All Posts tagged physio

Calf strength in Running and Walking

Calf strength in Running and Walking

Calf Strength in Running and Walking

Running and Walking are both movements that propel us forward, but did you realise that we use a different amount of energy from our lower limb muscles to perform both of these activities?

These differences in the amount we engage our different muscle groups in our lower limb, depending on whether we go for a run or a walk, are important to understand so that you can target your training effectively.

Why is Calf Strength Important?

What you may find most surprising is that both in walking and running our calves do most of the work in our lower limbs, so calf strength is super important to consider in our training. If you want more power in your strides for either running or, walking then spending some time each week on specifically improving your calf strength will definitely help your movement efficiency.

According to research (Novacheck, 1997) when we go for a walk our calves do 53% of the work, whereas when we go for a run our calves do 41% of the work. This is also why our calves are often sore after a walk or run. This can be especially so if we are new to the exercise or have had a break from walking or running for a while. Post walk or running calf stretches and or foam rolling will also help you keep your flexibility in calves.

At Saanich Physiotherapy and Sports Clinic we recommend that if you are going to start doing strength training, it is best to stretch and foam roll your targeted muscles first . Remember each stretch should be held for at least 30 seconds and foam rolling can done for approximately 1 minute on each leg. Now you are ready to tackle your strength training exercises. If you think about it, trying to contract a muscle that is already super tight it won’t be as effective as you will not have as much available muscle length to work with.

Here are some stats on other important muscles groups:

Lower limb muscle use during walking
Hip Extensors – 7%
Hip Flexors – 30%
Hip Abductors – 6%
Knee – 4%

 

Lower limb muscle use during running
Hip Extensors – 14%
Hip Flexors 20%
Hip Abductors 3%
Knee – Quads 22%

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Swimmer’s shoulder

Swimmer’s shoulder

With ninety percent of the driving forces coming from the upper body, it is little surprise that swimmer’s shoulder is a common condition in swimming. The shoulder is a complex joint, and as swimming placed it under load, an appreciation of its function and limitations can help keep the body injury free. This is especially true for those who swim very regularly or have poor stroke technique, as they are most at risk.

Shoulder mobility as a strength and a weakness

Compared to other joints in the body, the shoulders and hips have an unparalleled range of motion. This is due both of them having ball and socket joints capable of a 360 degree conical movement. However, stability for each of these joints differs. The hip joint fits snugly like a ball in a glove, as the rounded head of the thigh bone, fits into the deep, cup shaped socket of the pelvis. Unlike the hip, the shoulder has a small flat socket about half the size of the ball, along with several other bones, plus a collection of muscles and tendons that support this wide range of motion. Although one of the largest and most complex joints in the body, its unique structure is also a weakness, as the shoulder accounts for up to 20% of all athletic injuries and is the most commonly dislocated joint in the body.

This balance between shoulder mobility and stability is put to the test during sports that require overhead motion. Racket sports such as tennis, or throwing sports like volleyball require two or three patterns of overhead movement. Swimming however, requires multiple overhead movement patterns and a steady conical 360 degree motion of the humerus, the bone of the upper arm. This bone fits into a socket of the scapula, more commonly known as the shoulder blade, which has a cuff of cartilage called the labrum. This ring of rubbery tissue helps keep the ball like head of the humerus in place.
As the humerus fits loosely into the shoulder joint compared to the hip, a collection of muscles and tendons known as the rotator cuff, provide support for raising and rotating the arm. To further aid fluid motion there is a small sac of fluid called a bursa that protects and cushions the rotator cuff tendons. It lies between the rotator cuff and the roof of the shoulder blade, which has two bony projections, the coracoid process and the acromion, which is above the bursa and attaches to the clavicle. Otherwise known as the collar bone, the clavicle, makes up one of three bones of the shoulder, the other two being the previously mentioned humerus and scapula. These three bones are connected to the shoulder by four joints, one being the ball and socket joint of the humerus and scapula, one for where the scapula meets the ribs at the back, and two for the clavicle which joins the scapula at one end and the chest bone at the other.

All of these structures have the potential to be injured, and as such swimmer’s shoulder can derive from a variety of sources. An appreciation of the forces at work upon the body during swimming, can provide a greater understanding of the root cause of swimmer’s shoulder.

The sources of swimmer’s shoulder

Good swimming technique requires a greater range of motion and flexibility of the shoulder compared to other sports and plays a major role in the upper body’s ability to provide locomotion. This placing of the shoulder under load, is further increased since swimming is performed in a fluid medium. As opposed to air, water creates greater resistance and forces upon the structures of the shoulder.

In one study, two thirds of the elite swimmers reported shoulder pain. In some cases swimmer’s shoulder can involve irritation to the tendons of the rotator cuff muscles, but it can also be due a range of painful shoulder overuse injuries such as impingement. This is where the shoulder blade’s bony point that joins with the collar bone, rubs on the rotor cuff and bursa. This can then lead to inflammation of the bursa, known as bursitis, or tendonitis.

The four tendons that make up the rotator cuff and one of the bicep tendons are most commonly affected by tendonitis, once again as a result of wear. Like with any other joint in the body, the ligaments, tendons, and muscles around the shoulder can tear or become loose. This can lead to instability in the shoulder and the chance of greater injury, such as a tear to the the ring of cartilage that holds the humerus in place, or dislocation. Also these areas can be affected by chronic conditions such as osteoarthritis.

The repeated overhead motion of the arm in swimming and pressures placed upon the shoulder joints in water, mean that immediate care of a newly acquired injury and preventative measures are essential. Seeking physiotherapy treatment can identify the exact area of injury, alleviate pain and then planning can be put into place to regain stability, strength and flexibility. For example a gym program with some simple strength and flexibility exercises can be easily prescribed. Through future self management of the swimmer’s shoulder condition there lies the opportunity to proactively train the body so as to minimise the risk of injury.

Managing shoulder health

First of all as with any inflammation injury, the PRICE principle should be applied to the shoulder. This is achieved by protecting the injured area, resting the shoulder, applying ice for 15-20 minutes every two to three hours, compression with a bandage and elevation of the arm above the level of the heart.
Once the area has recovered due to rest or treatment by a physiotherapist, and a strengthening plan has been devised for the injured area and surrounding structures, then it is time to venture back into the water. At this point advice from your physiotherapist, doctor should be taken and the help of a qualified swimming professional or experienced swimmer could ease the transition back to the pool.
After all investigating and understanding proper swimming stroke technique, could prevent a relapse of injury and aid in the rehabilitation of an recovered shoulder. It is also important to know the limits that a recovering shoulder can take, being sure to train conservatively so as to avoid tired muscles. This is also true for those who are injury free, as training at a limit within the body’s fitness level will maintain stability of the shoulder and aid correct function.

Prevention through correct technique

Swimmer’s shoulder can develop with all styles of swimming, with freestyle, backstroke and butterfly seen to be the most responsible for injury, as the arms circle overhead. Although the most gentle looking, breast stroke still places pressure on other parts of the body, and like the other styles, requires good technique to avoid injury. So an option could be to vary the types of swim stroke performed, as this can provide rest and recovery to muscles, joints and tendons that would otherwise be overworked. Refining the technique and building the strength of each swimming stroke style can also avoid other swimming conditions that effect the knees, neck and lower back.

In general terms there are four areas of swimming technique that can aid protection against shoulder injury. As with land based activities, good posture is essential, so keeping the shoulders back and the chest forward will help. Next is developing symmetrical body rotation, that is encouraged by a balanced left and right breathing pattern. This allows for better support to the rotator cuff and generates more power by engaging the muscles of the back and core.

Regarding the best practice for stroke technique, hand placement as the arm enters the water and the shape of the arm when pulling through the water, are also essential in injury avoidance. It is best to have a flat hand as it enters the water at the start of a stroke. This is fingertips first, rather than thumb whereby the arm is rotated outwards. Lastly as the hand then catches the water and pulls through, the elbow should be high so that the water is pushed back, rather than down when the elbow is dropped or the arm is very straight.

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Biomechanical Running Analysis

Biomechanical Running Analysis

Running Analysis

A Running Analysis at Saanich Physio involves one of our experienced Physiotherapists observing and assessing how you run. We will watch you in real time and also video you, so that we can analyse your form in slow motion.

This kind of analysis is helpful whether you have an injury or if you want to know if you are running with optimal technique. We will explain our findings to you, with analysis of how certain movement patterns or imbalances may contribute to your injury or efficiency as a runner.

We highly recommend this no matter what level of ability you are, whether a beginner, weekend jogger or competitive athlete.

We Are Runners
We feel that in order to understand runners and running injuries, it’s helpful to be a runner yourself. Our Physiotherapists are all keen runners and between them have competed in short and mid distance track events all the way up to half marathons, full marathons and ultra-marathon distances.

Video Analysis
We watch you run in real time, then record you and analyse your form using slow motion video. We will outline how your form compares to the ideal. We will only look to change particular elements of your form if it is impacting on your injury, efficiency or if it will help you prevent injury.

Education
We focus on education, with a clear explanation of our findings and how they impact your body. We work with you to achieve a more efficient running technique.

Results

Our aim is to get you back running as quickly as possible if injury is stopping you. We will provide specifically targeted exercises and a return to running program if needed. Our aim is to help you achieve a stronger form, become more efficient, and prevent injury.

Our experienced Saanich Physiotherapists will analyse your running technique and help you achieve better form to prevent injury and maximise efficiency.
Your Physiotherapist will start by discussing your running program and injury history with you.

They will then video you running. From observing you in real time and also through slow motion recording, they will explain what ideal running form is and how your technique compares.

Based on the findings from the video analysis we can give you specific and individualised cues to help improve your form. You will have a chance within the session to practice this on the treadmill and review your video footage.

A biomechanical assessment may also be performed to test your joints and muscles for flexibility and strength. From this information we will create a specific and focused treatment plan that will work to correct your imbalances and help you become a better runner.

Three Steps to Better Form

Video analysis and running assessment software

Biomechanical assessment of your strength and flexibility

Personalised video home exercise program which can be accessed on your smartphone or computer

Conditions Treated

Patellofemoral joint injury/runner’s knee

Gluteal tendinopathy

Achilles tendinopathy

Patellar tendinopathy

Shin splints

Hamstring tendinopathy

Groin pain

Tibialis posterior tendon injury

Plantar fasciitis

Iliotibial band syndrome

Hip impingement, labral injuries

Foot pain

Stress fractures

Chronic strains and sprains

and more!

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Prevent falls, promote health

Prevent falls, promote health

Falls cause 2/3rds of deaths due to unintentional injury in the elderly, which is the 5th leading cause of death of people over 65 years of age.

A fall by an elderly person can be defined as “a situation in which the older adult falls to the ground or is found lying on the ground” or “any unintended contact with a supporting surface, such as a chair, counter or wall”. (Shumway-Cook & Woollacott 2017)

We have your health in mind, and the prevention of such an adverse event, in our best interest and priority. We have decided to write a blog post to provide you with information to help minimise your risk of falling and increase your chances to lead a fit and healthy aging process.

The following list presents risk factors that are relevant to individual factors that increase the chance of falling:

Muscle weakness
History of falling
Walk with a limp
Poor balance (feel wobbly when walking)
Use of a walking aid (e.g. walking stick or frame)
Poor vision
Arthritis
Depression
Poor cognition (e.g. memory/ ability to problem solve)
Age greater than 80 years old

Are any of the symptoms listed above relevant to you?

It is difficult to attribute ageing as the sole reason for the development of the traits listed above, as older adults of the same age can demonstrate physical function ranging from physically elite to entirely dependent on others for all activities of daily living. However, there are some common trends of declining function to do with the neuromuscular system which occur in older adults, and although age may not be the main cause for these changes in the systems of postural control, it is likely, increasing age has a detrimental effect.

The aspects of the systems of postural control potentially detrimentally affected by age include:

Muscle strength
Range of motion
Static balance (ability to remain stable when you are not moving)
Dynamic balance (ability to remain stable with movement)
Reactive balance control (ability to sequence movement, time muscle activation and adapt to changing tasks and environmental demands
Anticipatory balance control (the ability to stabilise the body before performing a movement)
Sensation (the ability to detect change in the external environment through vision, hearing, touch, ability to sense vibration, and proprioception, or the ability to sense where your body is in space)

It is also necessary to comment on the loss of bone density associated with increased age (>50 years old). A loss of bone density increases your risk of fracture when falling and is something everyone can and should actively work to minimise.

Our Physiotherapists are pleased to guide you and minimise your risk of falling. Therefore, we have developed a very simple home exercise program for all readers, using equipment all should have access to, to enable you to take action to reduce your risk of developing risk factors of falling and consequently your overall risk of falling, immediately!!:

Sit to stand (to increase muscle strength)

Sitting upright in a chair
Lean forward with hands on chair
Push through arms and heels keeping back straight
Squeeze your buttocks to stand as tall as possible
Repeat 15 squats
Perform 3 x daily

Thoracic extension (to increase range of motion)

Sitting on a chair which has a high back
Place a rolled towel horizontally behind your shoulder blades
Place both hands behind your neck and interlock your fingers
Touch elbows together
Bend backward to a comfortable position and hold for 30seconds
Perform 3 x daily

SLS (to increase static postural control)

Standing next to a stable object
Place one hand on the stable object
Lift one leg off of the floor to form a L-shape
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat on the opposite leg
Perform 3 x daily

SLS – Eyes closed (to enhance sensation especially proprioception)
As above, however once stable, close your eyes and hold for 30 seconds

Tandem stance (to increase static postural control)

Standing next to a stable object
Place one hand on the stable object
Place one foot directly in front of the other, so that your toes of the back foot are touching the heel of the front foot, forming in a straight line
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat with the opposite leg in front
Perform 3 x daily

Tandem walking (to increase dynamic postural control)

Continue to get into the position as above, however, continue walking – like you are walking on a tightrope! (We recommend alongside the kitchen bench for safety precautions)
30 minutes of walking daily (to increase bone density, dynamic postural control anticipatory balance and importantly cardiovascular fitness – or heart and lung health!!)
This program is very basic and does not cover all of the aspects of postural control. Please make an appointment with one of our physiotherapists to extend your exercise program, so that we can make it more tailored to your needs and more interesting. We will use modern, exciting equipment and more fun movements!!

Finally, the following listed items are external factors that also increase one’s likelihood of falling. They are known as secondary factors and are easily controlled:

Stairs
Throw rugs
Slippery surfaces
Poor lighting
Clutter in the home
Uneven pavement

Please take a moment to consider how you can minimise your risk of falling through controlling these listed items, for example placing non-slip mats in the shower, reducing clutter in frequently used walkways, having a bedside lamp to use when going to the bathroom in the middle of the night.

We hope you have found this blog helpful and please do call us for any questions or comments.

Reference:
Chapter 9 Shumway-Cook, A & Woollacott MH 2017, ‘Aging and Postural Control’, in M Nobel (ed.)Motor Control: Translating Research into Clinical Practice, 5th edition, Wolters Kluwer, Philadelphia, pp. 206- 228.

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