As the carefree days of summer come to an end, it can be difficult to transition back to a regular schedule. The start of a new school year can be a time for cheers and tears for both parents and children and the stress can only be magnified when your child is dealing with bathroom issues.

During the summer months kids have the freedom to use the toilet as needed and not on a predetermined schedule based around the school day. This can lead to an increase in bathroom issues for children already experiencing problems with bowel or bladder accidents or even a new onset of problems that your child had not already been dealing with.

Ways to Help

• Allow plenty of room in the morning schedule for potty time. Mornings can be stressful and rushed so allow a few extra minutes for your child to have any opportunity to take care of business if needed.
   
• Make sure your child knows where the closest bathroom to his or her school classroom is, along with understanding the classroom policy for going to the toilet if needed during class time. Often times children don't feel comfortable going to the bathroom in a strange or new place and will wait until it is too late.
   
• Help your child remember to go to the bathroom during the school day. Discuss at home the importance of using the toilet during break time and lunchtime. Kids often pass up the opportunity to go to the toilet and would rather use the free time for play. Check in with your child after the school day and ask if they used the toilet at school to stay informed of your child's bathroom habits.
   
• Talk to your child's teacher and school nurse if bathroom issues are a problem. They can then be more aware of the situation and realize that any requests for a bathroom pass out of the normal scheduled breaks are valid and needed.
   
• Pack an extra set of clothes, underwear, and socks for your child in a plastic bag to have in case of accidents. They can then use the plastic bag for any soiled clothing to bring home.
   
• Make sure your child is hydrating well during the day. Encourage the use of a water bottle if allowed in the classroom or frequent stops at the water fountain. Inadequate water intake can lead to constipation or increased urinary symptoms if their urine is too concentrated.
   
• Encourage your child to spend adequate time on the toilet. Kids often rush through toileting and don't spend enough time to fully empty their bowels or bladder. They also tend to ignore any bowel or bladder urge if something more exciting is happening or they don't want to miss playtime. Encourage your child to listen to their body and not postpone trips to the toilet.

Hopefully with a consistent emphasis on good toileting habits, bathroom issues can be held to a minimum or eliminated. If your child continues to experience problems with wetting or soiling, discuss these issues with his or her Pediatrician to make sure no other medical issues are present. CTS can also be a resource for any bowel or bladder issues with our Pediatric and Teen Bowel and Bladder program.

Jill Menefee, PT

No, don't worry, we are not going on strike! We're going to discuss the types of foot strike that occur with running. There is often much debate on how one's foot should hit the ground during a run in order to improve efficiency and reduce injury. We have all heard varying evidence behind whether to heel strike or to forefoot strike. To wear minimalist shoes or cushioned soles. It can all become quite confusing, and even a bit overwhelming for the average runner looking for a bit of exercise. Here, we will break down the various types of foot strike, and also discuss some tips on how to improve your own running form.

The heel striker. With a heel strike (rearfoot) gait pattern, the heel comes in to contact with the ground first followed by the rest of the foot. More often than not, in this case, the knee will be straight as the heel makes contact with the ground, which puts added stress on the knee. The leg is also more likely be further away from the runner's body as it lands. This is called over striding. Over striding causes the heel to essentially act as a brake, making one's body slow down as it has to catch up with the extended lower extremity. In other words, the runner has to work much harder in order to maintain their speed. However, this is not always the case, and if you can heel strike with your foot landing close to your body, and with your knee slightly bent, then you can prevent the braking mechanism and increased load to the knee.

The midfoot/forefoot runner. In this case, the foot is in a more plantar flexed position, and middle portion of the foot hits the ground first starting with the outside, and briefly touching down with the heel. The runner's knee is also in a slightly bent position when the foot makes contact with the ground, which reduces the stress to the extended knee, as is common in heel striking. In this type of running, the runner tends to have a shorter stride length, resulting in the foot making contact with the ground much closer to the individual's body and improving efficiency.

Now, whether you are a heel striker or midfoot/forefoot striker the importance lies in efficiency. We want our run to be as energy efficient as possible in order to prevent injury and fatigue. First, as you run, think of where your foot is as it hits the ground. You want your foot to make contact as close to your body as possible. Shortening your stride length will also increase the rate at which your foot hits the ground. This is known as cadence.

Next, tread lightly. The harder and louder your foot hits the ground, the more force it places on your joints. Think quiet, soft strides as your foot makes contact with the ground.

Last, we want to maintain an upright trunk with a slight forward lean and relaxed shoulders while we run. This requires a strong and stable core, and good postural control.

As always, consult your physical therapist if you have any questions about your running technique. Happy trails!
 

Toni Flynn, PT, DPT