Take Care of Your Hands and Feet

The hand is truly amazing! There are 27 bones in the hand. There are 15 muscles in the forearm that control the movements of the hands and fingers. We can turn the palms down and up, flex and extend the wrist, wave the wrist side to side, flex and extend the fingers, pull the fingers apart and bring them together, circle the thumb, and don’t forget the movement of the opposable thumb. Most of the things that we do with the hands require the strength of several muscles doing various movements simultaneously.

We probably think less often about our feet than we do about our hands, but the foot is amazing too. There are 26 bones in the foot. There are 29 muscles associated with the foot: 10 originate outside the foot but cross the ankle joint to act on the foot, and 19 muscles are inside the foot. All of these muscles work as a team. The ligaments in the ankle, which attach the bones together, contain receptors that give feedback to the brain about where the body is in space. We can dorsiflex the foot (pull the foot up toward the shin) and plantarflex the foot (point the toes). Inversion of the foot means rolling to the outside edge of the foot; eversion means rolling to the inside edge of the foot. We can lift the toes or curl the toes down. One of the most important things our feet do is transmit force both toward and away from the ground in weight bearing activities.

One thing we should do to take care of our hands is to wash them frequently. Plain soap and water washes away the viruses that cause the common cold, flu, COVID, and RSV. Remember to wash for 20 seconds, including between the fingers, the fingernails and the tops of the hands. Using hand cream will help prevent the skin from drying out. Some problems that may cause hand pain include arthritis, carpal tunnel syndrome, ganglion cysts, tendonitis, and trigger finger. For more information on these problems and treatments for them, check out the article on hands from John Hopkins Medicine. The pool is a great place to exercise the hands because the hands are constantly underwater, and therefore resisted. The Arthritis Foundation has a list of exercises for the wrists and fingers:

  • Hand and wrist wave – elbows are near the waist with the thumbs up, wave the hands side to side
  • Wrist stretch – the arms are near the surface of the water with palms together, then bring the hands toward the chest with fingertips pointing up.
  • Wrist rotation – circle the wrists
  • Finger curl – make a fist and extend the fingers
  • Cat’s claw – bend the fingers at the middle joint to simulate a cat’s claw
  • Piano – bend and straighten the fingers as if playing a piano
  • Finger flicks
  • Finger O – touch the thumb to the tip of each finger
  • Finger walk – slide one finger at a time toward the thumb
  • Finger spread – spread the fingers apart and move them back together
  • Finger lift – rest the palms on the thighs and lift the thumbs and then the fingers one at a time
  • Thumb bend – touch the thumb to the base of each finger
  • Thumb circles

You can also shake out the hands to release tension and help relax the muscles of the hands. Even though these exercises come from the Arthritis Foundation, they are beneficial to include in any water fitness class.

Some problems that may cause foot and ankle pain include heel spurs, corns, bunions, hammertoes, ankle sprains, fractures, planar fasciitis, Achilles tendon injuries and diabetes. For more information on these problems and treatments for them check out the article on feet from John Hopkins Medicine. Some exercises to do in the pool for the ankles and feet from the Arthritis Foundation are:

  • Point and flex the foot
  • Heel-toe lift – rock back on your heels then rise onto the toes
  • Ankle circles – or write your name with your foot
  • Ankle in/ankle out – roll the foot in to tap the big toe on the floor then roll it out to tap the little toe on the floor
  • Toe curl – lift the toes off the floor then curl the toes as if picking up a pencil

You can also walk on your toes and on your heels. Put one foot on the toes of the opposite foot and try to lift the the toes of the bottom foot.

Avoid gripping dumbbells with the wrists not in neutral. Avoid too much rebounding for the feet.

In addition to doing exercises for the hands and feet, there are some cautions for your water fitness class. Grip strength is important, but you want to be sure to relax the grip between sets with foam dumbbells. It’s a good idea to stretch the fingers or wiggle them or do one of the hand exercises above before beginning another set. Holding the dumbbells with the wrists extended can aggravate carpal tunnel syndrome. Be sure to keep the wrists in neutral, which avoids excessive strain and fatigue in the hands and wrists. To protect the feet, avoid excessive rebounding. When you tell your class to start jogging, they will automatically rebound. If you do not vary the impact forces, your class could easily rebound for 50 minutes. Include exercises in the neutral position with the hips and knees bent and the shoulders below the surface of the water (Level II), suspended exercises (Level III) and grounded exercises keeping one foot on the pool floor. When you do rebound, teach how to land. Landing toe-ball-heel will diffuse the shock. When landing toe-ball-heel, the heel barely makes contact with the pool floor before lifting off again, so do not cue to keep the heels down. Avoid repetitive impact on the ball of the foot because the metatarsal fat pad on the bottom of the foot frequently degenerates in women over 50. Offer modifications to jumping and rebounding for those who have plantar fasciitis. Aqua shoes are recommended because they can help protect the feet. Deep water exercise is best for anyone recovering from an ankle sprain.

Resource: Pauline Ivens, MS and Catherine Holder, PT, Do No Harm, 2011

You use both your hands and your feet constantly, so take good care of them. See you in the pool!

Author/Instructor Photo
Chris Alexander

Take Care of Your Knees

Royalty Free Human Joint Clip Art, Vector Images & Illustrations - iStock

The knee joint is the largest and probably the most stressed joint in the body. It is a hinge joint that allows flexion (bending) and extension (straightening) and a slight amount of rotation side to side. The bones of the knee joint are the femur (the upper bone), the tibia (the lower bone), and the patella (the kneecap). The smaller lower leg bone, (the fibula) is not part of the knee joint. Ligaments connect the femur and tibia and hold them in place. Two menisci cover the top of the tibia and serve as shock absorbers. Knee pain can be caused by a torn ligament, fractures, a torn meniscus, knee bursitis, patellar tendonitis, a loose body in the knee, a dislocated kneecap, osteoarthritis and other causes. For more information on knee pain symptoms and causes see the article on knees from the Mayo Clinic. The most common cause of chronic knee pain is arthritis (osteoarthritis, rheumatoid arthritis or posttraumatic arthritis), A Healthline Report in 2020 says that approximately 600,000 knee replacement surgeries are performed every year in the United States.

It is not always possible to prevent knee pain, but you can reduce your risk by maintaining a healthy weight, and keeping the muscles that support the knees strong and healthy, since weak muscles are a leading cause of injury. The muscles that support the knees are the 4 muscles of the quadriceps on the front of the thighs and the 3 muscles of the hamstrings on the back of the thighs. The pool is a great place to do exercises for the quadriceps and hamstrings because the buoyancy of the water lifts and supports the body, reducing the stress on the knees. Some good exercises that can be done in the pool for the knees include quad kicks (kicks from the knee), hamstring curls, squats, and lunges. We squat every time we sit down in a chair. Squats can stress the knee if done too deeply, but that is very unlikely in the pool! Vary the squat by having the feet wide apart, hip distance apart or together. You can also have one foot forward more than the other foot. In the pool you can do one-legged squats. To activate the deep core muscles before squatting, use the Heavy Concept. Imagine that you are trying to squat but are not able to. You will feel both your abdominals and the hamstrings contract isometrically. Use the same concept to return to standing. If you imagine that you are not able to stand up, you will feel both your abdominals and quadriceps contract isometrically. For an additional challenge, do your squats standing on a noodle. Lunges can be performed forward, to the side, to the back, or diagonally.

1. & 2. Quad Kick. 3. Hamstring Curl. 4. Squat. 5. Squat on a Noodle. 6. Lunge.

In addition to strengthening the quadriceps and hamstrings, there are some cautions to help you avoid an injury in your water fitness class. Rebounding is good for the knees, but landing with the knees turning inwards causes abnormal forces through the knees. The middle of the knee should align with the second and third toes when landing from a jump. Ballistic hip abduction (cheerleader jumps) puts a lot of pressure on the outside of the knees, and knees are not designed for this stress. Don’t include this exercise in your routine. Avoid forcefully throwing the knee during a kick. Cue to press your kicks rather than power popping your kicks. Eggbeater kicks have a circular motion that puts a lot of torque on the knees. They are not recommended for a group exercise class.

1. Do Not Power Pop the Knees. 2. Eggbeater Kicks Put Torque on the Knees.

It is a good idea to stretch the quadriceps and hamstrings at the end of class. Cue the quad stretch properly: the thighs are close together and the knee points down to the floor, then lift the abdominals, press the hip forward and take the knee slightly back until a stretch is felt in the muscle. Do not cue to bring your heel to your buttocks, as this forceful end range of motion can cause a meniscus tear. A hamstring stretch can be done by lifting the knee, then extending the leg, which is easy to do with the help of the buoyancy of the water. Do not round out the back to increase the stretch. A hamstring stretch can also be done by placing the foot on the pool wall. Exercising your legs to keep your quadriceps and hamstrings strong will reduce your risk of knee problems later on.

Resources: Ruth Sova, MS – Feet Ankle Knees Mini Session 10-06-22

Pauline Ivens, MS and Catherine Holder, PT, Do No Harm, 2011

See you in the pool!

Author/Instructor Photo
Chris Alexander

Take Care of Your Hips

Iliac Crest Pain - Causes, Treatment and Prevention

We use our hips all the time to sit down, stand up, and walk. The hip joint is a ball-and-socket joint that allows us to move our legs and at the same time gives us the stability necessary to bear the body’s weight. Unlike the shoulder joint, the socket part of the hip joint is extremely strong and dense with surrounding ligaments to keep the head of the femur (the ball part of the hip joint) in place. You rarely hear about a hip dislocation. To watch a short video describing the anatomy of the hip joint check out the John Hopkins Medicine website. Even though our hips are designed be be weight bearing, the extra pressure on the joints does make them more likely to develop arthritis. Other potential problems include bursitis and injuries because of a fall. Problems with the hip may show up as problems with gait, that is walking. Examples of gait/hip problems include:

  • Reduced step length (the distance you cover when you take one step)
  • Reduced stride length (the distance you cover when you take two steps, one with each foot)
  • Reduced walking speed; a slower gait increases the risk of developing a disability
  • Foot angle out of the line of progression (the toes point out or in instead of forward)
  • Rounded shoulders
  • Transferring body weight from side to side
  • Quad dominance (the thigh muscles are overactive and take over for the glutes and hamstrings during squatting, lunging, running and standing)
  • Gluteal Amnesia (the muscles on the back of the hip are weak and not activated during squatting, lunging and running)
  • Difficulty with sideways movements caused by weak hip abductors

For all of these reasons, it makes sense to do exercises that keep our hips heathy and strong. There are 22 muscles that act on the hip joint. These muscles allow the hip to flex (lift forward) and extend, abduct (lift to the side) and adduct, rotate to the midline and rotate to the side. Since the muscles that lift the leg forward (hip flexors) are strong and often tight from sitting too much, it is important to emphasize extension over flexion. Here are some exercises for your hips to include in your water fitness class:

  • Squats
  • Lunge in all directions, using a clock face
  • Walking in all directions
  • Shallow water running and deep water running
  • Crossover walk
  • Knee-lifts (emphasize extension)
  • Leg curls
  • Cross-country ski
  • Cross-country ski with rotation
  • Jumping jacks
  • Kick forward (emphasize extension)
  • Kick to the side
  • Kick backward
  • Inner thigh lift

In addition to strengthening the muscles of the hips, there are some cautions to help you avoid an injury:

Do jumping jacks with the toes pointed out in the upright position

Ballistic Hip Abduction. These are known as cheerleader jumps, but since very few activities requires forceful hip abduction, this move is not functional. Instead do jumping jacks. Make sure that the feet are parallel so the move is hip abduction. It is okay to change foot positions when doing jacks upright, but if the toes point out when performing suspended jacks, you are changing the move to hip flexion.

Ballistic Karate Kicks. When karate kicks to the side are thrown forcefully, there can be an injury in the labrum of the hip. Cue “control and press” so that the throwing action is eliminated.

Prone Flutter Kicks. Flutter kicks strengthen the hips and legs, but prone flutter kicks while holding on to the wall compromise the hands, hyperextends the neck, hyperextends the lumbar spine, and compresses the spinal discs. Performing the exercise with foam dumbbells does not improve these issues. The neck and spine are still hyperextended, and the spinal discs are still compressed. Instead, perform flutter kicks in deep water in a vertical position with neutral postural alignment wearing a deep water belt.

Abdominal pike and spine extension

Prone to Supine Abdominal Exercises use the hips to change positions, but they require accurate cueing. Going all the way to prone involves too much spinal extension and going all the way to supine involves too much spinal flexion. I have heard this exercise called by the amusing name of Sun Tan/Superman. But using this cue encourages going supine all the way and prone all the way. I prefer to call the exercise Abdominal Pike and Spine Extension. Bring the legs forward to a 90-degree angle in front, then tuck and extend the legs diagonally back, as in the pictures above. Wear a belt to do the exercise in deep water; do not do the exercise using just foam dumbbells.

Supine Crunch does not work the abs Limit the “L” Position

Crunches are not functional, but they do work the abdominals. The problem in the water is that we are not horizontal as are crunches on land. Instead we are in a reclined sitting position with the legs close to the surface of the water. Most people pull their knees to the chest, which is repeated hip flexion with lumbar spine flexion. This compresses the front edges of the discs of the spine. Also, placing a noodle under the armpits impinges the shoulder joint and risks damaging the nerves in the arm pit. Instead work the muscles of the core in a vertical position. See the previous posts Take Care of Your Shoulders and Take Care of Your Spine.

“L” Position. This position is a long lever in hip flexion and it is difficult to hold the torso in neutral. Limit the amount of time used in this position.

Kick too high

High Kick with Compromised Posture. Some participants try to increase the intensity of a high kick by getting the toes to the surface of the water. This causes too much spinal flexion and too much hip flexion. Instead, lower the kick so that the lumbar spine does not slip into flexion. Emphasize hip extension, the downward movement of the leg.

Finally, there are some good stretches you can do in the the water for your hips. Side steps lengthen the inner thigh muscles. Forward steps lengthen the gluteal and hamstring muscles of the forward leg and stretch the hip flexors of the back leg. Slow motion walking is good for balance and coordination. Swing one leg forward and back to stretch the hip flexors. Bend the knee when the leg swings back to lengthen the quadriceps. Crossover steps lengthen the outer thigh. Hip figure 8’s are good for hip mobility. Use a range of motion that is controlled and pain free. Take care of your hips so that you can continue to sit down, stand up and walk without difficulty into your golden years..

Resources: Ruth Sova, MS – Hips Mini Session 9-22-22

Pauline Ivens, MS & Catherine Holder, PT Do No Harm 2011

See you in the pool!

Author/Instructor Photo
Chris Alexander

Take Care of Your Spine

Eighty percent of Americans will suffer back pain at some time in their lives. Back pain often develops without a cause that shows up in a test or imaging study. According the Mayo Clinic, risk factors for back pain include age, lack of exercise, excess weight, diseases such as arthritis and cancer, and improper lifting. People prone to depression and anxiety and smokers have an increased risk of back pain. Regular low impact aerobics and abdominal and back muscle exercises that strengthen the core can help keep the back healthy and strong.

Exercises that improve posture is a good place to start. Bring the neck into alignment with chin tucks. Put a finger on your chin and, keeping your chin level, pull it away from your finger. Some people have trouble with this exercise and tend to pull the chin down. Another way to cue the exercise is to say “lift the sternum” which accomplishes the same thing. Next relax the shoulders and bring the shoulder blades down. Turning the palms forward can help accomplish this. When you stand, stand tall with your body weight evenly distributed between both feet and the knees pointing forward. When you sit, keep both feet on the floor with the knees bent at hip level or below,

Exercises to improve posture are exercises that strengthen the core. Although many people associate crunches with core exercises, the core includes all the muscles of the trunk. The pool is the perfect place to work the core because immersion in water activates the core muscles. It is a discreet but constant activation, and you do not feel it the same way as an abdominal crunch. The core muscles most in need of strengthening for good posture are the muscles of the upper back, the erector spinae and the glutes. Always stabilize the core before moving the arms and legs. The best exercise to strengthen the posterior muscles is to travel backwards in the pool. Some other exercises to try in the pool are:

  • Upright row. Cup the hands and pull the water toward you. You can also use webbed gloves, drag equipment or kickboards.
  • Lat pull-down. Hold resistance tubing overhead and pull the ends down to the sides. Or do jumping jacks with foam dumbbells or drag equipment.
  • Rear delt fly. Hold resistance tubing chest high and pull the ends apart.
  • Shoulder external rotation. Rotator cuff sweep out with thumbs up.
  • Straddle a noodle with the end of the noodle between the thighs; adjust the height of the knees to find the difference between extension, neutral and flexed.
  • Abdominal pike and spine extension. Go only 45 degrees to the back to avoid hyperextending the back. Use a deep-water belt. Do not try this exercise with just foam dumbbells. (See the previous post on the shoulders.)
  • Back rotation. Upper body twist or hula hoop.
  • Squats with feet hip distance apart or a narrow stance.
  • Hip extension. Skate kick or cross-country ski.
Good posture in deep water running
Poor posture in deep water running

In addition to strengthening the core, there are some cautions to help you avoid an injury. When running in deep water, maintain the spine in neutral alignment. In this position the spine is off-loaded because of the buoyancy of the water. However, people often lean forward which reduces the frontal resistance and allows them to travel faster, but this position also causes spinal compression even though there is no lower body impact.

Good Posture in Shallow Water
Poor Posture in Shallow Water

It is also important to maintain good posture in shallow water. Other things to avoid include prone flutter kicks at the wall. This compromises the grip, the neck, and the lumbar spine. Do not hang on the wall and do double leg lifts; this overloads the lumbar spine. Wall-hanging sit-ups do not exercise the abdominals and it is too difficult for many water exercise participants to get into that position. The risks outweigh any benefit. Crunches in a supine position put stress on the neck and use the hip flexors instead of the abdominals. Do not do rotation and forward flexion at the same time (opposite elbow to knee) as it puts stress on the lumbar spine. Participants with compressed discs or osteoporosis should avoid trunk flexion. It is better to work on core stabilization by bracing the core and emphasizing good posture.

The supine position puts stress on the neck
Supine crunches work the hip flexors
Avoid forward flexion & rotation

Working on good posture and strengthening your core muscles are good ways to take care of your spine and reduce your risk of back pain in the future.


Ruth Sova, MS – Backs Mini Session 9-1-22

Pauline Ivens, MS & Catherine Holder, PT Do No Harm 2011

See you in the pool!

Author/Instructor Photo
Chris Alexander

Take Care of Your Shoulders

What are the Rotator Cuff Muscles? - Brace Access

We don’t usually think about our shoulders, but we use them all the time to do things like lifting a bag of groceries, opening the car door, wiping the kitchen counter, picking up a child, lifting a drink, combing our hair, reaching behind our back to thread a belt through the loops and more. Two major bones of the shoulder are the humerus or arm bone, and the scapula or shoulder blade. The four muscles of the rotator cuff stabilize the shoulder joint or keep it in its proper position. Muscles in our chest and back and the deltoids on top of the shoulder are responsible for moving our arms in all the multiple directions they are capable of. Our shoulders are complex and amazing!

Rotator cuff injuries are common and increase with age. Fifty percent of adults over 60 have rotator cuff tears. Thirty-four percent of adults who have rotator cuff tears have no symptoms. For more information about the causes and treatment of a rotator cuff tear, see this article from the Mayo Clinic. It is a good idea to take care of your shoulders by keeping your muscles strong before an injury occurs. The water is an excellent place to do this because buoyancy decreases joint compression and allows better muscle function and relaxation. When the shoulders are submerged, circulation increases which assists in removing toxins and bringing in nutrients. Start by relaxing the shoulders. When your shoulder blades are flat, the rotator cuff is in good alignment. With your arms by your sides, turning the palms forward helps to bring the shoulders in good alignment. Some shoulder exercises to try in the water are:

  • Lat pull-down. Hold resistance tubing overhead and pull the ends down to the sides.
  • Jumping jacks with the thumbs up.
  • Breaststroke with the thumbs up
  • Rear delt fly. Pull the ends of resistance tubing apart at shoulder level.
  • Shoulder extension. Bring the arms in front of the body at the surface of the water and press down. You can add resistance with drag equipment, such as paddles. Or hold resistance tubing at the surface of the water with one hand and pull the opposite end down with the other arm.
  • Cross-country ski with the palms facing forward.
  • Rotator cuff sweep. Bring your elbows down near, but not glued to, your waist. Sweep your hands out to the side and back to center. Or keep your hands out to the sides and walk backwards.
  • PNF. (1) Bring one fist to the opposite shoulder then sweep it diagonally out to the side near the hip with the palm facing back. (2) Bring one fist to the opposite hip then sweep it diagonally up to the side with the palm up, as if pulling a sword out of its scabbard and brandishing it.
  • Figure eights to the sides, to the front, or one arm at a time.
Do not hang from dumbbells
Do not position noodle too high
Do not position dumbbells in arm pits
Do not breaststroke with thumbs down

In addition to strengthening the shoulder, there are some cautions to help you avoid an injury. Look at the drawing of the shoulder bones. The head of the humerus is like a golf ball sitting on a tee (the glenoid cavity). This allows the shoulders to be extremely mobile, but they are not designed for weight bearing. Therefore, do not hang on walls, because then you are using your shoulders to support your weight. The photos demonstrate some other things NOT to do. You want to avoid impinging the shoulder, which means pinching the tendons of the rotator cuff. Impingement occurs when you hang from foam dumbbells with the arms extended to the sides and when you are suspended from foam dumbbells in a reclining position. Using a noodle around the torso can also cause impingement if it is too high. Position it mid-torso, just below the shoulder blades. Do not hang from foam dumbbells under the armpits as it damages the nerves in the armpit. Always wear a deep-water belt when using foam dumbbells in deep water. Keep your feet on the pool floor when using foam dumbbells in shallow water. Keep your shoulders relaxed while working with foam dumbbells. Impingement occurs when using the equipment with shoulders shrugged. If you have difficulty holding the dumbbells under water without shrugging the shoulders, use a smaller set of dumbbells, or switch to webbed gloves. Another instance of impingement occurs when the arms are extended to the sides with the shoulder internally rotated, that is with the thumbs down. That is why the breaststroke is done with the thumbs up. Yes, swimmers do the breaststroke with the thumbs down, but they are in a horizontal position, not in the vertical position of exercisers in a water fitness class. Be careful about bringing your arms too far back when doing a breaststroke. This exposes the head of the humerus, risking an injury. Keep your hands within your peripheral vision, unless you are doing a slow stretch.

Overhead reaches are functional, but do not sustain them for too long. The shoulder muscles fatigue quickly, so take a break after a few repetitions, or alternate arms. Do not bring the arms in and out of the water. As the arms break the surface, the resistance is suddenly gone, and the movement becomes ballistic. When you hold your arms out to the sides, do not continuously maintain a position between 80 and 120 degrees, because that can cause bursitis. It is better to have the arms at a 70 degree angle. Fast arm circles overload the small shoulder muscles. Slow the arm circles down. When holding a noodle in the hands for upper body work, it is best to have the hands shoulder distance apart. If the hands are too narrow, the shoulders are rounded. If the hands are too far apart, the shoulder blades are no longer neutral. Triceps dips with the noodle behind the back are also hard on the shoulders, and there are many triceps exercises that are more effective.

Take care of your shoulders so you can continue to lift those grocery bags, open the car door, wipe the kitchen counter, pick up a child, lift your drink, brush your hair, and reach behind your back to thread your belt through the loops without pain.


Ruth Sova, MS – Shoulders Mini Session 9-8-22

Pauline Ivens, MS & Catherine Holder, PT Do No Harm 2011

See you in the pool!

Author/Instructor Photo
Chris Alexander