How to stay motivated to exercise during the foggy days of a San Francisco summer

Come December, almost every fitness magazine or blog features an article about how to stay motivated to workout during the winter months. The Internet is full of fitness tips for winter, while retailers push the latest in coldweather gear.

San Francisco is a city with little variability in our temperatures, making these articles virtually irrelevant to our fitness buffs. Yet, we do have one weather phenomenon that can be a buzz kill for outdoor recreationalists. While the rest of the country enjoys warm summer days, we often host an unwelcome guest named Karl the Fog. Karl is active on social media, with his very own Twitter, Facebook and Instagram accounts. Don’t get me wrong, some people welcome Karl and appreciate the cooling blanket he provides. It is easy enough to escape his presence with a quick trip inland. Plus, it’s pretty amazing to see his fingers of fog creep across the skyline, hiding the sun and its warmth in a matter of minutes. Others, myself included, are easily affected and develop feelings of fatigue and sluggishness. We may need a little push to get outside for exercise. On my first day of graduate school at UCSF almost 15 years ago, a professor told us to be sure to escape the city on weekends to avoid developing SAD—Seasonal Affective Disorder, a type of depression that often occurs during winter conditions…or, in our beloved city, during the summer when the sun doesn’t shine. I still get a burst of energy when I wake up to a clear, sunny morning. On those perfect days, I can’t wait to get outside and don’t want to waste a rare, beautiful day. Those kinds of San Francisco days make even the foggiest worth it.

So how can you stay motivated to exercise during the foggy days of a San Francisco summer?

      • Appreciate the cool- While the fog may be lingering in your neighborhood, just a few miles in any given direction the temps may be soaring, making a morning workout intolerable. Last weekend I was visiting my hometown and got out for a fairly early run…in 85 degree heat (and loved every minute of it). Yet, friends in hotter climates complain of having to workout at 5:00 am to avoid the heat, or worse, they have to stay in an air-conditioned gym for their daily dose of exercise.
      • Wait it out- Depending on the day, it may actually burn off. But, as soon as you see a glimpse of clear sky, head on out. You never know when Karl will return. It may be a matter of a couple of hours, or might stay clear the rest of the day.
      • Or don’t…There’s a strong chance that he’s here to stay for the day. Embrace the cool climate and know that you’ll have a sunny day soon enough. According to a 2011 study of 229 students conducted at sunny Santa Clara University (1), exercising outdoors was more enjoyable and resulted in less tension and stress, compared to indoor exercise.
      • Try a different neighborhood- In a city known for its microclimates, you can almost always find a sunny spot in San Francisco. Venture to a different neighborhood for some exploration and, fingers crossed, maybe a little sun. Some of the sunniest neighborhood in San Francisco include the Mission, Noe Valley, DogPatch and Potrero Hill.
      • Appreciate your surroundings- The outdoors take on an entirely different look and feel under the cover of fog. Views you have seen a million times, suddenly become new, taking on a different type of beauty. Have you ever seen The Presidio under cover of fog? Or heard the foghorn sounding under the Golden Gate Bridge? The trails in Glen Canyon become beautifully mysterious when shrouded in fog.
      • Take it indoors- There are a ton of great indoor fitness options, if you just can’t drag yourself outside to face the fog. Some of my favorites are TRX, yoga, Pilates, and circuit training workouts in the gym or at home.
      • Grab a friend or play some music- Can’t get out the door? Grab your iPod or call a friend. Both have been linked to increased motivation for exercise. In fact, a 2013 article in Scientific American (2) reports, “Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency. When listening to music, people run farther, bike longer and swim faster than usual—often without realizing it.”

Tips for exercising on foggy days:

      • Don’t overdress- While wet, foggy weather isn’t always cold weather. You’ll learn your lesson if you head out with too many clothes into the often warm, humid air. Your best bet is to dress just like you do for any SF day—layer, layer, layer (preferably in a sweat wicking fabric).
      • Don’t forget the sun protection- Sunscreen and sunglasses are a must on even the foggiest of days. According to dermatologists, 87% of the sun’s rays penetrate through clouds, fog and mist. While these can block sunlight, they don’t effectively block harmful UV rays.
      • Warm up appropriately- Depending on the temps, you may need more of a warm up on a foggy day. I recommend a dynamic warmup and light start to your workout.

Ahh…the sun just came out—time to hit the trails! See you soon, Karl.


1. Plante, TG, et al. Exercising with an iPod, Friend, or Neither: Which is Better for Psychological Benefits? Am J Health Behav.™ 2011;35(2):199-208.
2. Jabr, Ferris. “Let’s Get Physical: The Psychology of Effective Workout Music”. March 20, 2013.

Fit as a…fiddle?



Body image has been a hot topic over the past several years. Recently, many companies have run advertising campaigns to promote healthy body types in reaction to the extremely thin models who have been so prevalent in the media.

The recent video of dancer Misty Copeland has had a huge impact on the dance world and has made us think about the concept of an ideal dancer’s body.  I remember not too long ago, when “athletic body type” was considered a euphemism for “thick” or “heavyset.”  I hope you agree that while Misty is certainly athletic, she is neither thick nor heavyset.

Beyond the notion of an ideal body type, I’ve recently been thinking about the concept of fitness. I blame this partly on recently reading The Sports Gene by David Epstein, and also having just returned from a continuing education class filled with practitioners who each work with a different clientele, including college athletes, golfers, yoga practitioners, and the general population, some more active than others.   As I thought about the baseball pitchers, cyclists, runners, and CrossFit participants with whom we each work, I could easily identify ways they are fit, but I also thought of areas where they may be deficient.  I began to wonder about fitness.

When someone is decribed as “fit”, what does that really mean?  Does it mean the same thing to everyone?  There are different dictionary definitions of fitness, some of which brought a smile to my face:

1. The condition of being physically fit and healthy (I’m going to need a little more here…).

2.  Good health or physical condition, especially as the result of exercise and proper nutrition (ok, we may be getting somewhere…).

3.  The capacity of an organism to survive and transmit its genotype to reproductive offspring as compared to competing organisms (well….I bet you know plenty of people who have the capacity to transmit their genotype to reproductive offspring who you would not call fit).

So, we’re back to the drawing board with defining fitness.

Is a body builder with bulging biceps and massive quads more fit than a marathon runner?

Is Tiger Woods more fit than Serena Williams or Michael Phelps?

What does it mean to be fit?  Ah…what I would do to take a camera out onto the streets of San Francisco and ask people this question (stay tuned…).

As we think about each of the athletes and their respective sports, it quickly becomes clear that fitness is hard to define and describe.  While the bodybuilder might have larger muscles that allow him to lift heavy weights, the marathon runner would certainly show greater cardiovascular endurance across those 26.2 miles.  Tiger Woods and Serena Williams both demonstrate amazing muscular development and precise hand-eye coordination, but if he had to run around the golf course like she does the tennis court, could Tiger keep up with Serena?  Michael loves the game of golf and, like Tiger, has an amazingly strong core, yet I wouldn’t want either one of them representing the other’s sport in competition.

This is an important topic to me both personally and in my work with athletes of all ages, skill levels, shapes and sizes.  To me, there is no one definition of fitness.  I believe that fitness is a balanced combination of strength, stability, balance, flexibility, and endurance…and maybe even mindfulness.  What the general population thinks of as an ideal of fitness may actually be a person who excels in the sport in which they train, but has severe and potentially harmful imbalances in some of the categories mentioned above.  The fittest people with whom I work are those who enjoy a variety of exercise and sporting activities.  These are the folks who are rarely in our studio for treatment, except for the occasional tune up after having changed their routine. Often, the people who appear most physically fit are those who are plagued with injuries related to imbalances in overall fitness.

I’ve learned that there is no one ideal body type just as there may be different ideas of fitness.  I encourage my clients to be successful in their rehab and develop and improve their fitness by recommending a three key steps:

1. Move well and move often.

2. Find something you enjoy doing.

3. Mix up your routine—your body will thank you for it.

So, what does fitness mean to you?

And, in case you were wondering where “Fit as a fiddle” came from…

When should I see a physical therapist?

Many of the patients I treat are extremely active, though few make their living playing sports professionally. They are passionate about their lifestyle and sport of choice, and take their health very seriously.  With many sports and hobbies, aches and pains are likely to occur.  Athletes quickly get used to sore muscles and minor injuries, often considering these a normal part of an active lifestyle.

But should these be treated more seriously?

Many of the patients with whom I work initially ignored what seemed to them to be minor injuries, yet have since become more frequent or more intense.

At what point should you visit a physical therapist?

Read more for quick tips to decide if what you’re feeling needs a closer look.

1. Immediately after a specific injury.

A number of recent studies have shown support for early physical therapy for lower back pain.  The studies show that physical therapy within 2-4 weeks of a lower back injury leads to a decreased risk of surgery and injections, fewer doctor visits, faster recovery, and fewer incidents of chronic pain.

Clinically, I have seen even earlier physical therapy provide excellent results. I am a strong advocate of patients developing a relationship with a physical therapist as a practitioner on their medical team.  I also believe that patients should have email access to their physical therapists in order to communicate updates and ask general questions.  Often, a patient will email or call our office within the first few days of an injury and we will schedule them that day.  Earlier this year, I worked with a triathlete who developed intense back pain after a weekend race.  We saw her the next day and within a week she reported an 80% decrease in her symptoms. The following week she reported a 95% improvement and was able to race again exactly one month later. The sooner we can see a patient post-injury, the faster their recovery from the painful, acute stage.  This allows us to move to more advanced stages of physical therapy earlier, in order to address the root cause of their injury.

2. If an old injury has reappeared or never disappeared!

As I was getting ready to graduate one of my runners from physical therapy the other day, she asked, “but…how will I know if I need to come back?”  It was a great question, yet one without a definitive answer.  Runners, especially, are subject to occasional minor aches and pains.  At what point should they take these more seriously and seek help?

In general, you should reconnect with your physical therapist when:

You feel pain during an activity that gets worse as you continue the activity.  This is a sign that something is not right.

Your pain changes the way you perform the activity.  If you are running down the street with foot pain and you have to limp to avoid it, go home and call your PT.  Remember, the faster the painful symptoms are addressed, the more likely the root cause will be identified and other related injuries are less likely to occur.

You feel pain during three consecutive workouts or activities Often pain will be present at the start of an activity, but will disappear within a few minutes.  Does that mean it should be ignored?  No.  If you are consistently feeling the same or similar symptoms, even if they go away during the activity, schedule an appointment.  Pain is a sign of tissue fatigue or too much stress on a particular part of the body, likely related to an underlying movement dysfunction.  In English?  You’re likely not moving as well as you could, an area of your body is doing more than its fair share of the work, and it needs some help.

3. For an annual check up.

Physical therapists can be, and should be, the medical practitioners of choice for a musculoskeletal wellness/fitness screen, an assessment with a physical therapist to identify risk factors for developing a particular injury.  Much like we visit the dentist on a regular basis, we believe that everyone should schedule an annual preventative visit to their physical therapist to identify and address areas of dysfunction (that tight neck you’ve been complaining about, poor posture, or the shoulder that occasionally hurts in your bootcamp class).  Left undetected, these will likely get worse over time.  We would much rather see you once a year to revise your exercise program and keep you healthy, than have you wind up in our office as our newest patient!

Remember, you shouldn’t try to tough it out or wait until an injury becomes more severe before visiting your physical therapist.  You will wind up suffering needlessly and make our jobs even harder!

If you’re still not sure you should come in for an assessment, feel free to email us:

In your email, please provide the following:

-where is the location of pain?

-how did the injury occur?

-how long has have you had the pain?

-what makes it hurt?

-what makes it feel better?

We will review the information and advise you on the best option for your injury.  This may include advice for self-management, the need to schedule a physical therapy assessment, or a physician contact, if necessary.

Physical Therapists and Exercise

Why work with a physical therapist for fitness? 

PT’s are trained in movement:

We are healthcare professionals trained in optimal patterns of movement, posture, and form and will provide a safe and effective workout.

PT’s are experts in anatomy:

We will design a full body program to address strength, flexibility, cardiovascular health, and balance.

PT’s understand injury:

We will design a program that takes into consideration current and previous injuries, muscle imbalances, and current goals.

At TherapydiaSF, we offer a full selection of wellness services including:

  • Pilates
  • yoga
  • TRX training
  • general fitness training
  • small group classes
  • Fitness Screen: complete assessment of strength, flexibility, balance and independent program design.
  • RunRx: complete assessment of strength, flexibility, and video of running mechanics

It’s Beginning to Look a lot Like…already??

Maiden LaneReady or not, the holiday season is upon us!  The days are shorter, the air is crisp and, believe it or not, decorative snowflakes already adorn San Francisco city streetlights. As our calendars fill with holiday dinners, work celebrations and parties with friends, it can be hard to maintain our normal eating and exercise routines.  Yet, all it takes is a little bit of planning to make it through the season and still fit into your favorite pants come January.

1. Schedule your workouts: Just as you would with any meeting, add your daily workout to your calendar and treat it as you would any other commitment.  Everyone has a preferred time of day for a workout, but when the days get busy, it’s great to have your workout done first thing.  Another benefit of exercising early was shown in a 2011 study at Appalachian State University when researchers discovered that morning workouts are best to help provide a good night’s sleep.  Early morning exercisers slept longer and spent more time in the reparative or deep sleep cycle at nigh

2. Make exercise easy:  If you’re heading out for some shopping, park farther away to get a little extra walk in.  Take a breather from close quarters with family to take a run or walk through the neighborhood.  Almost 13 years ago I started my Birthday Run tradition.  I was born on Christmas and have the good fortune to spend most of my day surrounded by loved ones.  As a way to start to my new year and have some time on my own at the beginning of the day, I take a run the length of my new age wherever I am.  This may be a problem when I hit my 70s, but for now I enjoy the time by myself.  I tried to skip it once on a rainy Christmas Day a few years ago.  Fortunately, my cousin Jordan shamed me into going and, thanks to him, I haven’t missed a Birthday Run in 13 years.  If you can’t head out by yourself, make it a family affair and enjoy some fresh air and exercise with them.

3. Have someone to keep you accountable:  Just like Jordan was my conscience, sometimes it is helpful to enlist a friend to meet for a workout.  If you need a bigger push, schedule time with one of the therapists at TherapydiaSF who can design a program and help you stick with it.  Trained in movement and experts in musculoskeletal anatomy, physical therapists work with both injured and healthy clients.  At TherapydiaSF more than a quarter of our clients take part in our Wellness Programs including group classes, Pilates, TRX, or RunRx.

4. Everything in moderation:  Can’t pass up mom’s mashed potatoes at Thanksgiving or your friend’s toffee at her holiday party?  Feel free to sample, but watch your portions.  My friend and I had a rule around the holidays when we worked together at another PT clinic.  If we were going to indulge in a treat, it “had to be worth it”.  This generally included various homemade and gourmet treats.  Sometimes we disagreed on whether it was worth it, but just asking the question made us stop to think.  Some believe that the Law of Diminishing Returns applies to eating–the more you eat of something, the less enjoyment it provides. At parties, know what you’re eating by making one trip to the food table to fill a small plate versus sampling from passed hors d’oeuvres or revisiting the buffet over and over…and make sure it’s worth it!

What is Wellness?

Seems like everyone I know is a Wellness Coach these days.  Sounds great, but what exactly does it mean?  As much a buzzword in the health, fitness, and nutrition industry as local, organic, and artisanal are to the food and beverage industry, the term wellness may need a little more explanation.

On January 1, 2005 new legislation was passed to allow physical therapists in California to practice “wellness”.  What exactly did that permit us to do?  We could now see clients for “the promotion and maintenance of physical fitness to enhance the bodily movement related to health and wellness of individuals through the use of physical therapy interventions.” It is perplexing that physical therapists, healthcare professionals with extensive training in anatomy, physiology and pathology, had been previously relegated to treating only the injured.  There is no legislation to limit access to personal trainers and massage therapists.  Funny that it took a Senate Bill to allow CA PT’s to work preventatively with healthy adults.

I have always enjoyed my role as Wellness Provider (see definition above).   I believe that physical therapists are best poised to fill this role beyond formal rehabilitation.  Physical therapists have the training and formal education to help you before an injury occurs. You see your doctor and dentist on a regular basis.  Why not schedule an annual exam with an expert in neuromuscular health?

In addition to the Wellness Screen that many clients schedule annually, we offer a range of Wellness Services at TherapydiaSF.  Many clients have continued working with me following rehabilitation for a specific injury because of my training as physical therapist.  For those who wish to schedule Wellness sessions, we offer customized single and partner Pilates or TRX sessions as well as small group classes that are limited in size to provide attention to form. Injured or healthy runners benefit from RunRx, our program to evaluate run form and provide a custom, progressive training plan for improved performance and prevention of injury.


The label “Wellness Provider” is not exclusive to physical therapists.  Other professions use this term though it’s meaning may be different from industry to industry.   If you are interested in working with someone who calls him or herself a Health or Wellness Coach, ask them what it means.  Do they have specialized training in a particular skill beyond their primary occupation?  How are they unique compared to another massage therapist, personal trainer, nutritionist or life coach?

Don’t be fooled by labels.

Solving the Footstrike Puzzle


It seems that just about everyone has an opinion about running.  A few years ago most of the questions I’d get were about the effect of running on joints.  Now, the talk is focused on footstrike patterns–what part of your foot you should land on when running.  Some state that we should be landing on the ball of the foot (forefoot) and that modern running shoes have created generations of heel strikers.  Many of these passionate advocates proclaim that heelstriking is bad for the body and can cause injury.

Turns out, the argument is not so cut and dry.  According to continued research, there may not actually be one right way to run.  This is music to my ears.  I’ve always held firm to the belief that there is more than one way to get something done, including parking the car in the garage…ahem.

The question comes up frequently these days, though appears in many different forms-

“Should I switch to barefoot running?”

“Isn’t landing on your heel bad for you?”

…and much more commonly as a statement,

“So, I tried to change to a forefoot strike…”

“Heelstriking is bad for you.”

“If you run without shoes, you will land on your forefoot”

“Landing on your toes prevents injuries”

Seems like everyone knows all there is to know about running and running form.  Which is actually quite funny considering the researchers and clinicians are all still trying to wrap their heads around the footstrike puzzle.

When I evaluate a runner who wants to change their form, the first question I ask is, “why?”.  We live in an age with endless information at the tips of our fingers and connect with people and groups we don’t even know through social media, many who have strong opinions, seemingly supported by research. The runners with whom I work are tech-savvy, bright, educated, curious, motivated, and sometimes even obsessed.  They collect information from various sources and have other influences–friends, coaches, personal trainers, and other healthcare practitioners who may be suggesting one form over another. It is important I understand the motivation for wanting to become a forefoot striker.  My general recommendation is that unless a runner has an injury that may be helped by modifying form, there really is no reason to try to change how they are running.

A very famous and often quoted research study became gospel truth in 2010 when it was published in Nature.  Harvard researcher Daniel Lieberman studied 5 different groups of runners, including some who had never worn shoes and others who had always worn shoes but ran barefoot.  He evaluated their footstrike patterns as they ran at an average pace of 5:00/mile on a track fitted with a forceplate.  The study concluded that those who had never worn shoes ran with a forefoot strike pattern, implying there would be a difference in the running style of people who wear shoes.  The study also showed a decreased rate of loading and lower collision forces in barefoot runners when compared to shod runners.  However, while the media (need reference) boldly claimed, “running barefoot was less likely to cause injury as a result of the lower impact forces it caused,” the article concludes with a more accurate statement, “controlled prospective studies are needed to test the hypothesis that individuals who do not predominantly rearfoot strike either barefoot or in minimal footwear, as the foot apparently evolved to do, have reduced injury rates.”

A more recent study published this January evaluated the footstrike patterns in a different group of Kenyans.  Though this group is not known for distance running, they are still physically active and, like the participants in the earlier study, do not wear shoes.  Similar to the 2010 study, these runners ran barefoot along a track fitted with a forceplate but at a comfortable, distance-running pace, averaging around 8:00 per mile.  Contrary to the results of the earlier study, 72 percent landed on their heels, 24 percent on the midfoot, and only 4 percent on the forefoot.  However, when the participants were asked to run at a sprint, many landed closer to the forefoot while only 43 percent landed on their heels.  The results of this study seem to indicate that pace may dictate footstrike patterns more than choice of footwear.

One interesting observation that may surprise some is that running barefoot does not necessarily create a forefoot landing pattern.  In my assessment of hundreds of runners over the years, I quickly learned that this commonly held belief is false.  Many runners who think they are landing on their forefoot are actually landing in the middle of their foot or even continuing to strike heel first.  Another important consideration when working with injured runners or those interested in trying barefoot running is that while loading of the knee is decreased with a forefoot landing, loads and the foot and ankle are actually increased.  This may be a reason why someone attempts to modify their landing pattern, but the recommendation must be specific to the runner, depends on many other variables, and should only be made after a thorough assessment by a qualified professional.

TherapydiaSF offers running analysis through our RunRx program.  Call 415.765.1502 or email for more information.


Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG (2013) Variation in Foot Strike Patterns during Running among Habitually Barefoot Populations. PLoS ONE 8(1): e52548. doi:10.1371/journal.pone.0052548

Kleindienst, F.I., Campe, S., Graf, E.S., Michel, K.J., & Witte, K. 2007. Differences between fore- and rearfoot strike running patterns on kinetics and kinematics. International Society of Biomechanics in Sports. Ouro Preto, Brazil.

Lieberman, DE, Venkadesan, M, Werbel, WA, Daoud, AI, D’Andrea, S, Davis, IS, Mang’Eni, RO, Pitsiladis, Y. Foot Strike Patterns and Collision Forces in Habitually Barefoot Versus Shod Runners. Nature. 2010; 463(7280):531-535. 12.

On the Run

I can’t escape it.  My work follows me wherever I go.  Everyone always talks about how PT’s get to leave their work at the clinic.  Once we’re done with the daily documentation there really shouldn’t be anything that has to be done at home.  The one thing no one talks about is how hard it is to take off your PT hat to see the world through different eyes.

It used to be fun.  In graduate school we’d be given assignments to go out in a public space to observe people walking and completing daily activities.  Now I watch people wherever I am, evaluating their every move.   It’s so normal for me that I don’t even realize I’m doing it, much of the time.  It’s not until T and I are on one of our epic urban hikes and I’m performing running analyses on every poor runner who happens to bound by, gleefully unaware that I’m scrutinizing their every step and he tells me, in his kind way, that he’s heard enough.  It’s even gotten to the point where he calls out mechanics he doesn’t like in runners passing by and sometimes I have to tell him, in my kind way, that I’ve heard enough.  Ever the entrepreneur, he recently, and only half-jokingly, suggested I set up a booth on The Embarcadero and offer my services to the scores of runners passing by.

I have, however, begun to see this “problem” as more of a blessing than a curse. I do believe it’s made me a better PT by exposing me to all types of running styles.  I didn’t need to read a running magazine a few years ago to forecast the growing popularity of the minimalist shoe. In the past few years, I have seen a noticeable increase in the number of people running without shoes or in minimal shoes, and with that, a rise in the number of runners who come to me with an injury related to running because they haven’t transitioned correctly or may not be appropriate for minimalist footwear.  I also now see more runners landing on their toes than I have in the past, independent of shoe type, and while some runners look so natural moving down the road, the effort is palpable in many others.

I feel fortunate to work in a city where running is so popular, a job that involves the rehabilitation and prevention of running injuries, and in an era when research on running mechanics, styles, and trends is constantly emerging.  I look forward to sharing what I see and learn…just as soon as I get back from my run.