, bend the knee of your forward foot and keep the back knee straight.

Standing Quad Stretch

The quadriceps (quads), are a group of muscles along the front of the thigh. There are many different ways to stretch your quadriceps, but here is a simple one you can do while standing.

  • Stand on one leg (grab onto something solid if you need support).
  • Bend your knee and bring your heel toward your buttock.
  • Reach for your ankle with your hand.
  • Stand up straight and feel a slight pull along the front of your thigh and hip.
  • Hold the stretch for 20-30 seconds, release and repeat on the other leg.
  • Be careful not to strain your knee - the goal is not to touch your heel to the buttock, but rather to stretch the thigh.

Seated Hamstring Stretch

Because tightness in the low back and hamstrings is often related to muscle pain and stiffness in runners, this stretch can help maintain good running form and reduce the risk of stiffness, pain and injury.

  • Sit on the floor with your legs stretched out in front of you with knees straight.
  • In a slow, steady movement, lean forward at the hips, keep your knees straight and slide your hands up your legs to your feet.
  • Extend as far as you can, and flex your feet slightly to increase the stretch.
  • Hold the stretch for 20-30 seconds, release and repeat two to three times.

Hip Flexor Stretch

The hip flexors are a group of muscles that bring the legs up toward the trunk. Runners rely on these muscles, particularly when running uphill.

  • Begin in a forward lunge position and drop your back knee to the floor.
  • Raise your arms and hands up over your head and look up.
  • Press your hips forward and down toward the floor and feel a stretch through your torso, hip, groin and thigh.
  • Hold the stretch for about 20-30 seconds, release and repeat on the other leg.

Shoulder Stretch

This is a basic shoulder stretch you can do anytime and anywhere.

  • Begin standing up straight with shoulders relaxed and back.
  • Reach your right arm up over your head, bend your elbow and reach your hand behind your neck.
  • With your elbow pointing up to the sky, slide your right palm down to your back.
  • With your left hand, grip your right elbow and gentle pull it toward your ear.
  • Continue sliding your right palm down your back without straining.
  • Hold for 10-20 seconds and release.
  • Repeat with the opposite arm.
  • Be sure to keep your head up and resist the urge to bend your neck forward.

Plantar Fasciitis Stretch

This stretch is used to relieve the pain of plantar fasciitis by stretching the plantar fascia, a band of tough connective tissue that runs along the bottom of the foot to the heel.

  • Stand barefoot.
  • Lift one heel off the ground but keep the ball of the foot and toes flat.
  • You will feel a stretch on the underside of the ball of the foot.
  • Hold for a count of ten. Release.
  • Repeat ten times.



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