All Posts tagged Running Injury

Foot Pain? Strengthen your foot ‘core’

Foot Pain? Strengthen your foot ‘core’

As your cold-weather footwear makes the seasonal migration from the back of your closet to replace summer’s flip flops and bare feet, don’t underestimate the benefits of padding around naked from the ankles down.

Barefoot activities can greatly improve balance and posture and prevent common injuries like shin splints, plantar fasciitis, stress fractures, bursitis, and tendonitis in the Achilles tendon, according to Patrick McKeon, a professor in Ithaca College’s School of Health Sciences and Human Performance.

The small, often overlooked muscles in the feet that play a vital but underappreciated role in movement and stability. Their role is similar to that of the core muscles in the abdomen.

“If you say ‘core stability,’ everyone sucks in their bellybutton,” he said. Part of the reason why is about appearance, but it’s also because a strong core is associated with good fitness. The comparison between feet and abs is intentional on McKeon’s part; he wants people to take the health of their “foot core” just as seriously.

The foot core feedback loop

McKeon describes a feedback cycle between the larger “extrinsic” muscles of the foot and leg, the smaller “intrinsic” muscles of the foot, and the neural connections that send information from those muscle sets to the brain.

“Those interactions become a very powerful tool for us,” he said. When that feedback loop is broken, though, it can lead to the overuse injuries that plague many an athlete and weekend warrior alike.

Shoes are the chief culprit of that breakdown, according to McKeon. “When you put a big sole underneath, you put a big dampening effect on that information. There’s a missing link that connects the body with the environment,” he said.

Muscles serve as the primary absorbers of force for the body. Without the nuanced information provided by the small muscles of the foot, the larger muscles over-compensate and over-exert past the point of exhaustion and the natural ability to repair. When the extrinsic muscles are no longer able to absorb the forces of activity, those forces are instead transferred to the bones, tendons, and ligaments, which leads to overuse injuries.

It’s not that McKeon is opposed to footwear. “Some shoes are very good, from the standpoint of providing support. But the consequence of that support, about losing information from the foot, is what we see the effects of [in overuse injuries].”

Strengthening the foot core

The simplest way to reintroduce the feedback provided by the small muscles of the foot is to shed footwear when possible. McKeon says activities like Pilates, yoga, martial arts, some types of dance, etc. are especially beneficial.

“Anything that has to deal with changing postures and using the forces that derive from the interaction with the body and the ground [is great for developing foot core strength],” he said.

McKeon also described the short-foot exercise, which targets the small muscles by squeezing the ball of the foot back toward the heel. It’s a subtle motion, and the toes shouldn’t curl when performing it. The exercise can be done anywhere while seated or standing, though he recommends first working with an athletic trainer or physical therapist to get familiar with the movement.

He notes the exercise seems to have especially positive results for patients suffering from ankle sprain, shin splints, and plantar fasciitis. It’s even been shown to improve the strain suffered by individuals with flat feet.

The payoff could be more than just physical, as there could be financial savings. With strong feet, McKeon suggests that — depending on the activity — consumers may not need to invest hundreds of dollars in slick, well-marketed athletic sneakers (though he doesn’t recommend going for the cheapest of cheap sneakers, either). People with a strong foot core can actively rely on the foot to provide proper support, rather than passively relying on the shoes alone.

“You might be able to get a $50 pair of basketball shoes that don’t have the typical support that you’d expect. Because you have strong feet, you’re just using the shoes to protect the feet and grip the ground,” he said.

The easiest way to get started on strengthening the small muscles of the foot, though, is to kick off your shoes in indoor environments.

“The more people can go barefoot, such as at home or the office, is a really good thing,” McKeon said.

Ithaca College. “Going barefoot: Strong ‘foot core’ could prevent plantar fasciitis, shin splints, and other common injuries.” ScienceDaily. ScienceDaily, 17 November 2015. <www.sciencedaily.com/releases/2015/11/151117181929

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Sports Therapy 101: Muscle Injury

Sports Therapy 101: Muscle Injury

Anyone working in sporting environments would be very familiar with acute muscle injuries.

So how prevalent are they?

It’s been reported that a male elite-level soccer team with a squad of 25 players can expect about 15 muscle injuries each season¹. This equates to an average absence time of 223 days, 148 missed training sessions and 37 missed matches!¹

Despite how often people present with muscle injuries, how confident are you are diagnosing and classifying these injuries?

To be honest, I’ve had trouble over the years confidently grading a muscle injury, especially early in my career when I hadn’t seen many examples.

This widespread difficulty in the clinical setting was perhaps the impetus for a collaborative review of muscle injury classification, via a survey and analysis of 30 sports medicine practitioners thoughts in 2012.

What followed was an open-access publication² in the British Journal of Sports Medicine, which might be the most comprehensive guide for more accurately classifying muscle injuries.

The following is a summary of some of the concepts.

The healing time frames and principles of management more based on my experience.

 

Source: A great website!
http://physiodevelopment.com/classification-muscle-injuries-in-sport/

Classification of Acute Muscle Injuries in Sport

Broadly, a muscle injury can be classified as indirect or direct.

Indirect refers to an internal disruption to a muscle, without any external force/trauma involved.

Direct refers to any trauma (blunt or sharp) that impacts the muscle externally.

Indirect Muscle Injuries

Indirect muscle injuries can be sub-classified as a:
•functional muscle disorder, or
•structural muscle injury.

Functional Muscle Disorder

These can be further classified into the following:
•Type 1: Overexertion-related muscle disorder •Type 1A: Fatigue-induced muscle disorder
•Type 1B: Delayed-onset muscle soreness (DOMS)

•Type 2: Neuromuscular muscle disorder •Type 2A: Spine-related neuromuscular muscle disorder
•Type 2B: Muscle-related neuromuscular muscle disorder

Overexertion-related Muscle Disorder

Type 1A: Fatigue-induced muscle disorder:
•Increase in muscle tone (tightness or firmness) due to overexertion
•Diffuse, tolerable pain, involving up to the whole length of a muscle
•Imaging: clear

Healing Time Frame (approximate)

Less than 7 days.

Management
•Emphasis is on recovery (massage, ice baths, stretching)
•Prevention: •Warming up prior to exercise
•Maintaining good muscle length (stretching)
•Eccentric exercise and conditioning

Type 1B: Delayed-onset muscle soreness (DOMS):

•Generalised pain after unaccustomed eccentric exercise
•Swelling/oedema
•Pain at rest, as well as on isometric contraction
•Imaging: negative, except for oedema

Healing Time Frame (approximate)

Less than 7 days.

Management
•Emphasis is on recovery (massage, ice baths, stretching)
•Prevention: •Warming up prior to exercise
•Maintaining good muscle length (stretching)
•Eccentric exercise and conditioning

Neuromuscular Muscle Disorder

Type 2A: Spine-related neuromuscular muscle disorder
•General ache, with increase in muscle firmness.
•Occasional sensitivity of overlying skin
•No pain at rest
•Imaging: clear, possible oedema

Healing Time Frame (approximate)

Less than 7 days.

Management
•Principles of muscle retraining •Maintain or improve muscle length
•Improve strength (especially eccentric)
•Address any deficit in motor control (functional lower limb)
•Progress with sports-specific retraining

•Addressing any symptoms of lumbar spine dysfunction •Inflammation or irritation around lumbar nerve roots
•Treating any low back movement dysfunction or motor control disorder

Type 2B: Muscle-related neuromuscular muscle disorder

•Cramp like description of pain
•Increase in muscle tone
•May result from dysfunctional neuromuscular control (e.g., reciprocal inhibition)
•Imaging: clear, possible oedema

Healing Time Frame (approximate)

Less than 7 days.

Management
•Principles of muscle retraining •Maintain or improve muscle length
•Improve strength (especially eccentric)
•Address any deficit in motor control (functional lower limb)
•Progress with sports-specific retraining

•Retrain any dysfunction in agonist/antagonist muscle function •Are there adjacent muscle groups that are inhibiting the affected muscle, or contributing to an increase in muscle tone?

Structural Muscle Injury

These can be further classified into the following:
•Type 3: Partial muscle tear •Type 3A: Minor partial muscle tear
•Type 3B: Moderate partial muscle tear

•Type 4: (Sub)total tear

Partial Muscle Tear

Type 3A: Minor partial muscle tear:

•Tearing of small muscle fascicle or bundle
•Sharp pain and sudden onset of injury
•Localised pain, with possible defect on palpation
•Stretching induces pain
•Very often musculotendinous junction
•Often minimal loss of muscle strength
•Imaging: Positive disruption on MRI, with intramuscular haematoma

Healing Time Frame (approximate)

14-21 days

Management
•Optimise environment for healing, based on the stage of tissue recovery
•Maintain or improve muscle length
•Improve muscle strength (especially eccentric)
•Address any deficit in motor control (from a functional perspective)
•Sports-specific retraining and improve overall conditioning

Type 3B: Moderate partial muscle tear

•Tearing of greater diameter than the muscle fascicle or bundle
•Sharp, localised pain at onset of injury
•Possible fall of athlete
•Well defined, localised pain
•Palpable defect in muscle
•Stretching induces pain
•Definite loss of muscle strength and function
•Imaging: Positive with significant fibre disruption, possible retraction, and intermuscular haematoma

Healing Time Frame (approximate)

4-6 weeks.

Management
•Optimise environment for healing, based on the stage of tissue recovery
•Maintain or improve muscle length
•Improve muscle strength (especially eccentric)
•Address any deficit in motor control (from a functional perspective)
•Sports-specific retraining and improve overall conditioning

Type 4: (Sub)total muscle tear / tendinous avulsion

•Tear involving complete diameter of muscle, or tendinous avulsion from bone
•Localised dull pain at onset
•Athlete often falls
•Considerable defect in muscle
•Muscle retraction
•Considerable loss of function
•Haematoma
•Imaging: Subtotal/complete discontinuity of muscle/tendon, intermuscular haematoma

Healing Time Frame (approximate)

A minimum of 12 weeks.

Management

For complete tears, a much slower and extended rehab process follows, guided by pain and changes in muscle tone. The same principles still apply:
•Optimise environment for healing, based on the stage of tissue recovery
•Maintain or improve muscle length
•Improve muscle strength (especially eccentric)
•Address any deficit in motor control (from a functional perspective)
•Sports-specific retraining and improve overall conditioning

Surgery is advocated for complete tendon avulsion, followed by postoperative rehabilitation.

Direct Muscle Injuries

The main type of direct muscle injury to note is a contusion. This is characterised by:
•Direct trauma to muscle by an external force
•Haematoma, causing loss of mobility and function
•Imaging: Diffuse oedema and haematoma at sight of trauma

Healing Time Frame

In the absence of any structural damage, an athlete can often continue playing. If there is any associated muscle fibre disruption, then healing will be based on the severity of the indirect muscle injury (see above).

Management

Again, if there is no structural damage, just localised swelling and oedema, the emphasis is on recovery. Acute management of swelling and haematoma.
Additional Notes
•Healing time frames and management will vary slightly depending on the muscle group involved.
•Risk factors for injury will play an important role, for example (but not limited to): •Age, previous history of muscle injuries, level of competition, physical conditioning, and fatigue³.

References
1.Ekstrand J, Hagglund M and Walden M 2011, ‘Epidemiology of muscle injuries in professional football (soccer)’, American Journal of Sports Medicine, vol. 39, pp. 1226–32.
2.Ueblacker P et al 2013, ‘Terminology and classification of muscle injuries in sport: The Munich consensus statement’, British Journal of Sports Medicine, vol.47, pp.342–350.
3.Bruckner P et al 2014, ‘Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme’, British Journal of Sports Medicine, vol. 48, pp. 929-938.

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Knee Pain: Fix and Prevent. Here’s what research shows

Knee Pain: Fix and Prevent. Here’s what research shows

Knee Pain

Nearly all of us experience knee pain at some point in our lives for various different reasons. Knee pain is mainly caused by overuse of muscles, arthritis, or excessive foot pronation amongst other reasons, with knee arthritis the leading cause of chronic disability for US residents over 65. The good news is, chronic knee pain is actually avoidable, and there are several steps you can take for knee pain treatment.

Recently the New England Journal of Medicine published research suggesting physical therapy and exercise are just as good as surgery when it comes to knee pain treatment for arthritis. Taking good care of our knees by strengthening and stretching the key supporting muscles can prevent knee pain.

With that in mind, here are five useful methods you can try to help reduce your knee pain.

Stretch Your Muscles

We all know that sitting on our butts all day isn’t good for us. When our muscles begin to atrophy or grow imbalance due to this sitting fest, our inner thigh muscles (hip adductors and hamstrings) end up working overtime which often means extra pressure on our knee joints. Taking the time to stretch out our support muscles will lessen the chance of them tightening and causing any muscle imbalances. So, stretch your supporting muscles, and also strengthen weak muscles like your glutes (more about that below).

Strengthen Your Butt

Who thought knee pain treatment would involve your butt? Well, it does. In fact, many knee injuries are actually caused when your hip muscles are weak; this is especially true for Anterior Cruciate Ligament (ACL) tears. Weak butt muscles can cause your pelvis to drop and your femur to fall inward, creating extra stress from your hip right down to your knee and ankle!

A way to combat this is by doing hip extensions in order to help you strengthen up those glutes.

Tone Your Core

Weak core and abdominal muscles are another reason for your pelvis to tip forwards, but they can also cause other health problems and affect areas such as balance. There are plenty of ways to strengthen your core, such as stomach crunches, ab ball exercises, yoga, kickboxing or pilates.

Maintain a Healthy Weight

Being overweight greatly increases your risk of developing knee osteoarthritis (fives times more likely for men, four for women). Research has shown that just a 10 per cent decrease in weight can provide you with an impressive 28 per cent increase when it comes to knee function. How’s that for a fair trade? If you’re suffering from knee pain, try low-impact cardio such as a cross trainer, stationary bike, or water aerobics.

Wear the Right Shoes

Wearing high heels can increase compression on those knee joints by as much as 23 per cent, as well as encouraging tight muscles in your calves; another source of knee pain. Wear shoes that are comfortable and practical when possible, or at least go for a smaller heel when walking is involved.

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Barefoot running: What does the latest research suggest?

Barefoot running: What does the latest research suggest?

Is barefoot best?

Barefoot and minimalist running is growing in popularity across the world, with Americans spending $59 million on minimalist running shoes last year alone! It has been hailed as the natural way to run and as a saviour to those plagued by running injuries. However, Doctors and new research agree that running without traditional running shoes may actually increase the risk of foot injuries.

Research

A study published in last month’s Medicine and Science in Sports and Exercise looked at foot bone marrow edema after a 10 week period of running in Vibram Five Finger minimalist shoes. Twenty-six experienced runners were split into control and test groups, underwent an MRI scan and were instructed to continue running as normal. The test group were instructed to gradually transition to the minimalist shoes.

After the 10 week period, both groups were scanned again. The results indicated that of the 19 in the test group, the majority had developed at least grade 2 bone edema which indicates early bone injury. Three individuals had level 3 edema which the authors state to be ‘an actual injury’ and 2 runners had grade 4 edema – indicative of a stress fracture. Virtually all in this group had also spontaneously reduced their running loads, according to author Dr Ridge, “probably because their feet hurt”.

Discussion

Running barefoot (or in minimalist shoes) has been shown to reduce the body weight impacted on the heel by up to 3 times the person’s weight. This and the change in biomechanics brought on by a mid or forefoot strike can contribute to a reduction in shin splints, tibial stress fractures and knee pain to name just a few.

However, the reduction in heel strike must increase the weight distribution anteriorly, which clearly increases in the bones of the forefoot. Barefoot runners could therefore expect higher rates of metatarsal stress fractures, calcaneal stress fractures and achilles tendonitis.
Whilst running barefoot was the way of our ancestors who ran to survive when hunting (and being hunted!) we should not compare our modern lifestyles to those of cavemen and tribes hundreds and thousands of years ago, or even those in the present day.

For a start, most of us pound the pavement, or at best tarmac for the majority of our runs. Cavemen and tribes certainly don’t (didn’t) do this! They would be (or would have been) running on softer, more forgiving grass and earth which allows far more shock absorption and less bone stress.

Secondly, they are more active populations who use their bodies as intended! For those with desk and driving based jobs especially, who spend large portions of their days in one position, muscle imbalances tend to develop. Weaknesses in some muscle groups and reduced flexibility in others results in altered movement patterns and increased stresses on joints and tendons etc. This leaves us more prone to injuries when we start to perform repetitive movements like running. For this reason, I don’t think we should be placing all the blame for running injuries at the door of footwear manufacturers and citing cavemen as reasons to run barefoot! There are plenty of other culprits out there!

Conclusion

The authors of this study state that:
“Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers should transition very slowly and gradually in order to avoid potential stress injury in the foot.”

Substituting a mere mile per week of normal running at the start with one in minimal shoes “was probably too much,” Dr Ridge says.  Running in this way may have been normal for our ancestors, but it is entirely new for most of our feet and requires a lot of adaptation and development of intrinsic foot strength.

There are also certain individuals who are advised not to transition to barefoot or minimalist shoes at all. Those with poor foot structure or clear biomechanical problems may not be suited to the stresses involved and so should stick to their running shoes. Dr Ridge is now looking in more detail at the runners who participated in her study, to determine if mileage, running form or body weight have more of an impact. The results of this are expected in the summer.

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