Running Injury Magnet: Training and Injury prevention and treatment: October 2011

Monday, 31 October 2011

Lululemon Running Ambassador Photoshoot

Lululemon Running Ambassador Photo shoot

So today was my Lululemon Running Ambassador Photo shoot!!! It was an amazing day with photographer Bruce, and Community Leaders Laryssa and Sean! Great help from Taryn and support from the new Yoga Ambassador Kat! We had amazing weather, beautiful leaves and such a great shoot! Such beautiful and comfortable clothing with such great features! Here is a sneak peak of some of the shots from today's photo shoot!

Sunday, 30 October 2011

A Physiotherapist’s Perspective on Barefoot Running

by Karen

Crazy runners or cutting edge scientists? As a physiotherapist I am very skeptical about new trends in the world of running. So when I started hearing about a whole new breed of runner trotting along on the soles of their feet, naturally I raised an eyebrow or two. I mean what the heck is with these people? Barefoot? Shoes with toes? Really? Over my running career I have spent thousands and thousands of dollars on good quality footwear, and orthotics assuming these were helping to reduce impact and my risk of injury, so when I learned what research was saying about the impact of myfootwear choices I was more than a little shocked! So here is what the research, not just that crazy barefoot guy, is saying about barefoot and minimalist running!

Research says Running Barefoot has been shown to:

Decrease the total energy demand per step and improve efficiency of running gait, allowing you to run faster with less effort.

Improve performance by increasing a runners stride frequency closer to the optimal rate of 180 steps per minute.

Decrease the amount of ground reaction force on the body.

Increase stability at landing by changing the point of landing from heel strike to mid or forefoot, which decreases pronation and supination of the foot.

Decrease contact time with the ground, decreasing the opportunity for stress on the body.

Proceed with Caution

As a well-read and practiced physiotherapist, am I really telling you to throw caution and footwear to the wind? The final decision is of course up to you but please remember the following:

80 % of all injuries are caused by doing too much too soon

Shoes were created to protect the foot from sharp objects, snow, and burning hot concrete. The modern runners foot and body has gradually adapted to the use of shoes, especially those with large bulky heels and any sudden change in footwear, cadence, or running style increases your risk of injury.

Any change must be gradual to wreak the benefits of minimalist or barefoot running without increasing your risk of injury!

New Balance claims their lightweight trainer "Minimus" is "Radically Simple. Simply Radical"

If you are tempted to experiment with barefoot running I suggest trialing a very lightweight racing flat with very little heel before minimalist shoes or barefoot running.

Let us know about your trials with minimalist/barefoot running on ourfacebook page.

Karen Gilbert is a physiotherapist at CBI Health Group in London, Ontario and a competitive distance runner. Karen enjoys bringing together her love of running with her love of treating patients.

The Tensor Fascia Lata…not a drink you order at starbucks!

October 19th, 2011 by Karen

As runners we are often told we need a strong butt. And with that comes all this talk of this thing called the TFL…? So to give some clarity on the topic of butt’s and the TFL, here is a short and sweet piece for all you super keen runners out there!

The Tensor Fascia Lata (TFL for short) is a very long word for one pretty short muscle in the hip. This muscle helps to bend the hip up and out to the side. The TFL works during what is called the “swing phase” of the running gait cycle. The swing phase is the time in which the leg is off the ground and is pulled forward.

The TFL often works with two other muscles on the front of the leg, called the iliopsoas and the quadriceps, to bend the hip. In combination, these muscles are called the hip “flexors”. The TFL also has another job, which is to rotate the hip out. The TFL gets help from some of the buttock muscles to perform this movement.

The TFL connects to a long band of tissue called the iliotibial band (IT Band). The IT band runs along the side of the leg and attaches just below the knee. Runners often have short and tight hip flexors in combination with lengthened and weak buttock muscles. The buttock muscles work with the TFL to stabilize the hip, thus when the buttock muscles are weak, the TFL works extra hard to compensate during running.

As the TFL gets tight the IT band is more likely to rub or pinch the structures on the outside of the knee creating pain at the knee or at the side of the hip. This pain is callediliotibial band syndrome.

See my article on Iliotibial band syndrome for strengthening and treatment tips.

About the Author: Karen Gilbert is a physiotherapist at CBI Health Group in London, Ontario and a competitive distance runner. Karen enjoys bringing together her love of running with her love of treating patients.

Running Injury #5 Achilles Tendonitis / Tendinopathy

by Karen

Even the greatest warrior in the battle of Troy could not escape the pain and untimely demise of his Achilles tendon, so why should the almighty runner?

The Achilles tendon is a band of tissue that connects the calf muscles to the heel bone. Part way through the tendon there is an area that gets less blood flow. Because of this decreased blood flow the tendon is slow to heal after injury.

How do you know if you have it?

Achilles Tendonitis is pain felt at the back of the leg just above the heel. It is typically worse when you start walking or running, decreasing as you continue to exercise. The pain often worsens several hours after you stop exercising.

Within the first week or two of injury this is called a tendonitis (which means swelling in a tendon), when the condition becomes more chronic it is called a “tendinopathy” (which means a sick tendon). The cause of tendonitis or tendinopathy is an increase in the amount of load or stress on the tendon and is therefore called a “load injury”. A load injury can be caused by doing too much speed work, up-hill running or plyometrics.

So how do you treat it?

To treat a tendon-itis you want to use the RICE formula of Rest, Ice, Compression and Elevation. You should avoid anti-inflammatories as these will decrease your body’s natural healing response.

To treat a tendon-opathy the most effective treatment is one aimed at increasing your body’s ability to heal itself. Eccentric exercises including calf raises on the floor or a small step (with a focus on slowly lower during the down phase of movement) are most effective. A high number of repetitions of this exercise are required allowing a small amount of pain during the exercise, but not after, is recommended. Avoiding anti-inflammatories is essential.

Other treatment tips include stretching the muscles on the back of the leg and using a heel lift in your shoes for daily walking to temporarily unload the Achilles. Avoid anything that creates rubbing on the back of the heel.

Please ensure that you seek help from a qualified health care professional should your symptoms not resolve. Treatment options provided by a physiotherapist that can help decrease pain and speed healing include ultrasound or acupuncture, various taping techniques, manual therapy, and stretching and strengthening exercises in addition to those outlined above.

Running Injuries #3 Shin Splints

The Dreaded "Shin Splints"

September 20th, 2011 by Karen

There are very few people in the world of running who have escaped the pain in the lower leg that is shin splints.Shin Splints, or medial tibial stress syndrome, is a sharp pain on the inside of the leg that comes on either before, during or after running. Pain usually decreases with rest, but as we all know, runners do not like to hear the word rest.

But I have been working so hard to get faster! What do I do now!?

Shin Splints is most often caused by an increase in training, especially if you have started or increased the amount of speed work, plyometrics (drills or quick jumping movements), or up hill running.

Because of the cause, this injury is classified as a ”load injury”. This means that your body is not used to the high load and stress created by speed work, hills or drills, creating swelling and pain at the inside of the leg.

Oh No! I have a race in a few weeks and I just HAVE to get better!

Don’t stress, you can still keep running! For now you will have to nix the speed work, hills and plyometrics. Go back to training on more level surfaces, start cross training, especially pool running, since it is the most sport specific to decrease the load on the body!

Get in the ice bath!

Sorry folks, I know it’s cold but spending 5 minutes with your shins in a bucket of cold water with a tray of ice cubes thrown in will decrease pain and swelling and get you back to your pre-injury running much quicker! Other essentials are stretching the calf and hamstrings, and using a foam roller on the inside of the shins.

Get Stronger= Get Better!

To speed healing and prevent this from happening again, start doing 1 legged step downs over a small step, toe raises (lifting the top of the foot towards your shins then slowly lowering), and towel pulls (with your foot on the floor and your heel on the ground, use your toes to pull a hand towel from the outside to the inside of your foot.

Okay I tried that stuff but I still have pain!

If the pain doesn’t go away you should go see a health care professional such as a physiotherapist for other treatment options include ultrasound or acupuncture. You should also make sure you aren’t suffering from something more serious like stress fracture or compartment syndrome.

Plantar Fasciitis: Don’t Let it Slow You Down!

Most Runners know someone who has suffered from the dreaded morning shock ofPlantar Fasciitis. As if mornings aren’t rough enough, now you have to suffer stabbing pain on the bottom of your foot when you step down from your evening slumber.

Plantar Fasciitis is described as sharp pain on the bottom of the foot. Pain is worse first thing in the morning when you step out of bed, with toe-off, or with walking or running, and sometimes improves throughout the day.

Pain is most often caused by running too far too soon before the tissue has adapted, causing inflammation and degeneration of the fascia (connective tissue) on the bottom of the foot. Pain is often felt at the heel, where the fascia originates. Sudden changes in footwear or training surface may also be a cause.

Because plantar fasciitis is worse in the mornings, most runners suffer through the pain to get in their daily mileage. You can run through it but pain typically gets worse and starts to limit the distance you are able to run pain free. If the condition becomes quite severe, heel pain can plague even your daily walking! I find it hard to understand why anyone would want to suffer the pain of plantar fasciitis when early treatment can be so effective.

To beat the morning bummer try these treatment techniques:

For pain and inflammation: try to unload the fascia with techniques such as taping ororthotics. These should be used short term only. Ultrasound, and acupuncture are other treatments performed by health care professionals such as a physiotherapist, chiropractic, or massage therapist. Soft tissue massage helps to decrease sensitivity of the tissue and flush out by-products of your body’s natural healing process that often pool in the foot in the a.m causing the sharp increase in pain when your foot is placed on the ground.

To increase range of movement and tissue length: try stretching out the calf and hamstring muscles. Eccentric calf raises also help to create changes in the tissues that speed healing. Use of a frozen water bottle or golf ball under the foot also helps to loosen the connective tissue on the bottom of the foot.

To correct biomechanical flaws and strengthen the pelvis and lower limb: try one- legged squats over a small step ensuring that the knee stays in alignment with the second toe.

Most importantly remember that Plantar Fasciitis is primarily caused by over training. Be sure to increase your weekly mileage by no more than 10% in distance and 3% in intensity!

Top 5 Running Injuries #2: Iliotibial Band Syndrome

So your running along one a sunny Sunday morning, the wind is flowing through your hair and your body feels great –or does it? A sudden sharp pain on the outside of your knee starts about 5 km into your run. What the heck is that?! Your forced to cut your run short and you are NOT happy about it. The next day you try again and about 1km into your run the pain starts again and AGAIN you have to stop running, and this time you didn’t even break a sweat! Now you are really MAD! WHAT IS THIS PAIN?!

Iliotibial band syndrome or “ITBS” is cited as the second most common running injury (Tucker 2009) and is experienced as a burning or aching pain at the hip or outside of the knee. Pain increases when the knee is bent or straightened, going down stairs, or at a specific point during a run. Pain often decreases or goes away after a run.

What the heck is the iliotibial band? It is a long band of fascial or connective tissue that runs from the top of the hip down the side of the leg, attaching to the lower leg.

What is the cause of ITBS? The primary cause is too much too soon. The constant rubbing caused by the repetitive nature of hundreds or thousands of steps, before your body has adapted to the demand, leads to inflammation, irritation and scar- like tissue with poor blood and nerve supply.

Can I run through it? Not if the pain is severe.

As the condition worsens, pain comes on earlier in a run, no longer resolve after the run, or starts to bother you during daily activities. If not treated pain could prevent you from running for weeks!

How the heck do you fix it?

To reduce pain try ice or anti-inflammatories, modify your mileage or intensity, or seek professional help for ultrasound or acupuncture.

Strengthen weak gluteal muscles, and stretch or foam roller tight structures. Great exercises to increase gluteus medius strength include clamshells, leg raises, fire hydrants, or side jumps onto a bosu.

Gradually increase your painfree-mileage when returning from injury, making sure to cross train with short bouts on different machines to reduce the constant repetitive irritation on the outside structures. Try running faster rather than further as you gradually get back to running.

If it won’t go away? This type of injury can really end a season if you don’t get on top of it right away. I would suggest seeking treatment by a Physiotherapist, Massage Therapist, or Doctor early on. If this is a chronic thing for you make sure to get assessed to ensure you aren’t suffering from other conditions with similar symptoms such injury to the knee joint, or stress fracture.

Top 5 Running Injuries #1: Runners Knee

Paterllar femoral pain syndrome (PFPS), or “Runners knee” is the number one cited injury for runners (Tucker 2009).

Experienced as mild to severe pain at the base or behind the kneecap this condition is often accompanied by a grinding sensation. Runners complain of pain with running, stairs, bending the knee, or prolonged sitting. Pain usually occurs at a specific distance or time during a run but as the condition worsens pain can occur earlier in your run, post run, or even at rest.

So great, I know what I have but can I run through it?

The answer is yes…and no.

Science has found that no structural damage occurs inside the knee with PFPS but the constant rubbing turns on pain receptors which tell your body you’re in pain, create swelling, and turn off muscles that support the knee. This could create compensatory strategies, creating real damage anywhere along the kinetic chain. Your best bet is to take a step back in your training, and engage in only pain-free running or exercise.

I realize this is a hard concept for us runners but PFPS can easily be treated allowing you to get back to your typical mileage in no time!

Okay so how the heck do I fix it you ask?

To reduce pain try ice or anti-inflammatories , modifying your mileage or intensity, get fitted for proper running shoes and run on flat surfaces.

To improve kneecap tracking pay attention to your running form to stop your knee from buckling towards midline while loading, strengthen weak gluteal muscles and stretch tight structures like the IT band. Great exercises to increase gluteus medius strength include clamshells, leg raises, fire hydrants, or side jumps onto a bosu.

Gradually increase your mileage when returning from injury, running the distance you are able to perform pain free.

What do I do if it won’t go away?

Seek help from a Physiotherapist, Doctor, or Massage Therapist for further treatment and to ensure you aren’t suffering from other conditions with similar symptoms such injury to the knee joint or cartilage, or stress fracture.

Running Injuries 101

If you run to win, if run to loose (weight that is), if you run to belong, or you simply run because it is what you have always done. Whatever your skill level, whatever your goal, there seems to be no escaping it.

Injuries.

Injuries are what separate those who can from those who cannot. We’ve all had a season when all our hard work and calculated planning seems to blow up in our face. And when we do we look back over our training and wonder, “where did I go wrong?”

The answer is obviously different for everyone and although I can’t give you a quick fix solution, as a Physiotherapist and an avid runner, I can give you ways to treat it, prevent it, and kick butt despite it! I hope that by identifying the top 5 injuries runners suffer I can help make those devastating seasons, even the elite athletes suffer from, a thing of the past!

I can’t cover everything I’ve ever learned in one article so stay tuned for each part of this series where I will outline one running injury, how to know when you have it, whether you can run through it, and most importantly how to get rid of it!

So here we go, the top five running injuries is no particular order:

Patellar Femoral Pain Syndrome
IT Band Syndrome
Shin Splints
Plantar Fasciitis
Achilles Tendonitis