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Training - Acute Calf Injuries
Posted by: on Saturday, April 11 @ 12:09:50 BST
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There is no worse thing than can happen to a runner than having to limp home with an injury, from a favourite run, just when everything seemed to be ticking along nicely. Or so it certainly seems at the time.
Why is it that this often seems to happen just when fitness is at last improving? Is it all down to the fickle finger of fate? In this article, I will concentrate on injuries to the calf but also use this example to illustrate some important aspects of understanding injuries in general. In subsequent articles I will describe other common injuries and as well as offering advice on dealing with these when they occur, consider what has led to the injury in the first place. If we can understand why injuries have happened, then we are one step closer to preventing them recurring in the future.
What is it?
When we talk about an injury being acute, all that is meant is that it has happened suddenly. So this is not the type of injury that starts of as a mild ache and with successive runs becomes more and more painful. I am talking here about an injury that occurs with relatively little warning.
Calf muscle tears can happen whilst playing sports such as squash, badminton or football as well as running. In runners, these injuries are more likely to occur during speed sessions or hill sessions and when the quality of the work rather than the quantity is being increased. A particularly “good” way of bringing on this type of injury is attempting to carry out a track session or a hill session when your legs are still tired and stiff from a recent race. (This is a lesson that I personally seem to find hard to learn). Also, the more mature runner seems to be more prone to this particular injury than those still in the first flush of youth.
The tear itself involves disruption of a greater or lesser number of actual muscle fibres depending on the severity of the injury. This is felt as a sudden severe pain in the calf muscle at the back of the lower leg, followed by spasm or cramping in the muscle and loss of function, causing a limp. It may be impossible to continue running, but if you do carry on, the running action will be inhibited by recurring spasms in the affected muscle. It is really best to stop at this point. The muscle will then be found to be tender to the touch and some localised swelling may develop over the next few hours. Sometimes the small blood vessels running alongside the meaty muscle fibres will also be damaged and bleeding into the muscle can occur with the appearance of bruising sometimes being delayed for several days. More often the cause of the swelling is oedema (or leaking tissue fluid from the damaged fibres) and later inflammation plays a part.
How do you treat it?
It really is much better if you can arrange to have this injury on the treadmill or at the track so that it is easy to stop immediately. When it happens several miles from home or the car, the temptation is to hobble back. This will not be enjoyable and will risk worsening the extent of the injury.
So, as for all acute injuries, the immediate treatment consists of Rest, Ice, Compression and Elevation (RICE).
Rest just means stop for now. Ice should be applied (but not directly to the skin) as soon as possible and for around 30 minutes. Compression in the form of a crepe bandage such as a Tubigrip may help to reduce the swelling but ask your pharmacist to recommend the appropriate size. Finally, elevation is best managed by lying on the floor with the affected leg raised on a chair or a stool so that the leaking tissue fluid within the muscle has the best chance of draining away rather than ac*****ulating around the injury.
Having dealt with the immediate management of the problem the next question is how can the injury be healed as quickly as possible?
It is rarely correct advice to rest completely from all exercise. Within 48 hours it is perfectly reasonable to begin gentle calf stretches and find out what activities can be carried out without causing pain. This might be a good time to visit the local gym or try some cross training such as cycling. Regular cyclists tend to have fairly impressive calf muscles so presumably the calf muscles are exercised by the motion of cycling. However, the range of movement is less than in running and is much more controlled. It is also possible to cycle whilst hardly moving the ankle joint at all and therefore the rest of the leg and the cardiovascular system can get a good work out without compromising the healing of the injury. The step machine in the gym can also be used provided that a flat-footed approach is used rather than rising up on to the balls of the feet. Eventually, perhaps after 1-2 weeks, the treadmill can be used to take the first tentative running steps. This way the speed of the belt can be very gradually increased from day to day whilst allowing the opportunity to stop at the first sign of actual pain. A feeling of stiffness which is felt when starting to run but gets better as the muscles warm up is probably OK, whereas pain which increases during a session is a sign that too much too soon is being attempted. A good indicator is to see what reaction there is in the muscle the next day and then either back-off from training or gradually progress things depending on how it feels.
Why did it happen?
Injuries don’t just happen for no reason. Also, very few injuries that befall runners can be described as being accidental. During the golden era of British middle distance running, Steve Cram once twisted his ankle by stepping on a Coke can and around about the same time Steve Ovett injured his lower leg by running into some church railings while chatting to a training partner. These are rare exceptions to the rule that no injuries in running are purely accidental but even in these cases the level of fatigue or the lack of concentration were certainly partly responsible.
For a calf injury, the sort of questions to ask yourself are, why a calf tear and not some other injury? Why one leg and not the other? Is the calf muscle on the affected side weaker or stiffer than on the other side? Why today and not yesterday? Is the particular training session to blame or has there not been sufficient recovery from the last race or the last hard session? Has there been an attempt to increase training intensity too quickly? By answering these questions we can begin to piece together the reason why the injury occurred and can then take steps to prevent it happening in the future.
At a more mechanical level it seems that the muscle tears due to a combination of muscle strength inadequacy, possibly an imbalance between the opposing groups of muscle which move the foot in one direction or the other, relatively inflexible muscles, muscle fatigue and sometimes inadequate warm-up.
How to stop it happening again?
If you can work out how it happened in the first place then you are part of the way along the road to preventing a recurrence.
Whatever the cause, strengthening and stretching of the muscle involved will always be a good idea. There are two main muscles that need to be stretched. The deeper of the two, the soleus, gets its best stretch when the knee is bent and the foot is dorsi-flexed (foot pulled upwards towards the shin). The more superficial muscle, the gastrocnemius, is stretched best in a similar way but with the knee straight. The classic stretch for the calf is done by facing a wall and pushing against it with your hands, with one leg pushed back with the heel on the floor. Do the stretch once with the back leg straight and again with the knee bent slightly. This should be done slowly and held for about 10 seconds. It seems that it is even more important to do this after an exercise session rather than before.
Runners often assume that their leg muscle must all be fairly strong just from the exertions of running. This is often not the case. Calf muscles can be strengthened by pushing up onto your toes from a flat-footed position and as the muscles become stronger weights can be added (either across the shoulders or held in each hand). Calf machines will be available in some gyms. It has been shown that one of the most important ways of strengthening the calf muscle is to exercise it eccentrically rather than concentrically. Concentric contractions occur when the muscle shortens as it contracts whilst eccentric contractions occur when the muscle is contracting and lengthening at the same time. In other words, when some other force (such as an opposing muscle group or gravity) is causing the muscle to lengthen whilst the contraction controls the rate and extent of lengthening. Eccentric muscle contractions put the biggest strain on the muscle fibres and when applied in an uncontrolled way may cause tearing. Strengthening the muscle eccentrically in a controlled way will build up the resistance of that muscle to future tears.
Stair exercise
This is a great exercise for improving the eccentric strength of the calf muscles. It is also a good strengthener for the achilles tendon. Balance on the edge of a step facing the stairs with the heels unsupported. Use your hands on the rail or wall for balance only but not to take any weight. Under the control of the calf muscles, allow the heels to gradually sink below the level of the step and then raise yourself back up, using the calf muscles until the heels are again level with the step. This can be repeated ten times to form one set, with the set being repeated three times a day. It is possible to make this progressively harder, as the strength improves, by starting with both legs together and doing the exercise slowly then doing it one leg at a time, with the other foot dangling free, and finally increasing the speed and possibly even holding a weight in one hand.
Finally
So remember, there is almost always a good reason to explain why an injury has occurred. This is the most important thing to consider when injury does strike. Understanding this will improve the prospects of decreasing the risk of a similar injury in future.
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Training - Common Problems around the ankle
Posted by: on Saturday, April 11 @ 12:09:04 BST
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As we have seen in earlier articles in this series, muscles are obviously important to the runner and may be a source of injury problems. In the following pages, I will explain why strong healthy tendons may be the critical factor in determining athletic greatness or alternatively the source of significant injury misery.
Achilles tendon injuries
Fans of Greek mythology will have found some irony in the fact that the seemingly unbeatable champion Haile Gebrsellasie revealed his only point of weakness to be his achilles tendon. The strongest tendon in the body is named after the hero from Greek mythology whose mother, Thetis, dipped him in the river Styx to render him invulnerable to wounding by enemies. Unfortunately she forgot that she had a firm grip on his ankle preventing the magical waters protecting this area. Achilles eventually died from a wound to his ankle. Fortunately, injuries to the achilles tendon these days have never been known to be fatal but they can be a source of serious discomfort and can be a miserable injury to deal with.
Athletes are often advised to rest from running for varying periods when achilles problems strike. The problem here is that if nothing else is changed then the injury will inevitably recur.
Consider the kangaroo
You may think that strong leg muscles are the most important factor in determining the speed of forward propulsion. Take a look at Christian Olsson, the Swedish triple jumper. His ability to translate speed on the runway to the jumps seems more likely to be due to fantastic elasticity in his tendons than massive strength from his fairly skinny legs. The secret may well lie in the elastic fibres contained within the tendon. After all, the kangaroo’s secret is not extreme power coming from its muscles but rather relates to the elasticity of its tendons. Each time it lands, energy is absorbed in elastic fibres in the tendon and is then returned very efficiently, almost like a spring uncoiling.
It is now thought that the calf muscles are not very active in the push-off phase of the human running action. They seem to work hardest when the foot first makes contact with the ground. The calf muscles and the achilles tendons then act mainly as a sort of shock absorber to control the impact with the ground. If the achilles is not strong enough or the impact is too great damage will occur. For overpronators, it may be that the direction in which the tendon moves with each step is the critical factor; the tendon may be moving in a direction which puts too much demand on an otherwise reasonably strong tendon.
If the tendon is not healthy the energy absorbed from the impact will not all be returned to help with forward motion. Some of the force of the impact will then produce further stresses on the tendon and small tears and areas of damage will ac*****ulate.
What types of injuries occur?
Until fairly recently, most injuries to the achilles tendon were diagnosed as tendonitis. The “-itis” is medical shorthand for inflammation. Treatment would then focus on periods of rest and anti-inflammatory drugs. Sometimes steroid injections were given alongside the tendon in an attempt to soothe the inflammation. As inflammation needs time to develop after the stressful activity has occurred, typically the pain will often not be felt for several hours after the activity, classically on getting up the following morning. If inflammation is the problem, a few days rest will settle symptoms but the pain is likely to recur if the training is not modified.
Achilles tendon injuries are more usually a form of tendonosis, with inflammation playing a relatively minor role. Tendonosis is a rather vague term which basically just means an unhealthy tendon. As a result of an imbalance between the strength of the tendon and the forces applied to it, small areas of damage appear within the tendon. The problem is that the achilles generally doesn’t repair itself well. This is even more of a problem in older runners. Depending on the severity of the damage, the pain will come on at different points during a run. It may actually settle down after 5 or 10 minutes, only to gradually worsen towards the end of a run. The tendon will be sore and tender immediately after a training session (unlike the situation with the inflammation associated with tendonitis). It will also feel stiff and sore the next morning
Partial rupture and complete ruptures of the tendon usually occur in tendons already severely damaged by the degeneration of tendonosis. Pain will appear suddenly, probably when the tendon is put under extra strain, such as beginning a sprint, running up hill or sudden change in direction. If the tendon is completely ruptured it may feel as though you have been struck on the back of the leg. Walking will be difficult or impossible. You may even hear a crack! If you think there is any chance that the tendon has completely ruptured you should seek emergency medical attention
Treatment
Do you need to stop running? It is probably advisable to avoid running for at least one week after the symptoms first develop. After that, advice would depend on the grade of injury. In his book Lore of Running, Dr Tim Noakes describes 4 grades of injury. Grade 1 would be discomfort in the tendon first thing in the morning, Grade 2 would be pain on running but not affecting performance, Grade 3 is pain affecting performance and in Grade 4 running is impossible.
Whatever the grade, before returning to training, correct any of the potential causes that you can. This may be the time to invest in a new pair of running shoes. Make sure that the calf muscles are not tight. For Grade 1, after 1 week’s rest, it is probably not necessary to modify training too much. In Grade 2, it will be necessary to cut back on speed and hill work and possibly also mileage. In Grade 3, any running should be restricted to short jogs and cross-training is much preferred. For Grade 4, clearly no running should be attempted.
For all grades, eccentric exercises of the calf muscles and achilles tendon should be carried out. It is possible, over time, to strengthen the achilles tendon and, with healing, the elasticity will return. This will improve running ability and provide greater protection against injury in the future.
Exercises to strengthen the achilles
These are similar to those described for the calf in the September edition of British Runner. As achilles problems are often the result of the tendon having to operate in a direction other than straight up and down it may be worth modifying the stair exercise to work the tendon through various angles. Start by letting the heels drop down below the level of the step under the control of the calf muscles while standing upright in the centre of the step. Push back up using the calf muscles. Then lean your body weight over to one or other side. You will need to lean against a wall or on a banister but try to keep most of your weight on your feet. Again drop the heels below the level of the step and push back up. Repeat, leaning over to the opposite side. You should feel the strain in different parts of the tendon. Repeat 10 times. These exercises ideally should be done daily in order to keep the tendons healthy and give yourself the best chance of avoiding problems in future.
Why is the achilles tendon prone to injury?
Readers of previous article in this series will have noticed that a recurring theme of mine is to try and work out why the injury has occurred in the first place. Achilles problems are often experienced after a relatively sudden change in the type of training. More often this is when the quality is stepped up as in hill or speed training but occasionally it can be related to an increase in volume. Contributing factors include tight calf muscles (see British Runner September 2004), overpronation (yet again!), stiff-soled shoes, shoes with flatter heels than normal and stiff ankle joints. Older tendons are also more prone to damage.
Ankle strains
Although running cross country and on trails gives the muscles and tendons some protection from impact forces, the uneven ground requires the ligaments around the ankle to work harder. If the ligaments are not up to the job or too much is asked of them (by going over on the ankle) the ligaments will tear. Occasionally the damage is so great that the stability of the ankle is immediately affected and urgent treatment will be required. More often a few fibres in the ligaments on the outside of the ankle will tear and bruising and swelling will accompany the pain.
Immediate treatment is the usual; rest, ice, compression (with a crepe bandage or Tubigrip) and elevation. Until it is possible to walk without a limp, no attempt should be made to run. An ankle support may enable a slightly earlier return to training. Make sure that the ankle isn’t allowed to stiffen. As soon as pain permits, move the ankle joint through a full range of motion.
After one episode of ankle strain (or sprain, same thing!) the likelihood of further injury is increased. Contrary to popular myth, this is usually not due to a reduction in mechanical strength but is the result of a reduction in the body’ ability to sense what position the foot is in, allowing muscles to make quick adjustments to take account of uneven surfaces. This is because sensory nerve endings are contained within the ligaments and are damaged at the time of the original injury. To restore things to normal, exercises on a wobble board will help to restore a normal range of movement and also retrain the ligaments in their ability to sense the position of the foot.
So remember
There is usually a good reason why a specific injury has occurred at a particular time. If a period of rest is required, do what you can to prepare muscles, tendons and ligaments for future challenges. Injuries will recur if the causes have not been attended to.
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Dodgy Knees
Posted by: on Saturday, April 11 @ 12:08:20 BST
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Have you ever wondered why so many runners complain about having “dodgy knees”?
The good news is, that it should be rare for a runner to have to give up their activity due to knee problems. The causes of most knee problems can be readily understood and in the vast majority of cases injuries can be encouraged to disappear. The bad news is that painful knees are an extremely common source of (hopefully temporary) grief in runners. I will try and explain why.
The knee joint
Mostly, the knee functions as a hinge, allowing the lower leg to swing back and forth. However, to complicate matters (and increase the potential for injury) a little rotation also occurs at the knee. The bony fit between the rounded lower ends of the thigh-bone (femur) and the flat upper surface of the shin-bone (tibia) is poor and stability of the joint depends on strong ligaments. Acute injuries of the knee are usually related to twisting, particularly when the thigh rotates on a fixed lower leg. Skiers and footballers are particularly prone to this type of injury.
The knee-cap (patella) also forms part of the knee joint. It is part of the mechanism for straightening the knee and lies between the strong quadriceps muscles on the front of the thigh and the patellar tendon which connects the quadriceps to the shin bone (tibia). The patella moves up and down in a groove between the rounded ends (condyles) of the thigh bone and improves the mechanical efficiency of knee straightening (extension). Problems in relation to the knee cap and patellar tendon are usually of the overuse type. The use of the term here doesn’t necessarily imply ridiculous numbers of miles on the road but rather more running than the joint can currently cope with.
Knee-cap pain
This is the simplest term to describe the most common type of knee pain in runners. You may sometime see it referred to as patello-femoral pain.
Classic symptoms are gradually increasing aching felt behind the knee cap but sometimes difficult to pinpoint. Pain can occur during running but also when sitting for a while with the knees bent. This gives rise to the “cinema sign”: a preference for an aisle seat as the knees only feels comfortable when the legs are stretched out. It feels a bit like “toothache of the knee”. There will often be pain on going up and especially down stairs. Really anything that requires bending at the knees can bring this on.
The onset of this type of problem may coincide with a spell of hill running or an increase in mileage, particularly the type of running where the knee doesn’t get fully straight at any stage. Other causes are the usual suspects i.e. over pronation and poorly supporting shoes. Cyclists are more likely to get this problem if their seat is positioned too low or they remain seated when tackling steep hills.
The pain is caused by the effects of grinding between the underlying surface of the knee cap and the femoral condyles. This is the result of a failure in the “tracking” of the knee cap in such a way that it doesn’t slide up and down cleanly in the groove between the condyles.
Normally, the knee cap’s tracking is controlled by the four different components of the quadriceps muscle. Particularly important is the part that pulls the knee cap towards the inside of the leg (vastus medialis). By the time the knee cap pain has become a problem this part of the muscle will have lost some of its bulk and will be weak. You may see this when you straighten the knee fully and look at the muscle just above the knee cap and towards the inside (rather than the outside) of the leg.
Patellar tendon pain
This type of pain might be felt anywhere between the lower end of the knee-cap and the knobbly piece of bone at the top of the shin (tibial tuberosity). Pain is usually felt after exercise and can also be worse on stairs and prolonged sitting.
Pain here is related to damage to the patellar tendon. Although there may be an element of inflammation, more often the problem is what is technically described as a tendinopathy with areas of degeneration and weakening replacing the normal healthy tendon.
Part of the function of the patellar tendon is to absorb (along with the achilles tendon) some of the impact stresses of running on hard surfaces. If the tendon is not up to the stresses applied to it there is a risk of damage. It will be especially stressed if there is a tendency to excessive rotation at the knee (again over-pronation and poor shoes!); tight hamstrings; or tight and relatively weak quadriceps. Faster running, kicking footballs, bounding or using the leg extension machine in the gym may all contribute to this type of injury.
ITB pain
The ilio-tibial band (ITB) is a long tendon-like structure which runs down the outside of the thigh and inserts into the outside of the shinbone just below the knee. It is connected to hip muscles at the top of the leg and by balancing the adductor muscles on the inside of the thigh helps to control movement at the hip by limiting adduction (movement of the leg towards the midline). Unfortunately for those with ITB pain, the tendon has to move back and forth over a prominent piece of bone at the lower end of the thigh bone when the knee bends and straightens. This back and forth movement can cause damage due to rubbing under certain cir*****stances.
ITB pain is more common in runners who have been running for several years. Cyclists too may be prone to this. Bandy legs; running on the camber of the road (the downhill leg
being particularly affected); tight hip muscles and tight ITB can all contribute to the problem as can inadequate shoes. Pain may be worse on running up and down hills but usually eases off quite quickly after stopping.
Curing the injury
First of all try and work out which of these three most common causes of “dodgy knees” is to blame. Think back to your recent training and see if the cause can be identified. Could you do with a new pair or more suitable pair of shoes?
Next plan your own self-help programme or seek the support of a physiotherapist. Cut back on any activities which make the pain worse. This may still allow some running. Expect to see improvements in symptoms but possibly only after 3 or 4 weeks of exercises.
Stretching and strengthening exercises
Stretching is especially important after exercise and stretches can be held for around 10 seconds at a time. Warming up may be more important than stretching immediately before exercise. Stretches can be held for around 5 seconds each at this time so it shouldn’t take long.
Hamstrings and quadriceps stretches
These are particularly important when patellar tendon pain is the problem. The hamstrings on the back of the thigh, are stretched when the knee is straight and the body is bent forward to get the hand as close to the foot as possible. It is better to do this sitting down or with the leg that is being stretched supported on a wall or on the back of a chair of suitable height. Bending down to touch your toes whilst standing might stretch the hamstrings but can also cause back strain. A fuller description will be provided when the hamstrings are discussed in more detail in a later issue.
To stretch your quads, whilst standing with the other leg straight, bend at the knee and catch hold of your ankle or foot behind you. Pull on the ankle or foot and bring the heel as close to your buttock as possible. Avoid leaning forward.
ITB stretch
Whilst standing, cross the left leg behind the right. Bend your body over to the right as you push your left hip out to the side. You should feel a stretch on the outside of your hip.
Quads strengthening
Regardless of the cause of knee pain you can’t really go far wrong with “static quads” exercises as those will help to stabilise the knee. These are especially important for knee-cap pain sufferers. These are done with the knee kept straight with no movement taking place at the knee itself. Whilst sitting on the floor with the legs out straight in front, raise one leg a few inches up from the floor. To begin with hold this in midair for 5 seconds at a time before lowering the leg under control. Repeat with the other leg. Try and do 50-100 on each leg every day! Fortunately they don’t all have to be done at the one time. Ten to fifteen on each leg in a session will be enough. As the quadriceps become stronger each leg raise can be held for 10 seconds. Eventually a small ankle weight can be used but only with the leg kept straight.
Many runners have surprisingly weak quadriceps in general. If this is the case, after a period of static quads work, further strengthening can be carried out. Those with patellar tendon pain may find these additional exercises particularly helpful but progression should be very gradual. Suitable exercises include quarter squats (double leg progressing to single leg) without any weights at first, and lunges. If you have access to weights machines, using leg press machines is certainly much safer than the leg extension machine which can place excessive forces on the patello-femoral joint. For those with knee-cap pain it is better to avoid any bent leg exercises until the pain has settled with static quads exercises only.
Remember
Although knee problems are common, most can be sorted out. Try and work out why the injury has occurred at this time. Decide what is the most likely diagnosis for your particular “dodgy knee”. Recovery will take some time and effort.
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Training - Groin Pain
Posted by: on Saturday, April 11 @ 12:07:44 BST
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Groin injuries come in two main varieties. Fortunately, the most common types are relatively easy to diagnose and treat. On the other hand, there are some more unusual ones that may be trickier to pin down.
In this article we will consider the background to the most common problems and discuss what self-help measures can be used. I will then briefly describe the more difficult ones that may require the help of an appropriate professional.
The groin region
The groin is a complicated area for a number of reasons. This is where the relatively stable abdomen and the very mobile legs join: where the powerful muscles responsible for flexing the hip and the trunk are inserted into bone. In most cases the muscles will be acting to move the leg in relation to the trunk, which should ideally be kept as stable as possible for greatest efficiency. For instance the hip flexors will be called into action when kicking a football, when a sprinter blasts out of the blocks, when running uphill or even performing sit-ups. One of these muscles, the rectus femoris (part of the quadriceps), also acts to straighten the knee. Therefore, lifting (flexing) the leg in front of the body whilst the knee is bent, involves this muscle contracting and stretching at the same time (think of a sprinter coming out of his blocks). This puts the muscle at risk of injury if strength, flexibility and co-ordination are not perfect.
So much for moving in a forwards direction. Another important group of muscles in this area are the adductors which are located on the inside of the thigh. Injuries here are common in soccer, rugby, hockey, basketball, netball and racquet sports. Anything involving a sudden change of direction.
The adductors act to bring the legs together, as in gripping the sides of a horse when riding. They are also the muscles that are used when kicking a football with the inside of the foot. In running they are important stabilisers, helping to limit side to side movement and thereby improving the efficiency of forward momentum.
In running, the adductors can be injured in sprinting as they contract strongly to prevent the tendency to move from side to side such as in the first few strides of a sprint from blocks. Distance runners can develop problems due to running on uneven or slippery ground, on the side of a hill or even on a road with a steep camber.
It may be possible to pinpoint a particular episode which produced the groin injury, such as a blocked kick in football or inadvertently doing the splits whilst running on a slippery surface. However, it is quite likely that underlying deficiencies may have made the injury more likely. In particular, poor flexibility in the hip joints (especially in men) or in the lower back, and muscle weakness may have played a part. It is therefore vitally important that in addition to dealing with the recent injury that any underlying inadequacies are addressed in order to reduce the chance of further episodes occurring.
Adductor injuries
These muscles (usually the adductor longus) are injured when the leg is forced outwards at the hip. Pain will be felt immediately, towards the top of the inner thigh near to the pelvic bony origin of the adductor muscles. Depending on the severity, walking may either be impossible or only with a limp. As the muscle lies close to the surface, you will often be able to identify a tender spot on probing. Contracting the adductor muscle, by trying to bring the legs together against resistance, will produce pain as will stretching the leg out to the side.
Immediate treatment, as in all acute injuries, should be to stop the activity, apply ice (never directly to the skin) and apply a compression bandage. Within a few days stretching exercises can be started. These are best performed non-weight bearing to begin with.
One such exercise is done by sitting down with legs in front and knees straight. Move your legs as far apart as possible and gradually bend forward at the hips until a stretching sensation is felt along the inside of the thighs. Another useful stretch is done by lying on your back with your knees bent and your feet together. Whilst keeping your feet together let the knees fall away to the side. It may help to press down on the insides of the knees with your hand. These stretching exercises should stop short of the point where pain would be provoked.
Although not able to run at this time, cycling may be pain free and can be used to maintain aerobic fitness. As well as attending to flexibility, as discomfort settles, efforts should be made to strengthen the adductors. Begin with isometric exercises (the muscle contracts without the leg moving) such as squeezing a ball between the knees, either sitting or lying flat. The next stage would be strengthening exercises done on an adductor machine in the gym or with an elastic band attached to a fixed object. Start with the legs apart, contract the adductor muscles to bring the legs together. In the final stages of recovery, more dynamic movements should be carried out. These might include running sideways (side-slip), without crossing the legs to begin with, or astride jumps onto a bench (a favourite in circuit training).
Hernias
A hernia is an area of weakness in the muscles that form the abdominal wall. The pressure inside the abdomen increases when we cough, sneeze or strain and if there is a weakness the pressure will cause a bulging in that area. The most common site for a hernia is in the groin (inguinal hernia) just above the groin crease. There is also a variant on the classic inguinal hernia called a sportsman’s hernia or Gilmore’s groin (after the surgeon who described the condition). The condition itself probably reflects a mixture of pathologies with various degrees of disruption of some of the muscles in and around the groin area. In some ways it could be considered as the earliest stages of a hernia, before an obvious bulging of the abdominal contents has developed. Pain, often a dull ache, in the lower abdomen is the main symptom. Referred pain may also be felt in the inner thigh. Running, kicking and performing sit-ups may produce the pain, as can coughing and sneezing. The athlete with a sportsman’s hernia may find that relatively short periods of rest will allow the symptoms to settle. However, the pain usually returns when more intensive training begins and surgical repair may be required but is usually very successful.
Less common problems
As well as the two most common problems described above the origin of groin pain can be any of the other anatomical structures in the region. The hip joint itself lies very deep within the groin area and hip joint pain will be experienced here rather than on the outside of the leg. Hip joint pain can be due to arthritis, joint strain, capsulitis or even a stress fracture. Back problems can also, somewhat confusingly, present with groin pain as can various problems involving the internal organs such as bladder, kidney, bowel and reproductive organs. The bones at the front of the pelvis (pubic rami) may also be the site of stress fractures.
For that reason, and in view of the serious nature of some of these conditions, unless the symptoms are typical of an adductor injury and respond well to treatment, it is advisable to seek a professional opinion.
So remember
The most common type of groin injuries can usually be diagnosed and treated quite easily. Adequate treatment and attention to good flexibility, balanced muscle strength and good core stability will help to prevent acute injuries giving rise to chronic problems.
There are also many less common causes for groin pain. Therefore if the symptoms are unusual or don’t respond to treatment, professional advice should be sought.
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Training - What?s so special about the hamstrings? (Part 2)
Posted by: on Saturday, April 11 @ 12:07:14 BST
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Acute hamstring tears
Unfortunately, a not infrequent sight in a 100 metre sprint event is the athlete who leaps into the air in obvious pain and comes to a complete halt clutching the back of the leg. The diagnosis of a hamstring tear can usually be made from a distance. The athlete will have felt a sharp pain in the middle of the hamstring area followed by painful spasm. Often this occurs during the “pick up” phase, as the athlete’s stride lengthens.
Later it may be possible to detect an area of swelling or even a gap in the muscle. Bruising may appear on the surface or remain deep within the muscle. It may be several days before the bruising becomes visible. For an acute injury such as this, the immediate treatment is RICE.
Rest the muscle (but not the rest of the body) for 48 hours.
Apply Ice to the injury as soon as possible but not directly to the skin.
A properly applied Compression bandage may help but don’t try this unless you are sure that it you can apply it correctly.
Finally, keep the leg Elevated as much as possible. This may help to limit swelling.
After the first 48 hours, depending on pain, some gentle stretching exercises may be started. If at all possible, visit a physiotherapist at this stage.
Chronic hamstring pain
Repeated episodes of pain which seem to arise from the middle of the hamstrings muscles may actually be due to irritation of the main nerve to the leg (sciatic) producing “adverse neural tension”. The source of the problem could well be in the lower back. True chronic hamstring pain, occurring in the muscle belly, is really more often recurrent minor tears as a result of a return to intensive training before the underlying problem has been properly addressed. If the cause of the original tear has not been dealt with then further injury is almost inevitable. Treatment here should be directed towards the underlying problem.
Hamstring origin problems
This really is a pain in the butt. Pain is felt in the region of the bony part that you sit on (ischial tuberosity) as this is where the hamstring muscles are attached. This usually develops as the result of repeated overloading of the muscle over a period of time. It is especially likely to occur when there is a sudden increase in the intensity of training, such as speed work, and at this time of year it may also be seen in relation to excessive activity of the hamstrings when running on treacherous surfaces.
Pain may be felt on running, particularly at speed, whilst sitting on hard surfaces and sometimes even whilst driving.
Hamstring tendon problems
This less common type of hamstring problem is felt as pain in the tendons behind the knee joint. This is an overload type of injury. It occurs if the tendons are the weakest link in the chain and too much is being asked of them. Bearing in mind the knee stabilising actions of the hamstring muscles when they work individually, pain here may occur after prolonged activity on uneven surfaces. Track runners may also develop painful hamstring tendons related to bend running.
Often the pain will diminish during activity, as the runner warms up, only to return later in the session or even some time afterwards.
Improving strength and flexibility
Healthy muscles are strong and flexible. They are also balanced in strength with the muscles working in the opposite direction. Almost always, the occurrence of an injury indicates that all is not as it should be in one or more of these departments.
There is currently a fair amount of controversy surrounding the pros and cons of stretching. What everyone would probably agree on are the benefits of a warm-up prior to undertaking strenuous activity. If nothing else, it seems to help psychologically in preparing for the effort ahead. Stretching the major muscle groups within the range in which they will be working, and for a short duration, is also a sensible precaution before attempting anything too drastic. What is not certain (although it used to be!) is the value of prolonged and more extreme stretching before running. It is even possible that excessive and prolonged stretching of a muscle before activity may increase the risk of injury.
On the other hand, developing a discipline of gently stretching muscles after a hard effort makes sense as the muscles will often have become gradually tighter as the session progresses. General flexibility work can also be carried out, if required, at a time separate from running activity.
Many specific stretches are described for the hamstring muscles (see also British Runner December 2004). My advice would be to avoid any stretch in which the body weight is being supported by the leg in which you are trying to stretch the hamstring (i.e. bending forward to touch the toes). It makes more sense to be sitting down with the leg to be stretched straight out in front and the other one bent at the knee, perhaps with the sole of the foot flat against the inner thigh. Another acceptable stretch can be done by standing on one leg whilst the leg to be stretched is straight out in front and supported at a suitable height (the open boot of the car seems to be the right height for my pre-race stretching). In both of these stretches you should gradually lean forward bringing the chest closer to the knee. The stretching feeling may be slightly uncomfortable but should certainly not be painful.
The hamstring muscles need to be strong in two different situations during the running action. Firstly, with the foot in contact with the ground and supporting body weight as it produces extension at the hip joint to propel the body forwards. Exercises to strengthen the hamstrings in this activity would include half squat exercises either with no or a relatively light weight, hill running, step-ups (or a step machine). The hamstring machine in the gym can be used if the weight used is light enough to allow 15-20 reps and if this is done as part of the overall strengthening regime rather than as the only exercise.
The other important action of the hamstrings is working eccentrically, by applying the brakes to control the forward movement as the unsupported leg swings forward. The hamstrings can be conditioned to make it easier to cope with this action by various exercises involving swinging the leg back and forward whilst standing with the body weight supported on the other leg (a hand can be placed on an adjacent wall for balance if needed). Start by swinging the leg forward and back with the knee bent then progress to the same exercise with the knee straight. The final version is a combination which produces a sort of bicycling motion. Swing the bent knee forward, then straighten the knee followed by bringing the leg back straight and then bending the heel up towards the buttock before the knee swings forward again. Try 10 slow ones to begin with then gradually increase the speed and number.
Remember
There is always a reason why a particular injury should strike at a particular time. Examine the period of training leading up to the injury and consider also where flexibility or muscle strength and balance may be an issue. At least one initial visit to the physiotherapist should help with starting you on the right path to correct rehabilitation and recovery.
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Training - What?s so special about the hamstrings? (Part 1)
Posted by: on Saturday, April 11 @ 12:06:41 BST
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Or putting it another way, why should a footballer like Michael Owen or Great Britain’s Olympic sprinter Darren Campbell be prone to injuries in the same muscle as some marathon runners? Similarly, why should your hamstrings start complaining at the beginning of the cross-country season, at a time of the year when pace is not usually at its most electrifying.
Read on below and in Part 2 next month and I will try and provide some answers.
Introducing the hamstrings?
The hamstrings are a group of three muscles that run down the back of the leg from the bone that you sit on (ischial tuberosity) to the lower leg just below the knee. They are attached to the two bones of the lower leg, the tibia (on the inside) and fibula (on the outside).
What do they do?
If you asked a medical student this question they would probably answer by saying that the hamstrings produce flexion (bending) at the knee. However, their function is very much more complicated than this and therein lies the problem.
Because the hamstrings pass across two joints (hip and knee), when they contract (shorten) they have the potential to cause movement at both joints. To make things even more complicated what effect their contraction has on the leg will depend on whether the leg is supporting weight.
With the foot and leg off the ground the hamstrings action will draw the whole of the leg back. This is referred to as extension at the hip joint. If the whole leg is prevented from moving back either by contraction of the hip flexors which lie in front of the hip joint or by physically blocking the leg’s movement, then the knee will bend, bringing the heel up.
When the leg is supporting the body weight with the foot fixed on the ground, contraction of the hamstrings will act in the opposite direction with the leg moving the body forward rather than the body moving the leg back.
To make it even more complicated (just a little)
Nearly there! All of the above describes the muscle working concentrically. In other words the muscle contracts and shortens and brings the two ends (and their attachments) closer together. Sometimes the hamstrings have to work eccentrically to oppose strong muscle activity moving the leg in the opposite way. If the leg is swinging forwards this can only happen under full control if something is applying the brakes. And that something is the hamstrings. As we have seen in earlier articles muscles have to work hardest when they are working in this way. This is when the hamstring will be more prone to injury.
Cross country running
So what has any of this got to do with cross country running. As the hamstrings are inserted into the two lower leg bones (two towards the inside and one on the outside) they have one more trick they can perform and that is rotation of the lower leg in either direction when the knee is bent. The amount of rotation is small and it is probably easier to think of the hamstrings as stabilising the knee and preventing rotation in the opposite direction. When running on a slippery or uneven surface the hamstring muscles have to continually work eccentrically to stop the foot slipping forward or the knee twisting. Particularly over longer distances the muscles will become fatigued and complain in the only way they know how – by causing pain. This is more likely to appear gradually and sometimes only after the activity has stopped.
Footballers and sprinters
Footballers also may suffer from this type of injury due to sudden changes of direction and changing their balance during a match. This more often happens towards the end of each half of the game when the muscles are most fatigued. Sprinters more often suffer from the more dramatic type of injury that makes them leap in the air clutching the back of their leg. This tends to occur when the stride is lengthening during acceleration. At this stage the muscle is being asked to contract whilst lengthening (working eccentrically) as the knee straightens whilst at the same time contracting and shortening (working concentrically) to pull the leg back at the hip. If the co-ordination of this is not precise, or the sprinter overstrides, then the muscle will be placed under excessive tension. This is when a tear might occur.
Which runners are most at risk?
When any muscle is subjected to stress, weakness or insufficient flexibility will make a tear more likely. Imbalance between the strength of opposing muscle groups (e.g. hamstrings versus quadriceps) is also thought to play a role. This situation can arise when the quadriceps become overly developed as a result of poorly planned weight training. As the hamstrings arise from the pelvis a forward tilted pelvis (which makes your rear end stick out) will increase the tension placed on the hamstrings as will a stiff lower back.
Hamstrings that are fatigued or glycogen depleted are also at increased risk and overuse by too much hill or speed work or running on slippery ground also increases the risk of injury.
One word of warning
Pain down the back of the leg does not always mean the hamstrings are to blame. The main nerve to the leg muscles (sciatic nerve) runs down the back of the leg deep to the muscles. Pressure on this nerve due to back problems (to be discussed in a subsequent article) can produce pain very similar to hamstring pain. Moreover, irritation of this nerve can produce a situation of “adverse neural tension” which can then cause abnormal function in the hamstring muscles. For those reasons, obtaining an accurate diagnosis from a chartered physiotherapist or a sports doctor is a sensible precaution prior to embarking on a recovery programme.
There is hope
For those of you who have trouble-free hamstrings the good news is that by taking certain precautions and carrying out a few straightforward exercises you should be able to keep them healthy. For those who have previously struggled with hamstring problems, the road ahead may be somewhat longer but by careful attention to flexibility and muscle balance it is almost always possible to be running freely again without having to resort to the surgeon’s knife. In next month’s British Runner I will describe the injuries themselves, their treatment and the all-important rehabilitation required to get things going smoothly again.
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Training - Injuries and the veteran runner
Posted by: on Saturday, April 11 @ 12:06:13 BST
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Whenever two or more runners get together, it never seems to take very long before the subject turns to recent injuries. This seems to be especially true when the runners in question are of a more mature age. Anyone overhearing their conversation could be forgiven for thinking that these were actually the victims of some terrible ailment, rather than a group of very fit individuals.
Injuries can be such a problem in the veteran athlete that the usual reason for not improving performances in a particular season is the interruption to training from the latest injury rather than the direct effects of the aging process itself.
So just why does injury seem to be such a big problem for the veteran athlete?
Why are veteran athletes more likely to suffer injuries?
The first problem, and this can’t be avoided, is that the older you are the more time you have had to ac*****ulate the battle scars of previous traumas. Injuries from teenage and early adult years, that caused little upset at the time, may come back to haunt you. It becomes harder to compensate for persistent abnormalities as time goes on.
Unfortunately, new injuries are also more likely. The runner most at risk is probably the new convert to the sport who launches in with too much enthusiasm after a prolonged period of relative inactivity.
But even the runner who has kept going from his/her junior days right into their forties, fifties and sixties and beyond is at increased risk of injury. Part of the reason for this is what I call BMAD or Body Mind Age Disassociation. In other words, the training mind is somewhere back in the early twenties whilst the body has continued to grow older.
However, there are some age-related changes which are inevitable. Maximum attainable heart rate will gradually decrease with increasing age at a rate of around one beat per year. The ability to use oxygen (VO2 max) also decreases gradually with age. As a result of these inevitable physiological consequences of aging the older athlete may end up training at closer to maximum capacity in order to achieve the same training times as in previous years. This can be a recipe for disaster.
One further reason for increasing numbers of injuries with age is that the body is less able to absorb the shock of impact from training on hard surfaces. This is due to a reduction in the resilience and water content of the connective tissue component of important structures such as tendons, ligaments, muscles and the discs between the vertebral columns of the spine.
Why do the injuries take longer to heal?
It is important first of all to accept that injuries definitely will take a little longer to heal with increasing age. The reason why some injuries take a lot longer to heal is that the athlete has somehow suc*****bed to BMAD and has attempted to return to training after a time interval that may have been appropriate ten years previously. The mechanisms of tissue repair are exactly the same regardless of age (inflammation, proliferation and remodelling) but each one of these stages takes longer. Added to this is the gradual reduction in local blood supply with increasing years. This is particularly relevant to areas which start of with a relatively poor blood supply such as the achilles tendons. If you know that there will be a slower repair of connective tissue it should be possible to factor in some extra time for recovery before returning to full training.
What can be done to prevent injuries?
One of the main reasons for getting slower as we grow older is decreased flexibility due to stiffer muscles and ligaments. This will lead to a shorter stride and as it is relatively more difficult to increase the speed of muscle contraction and thereby increase the cadence it is difficult to compensate for a shorter stride. Even those runners who seemingly were able to do without stretching exercises in their youth would be well advised to introduce regular stretching sessions as an adjunct to other training sessions.
Allowing more time for recovery is not just important following injury. There are another two situations where this is important. Firstly, following a hard training session or race, veteran athletes should allow longer time before attempting a further hard session. Whereas the young athlete may find he/she can manage hard sessions on consecutive days and even then can manage a reasonable run the next day as a “recovery” session, the veteran athlete should include more complete rest days and be less ambitious in the type of recovery session they use. Cross training can be particularly helpful. Substituting a session of cycling or gym work for a run will allow greater potential for recovery whilst exercising the muscles in a different way. This also helps to build overall muscle strength and fitness.
The other time when additional recovery should be allowed is during an interval training session. It is not always a great idea to run interval sessions with athletes of very different age groups. As in other aspects of life the veteran athlete is likely to find that more time for recovery will be required between efforts if the same level of performance is to be repeated over subsequent repetitions.
So remember
The main reason for deteriorating fitness with age in the general population is increasing inactivity. There are, however, some inevitable physiological changes that ensure that no matter how hard an individual trains it is unlikely that performances will continue to improve during the whole lifetime of an individual. The good news is that the slowing resulting from the inevitable consequences of aging is relatively small compared to the decline in fitness caused by inactivity. So runners can continually improve their level of fitness compared to the inactive members of their age group throughout the whole of their life.
If, along with increasing age, it has been possible to acquire a little more wisdom, it might even be possible to avoid the training mistakes of an impetuous youth and enjoyment of the benefits of fitness will continue right into the twilight years.
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Training - Acute Calf Injuries
Posted by: JonB on Thursday, March 09 @ 17:32:48 GMT
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There is no worse thing than can happen to a runner than having to limp home with an injury, from a favourite run, just when everything seemed to be ticking along nicely. Or so it certainly seems at the time.
Why is it that this often seems to happen just when fitness is at last improving? Is it all down to the fickle finger of fate? In this article, I will concentrate on injuries to the calf but also use this example to illustrate some important aspects of understanding injuries in general. In subsequent articles I will describe other common injuries and as well as offering advice on dealing with these when they occur, consider what has led to the injury in the first place. If we can understand why injuries have happened, then we are one step closer to preventing them recurring in the future.
What is it?
When we talk about an injury being acute, all that is meant is that it has happened suddenly. So this is not the type of injury that starts of as a mild ache and with successive runs becomes more and more painful. I am talking here about an injury that occurs with relatively little warning.
Calf muscle tears can happen whilst playing sports such as squash, badminton or football as well as running. In runners, these injuries are more likely to occur during speed sessions or hill sessions and when the quality of the work rather than the quantity is being increased. A particularly ?good? way of bringing on this type of injury is attempting to carry out a track session or a hill session when your legs are still tired and stiff from a recent race. (This is a lesson that I personally seem to find hard to learn). Also, the more mature runner seems to be more prone to this particular injury than those still in the first flush of youth.
The tear itself involves disruption of a greater or lesser number of actual muscle fibres depending on the severity of the injury. This is felt as a sudden severe pain in the calf muscle at the back of the lower leg, followed by spasm or cramping in the muscle and loss of function, causing a limp. It may be impossible to continue running, but if you do carry on, the running action will be inhibited by recurring spasms in the affected muscle. It is really best to stop at this point. The muscle will then be found to be tender to the touch and some localised swelling may develop over the next few hours. Sometimes the small blood vessels running alongside the meaty muscle fibres will also be damaged and bleeding into the muscle can occur with the appearance of bruising sometimes being delayed for several days. More often the cause of the swelling is oedema (or leaking tissue fluid from the damaged fibres) and later inflammation plays a part.
How do you treat it?
It really is much better if you can arrange to have this injury on the treadmill or at the track so that it is easy to stop immediately. When it happens several miles from home or the car, the temptation is to hobble back. This will not be enjoyable and will risk worsening the extent of the injury.
So, as for all acute injuries, the immediate treatment consists of Rest, Ice, Compression and Elevation (RICE).
Rest just means stop for now. Ice should be applied (but not directly to the skin) as soon as possible and for around 30 minutes. Compression in the form of a crepe bandage such as a Tubigrip may help to reduce the swelling but ask your pharmacist to recommend the appropriate size. Finally, elevation is best managed by lying on the floor with the affected leg raised on a chair or a stool so that the leaking tissue fluid within the muscle has the best chance of draining away rather than ac*****ulating around the injury.
Having dealt with the immediate management of the problem the next question is how can the injury be healed as quickly as possible?
It is rarely correct advice to rest completely from all exercise. Within 48 hours it is perfectly reasonable to begin gentle calf stretches and find out what activities can be carried out without causing pain. This might be a good time to visit the local gym or try some cross training such as cycling. Regular cyclists tend to have fairly impressive calf muscles so presumably the calf muscles are exercised by the motion of cycling. However, the range of movement is less than in running and is much more controlled. It is also possible to cycle whilst hardly moving the ankle joint at all and therefore the rest of the leg and the cardiovascular system can get a good work out without compromising the healing of the injury. The step machine in the gym can also be used provided that a flat-footed approach is used rather than rising up on to the balls of the feet. Eventually, perhaps after 1-2 weeks, the treadmill can be used to take the first tentative running steps. This way the speed of the belt can be very gradually increased from day to day whilst allowing the opportunity to stop at the first sign of actual pain. A feeling of stiffness which is felt when starting to run but gets better as the muscles warm up is probably OK, whereas pain which increases during a session is a sign that too much too soon is being attempted. A good indicator is to see what reaction there is in the muscle the next day and then either back-off from training or gradually progress things depending on how it feels.
Why did it happen?
Injuries don?t just happen for no reason. Also, very few injuries that befall runners can be described as being accidental. During the golden era of British middle distance running, Steve Cram once twisted his ankle by stepping on a Coke can and around about the same time Steve Ovett injured his lower leg by running into some church railings while chatting to a training partner. These are rare exceptions to the rule that no injuries in running are purely accidental but even in these cases the level of fatigue or the lack of concentration were certainly partly responsible.
For a calf injury, the sort of questions to ask yourself are, why a calf tear and not some other injury? Why one leg and not the other? Is the calf muscle on the affected side weaker or stiffer than on the other side? Why today and not yesterday? Is the particular training session to blame or has there not been sufficient recovery from the last race or the last hard session? Has there been an attempt to increase training intensity too quickly? By answering these questions we can begin to piece together the reason why the injury occurred and can then take steps to prevent it happening in the future.
At a more mechanical level it seems that the muscle tears due to a combination of muscle strength inadequacy, possibly an imbalance between the opposing groups of muscle which move the foot in one direction or the other, relatively inflexible muscles, muscle fatigue and sometimes inadequate warm-up.
How to stop it happening again?
If you can work out how it happened in the first place then you are part of the way along the road to preventing a recurrence.
Whatever the cause, strengthening and stretching of the muscle involved will always be a good idea. There are two main muscles that need to be stretched. The deeper of the two, the soleus, gets its best stretch when the knee is bent and the foot is dorsi-flexed (foot pulled upwards towards the shin). The more superficial muscle, the gastrocnemius, is stretched best in a similar way but with the knee straight. The classic stretch for the calf is done by facing a wall and pushing against it with your hands, with one leg pushed back with the heel on the floor. Do the stretch once with the back leg straight and again with the knee bent slightly. This should be done slowly and held for about 10 seconds. It seems that it is even more important to do this after an exercise session rather than before.
Runners often assume that their leg muscle must all be fairly strong just from the exertions of running. This is often not the case. Calf muscles can be strengthened by pushing up onto your toes from a flat-footed position and as the muscles become stronger weights can be added (either across the shoulders or held in each hand). Calf machines will be available in some gyms. It has been shown that one of the most important ways of strengthening the calf muscle is to exercise it eccentrically rather than concentrically. Concentric contractions occur when the muscle shortens as it contracts whilst eccentric contractions occur when the muscle is contracting and lengthening at the same time. In other words, when some other force (such as an opposing muscle group or gravity) is causing the muscle to lengthen whilst the contraction controls the rate and extent of lengthening. Eccentric muscle contractions put the biggest strain on the muscle fibres and when applied in an uncontrolled way may cause tearing. Strengthening the muscle eccentrically in a controlled way will build up the resistance of that muscle to future tears.
Stair exercise
This is a great exercise for improving the eccentric strength of the calf muscles. It is also a good strengthener for the achilles tendon. Balance on the edge of a step facing the stairs with the heels unsupported. Use your hands on the rail or wall for balance only but not to take any weight. Under the control of the calf muscles, allow the heels to gradually sink below the level of the step and then raise yourself back up, using the calf muscles until the heels are again level with the step. This can be repeated ten times to form one set, with the set being repeated three times a day. It is possible to make this progressively harder, as the strength improves, by starting with both legs together and doing the exercise slowly then doing it one leg at a time, with the other foot dangling free, and finally increasing the speed and possibly even holding a weight in one hand.
Finally
So remember, there is almost always a good reason to explain why an injury has occurred. This is the most important thing to consider when injury does strike. Understanding this will improve the prospects of decreasing the risk of a similar injury in future.
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Training - Back pain
Posted by: JonB on Wednesday, October 26 @ 18:03:23 BST
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There are two types of runners: those who have already had back problems and those who will suffer with their back at some time in the future. It seems to be just about unavoidable. However, there are things that can be done to reduce the frequency of back problems and allow quicker recovery when problems do occur.
Causes of back pain
As the human species evolved, there was a change from moving around on all fours to walking upright. Unfortunately, the back hasn?t quite kept pace with this development and is not ideally suited to maintaining this upright posture. It is even less able to cope with sitting in front of a computer for hours or slumping in front of the television. Almost all runners will experience back pain at some times in their lives. Although this may interfere with the ability to run, the problem itself is often not directly caused by the sport.
On the other hand, back pain in cyclists is more likely to be related to training on the bike. Particularly if the bike is not set up properly, in terms of saddle height and angle and frame size, the rider is at risk of developing an aching back. A simple adjustment, such as cranking up the height of the saddle a few notches, may bring great relief.
In runners, it is less often the running that causes the problem but rather those activities you do when you?re not running. Attention to posture at all times is important. Those who work at a desk should ensure that seating is of adequate quality and appropriate to the individual. The height of chairs should be adjustable to avoid the slumped position. A footrest may help. In more extreme cases using a ?kneeling chair? may help to take the pressure off the spinal structures. Try and get up from your desk and move around at least once an hour. Gentle stretching exercises can be done without scaring your work colleagues.
However the running action itself can cause the back to complain. Poor running posture (exaggerated forward or backward tilt), rolling shoulders, poor arm action, excessive downhill running, and inadequate cushioning in footwear can all give rise to problems.
Structure and function
The spine must be able to support the body weight and protect the spinal cord. It also must be flexible enough to allow bending and rotation. To allow this to happen the spinal column is made up of many individual bones (vertebrae) stacked one on top of the other. Discs of tough fibrous material with some jelly-like substance in the core provide some cushioning. Ligaments hold together the many small joints in the back. Providing the power are the back, trunk and abdominal muscles. These muscles must be strong, capable of stamina and well co-ordinated in order to function properly.
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Training - Shin Problems
Posted by: JonB on Wednesday, September 07 @ 13:27:45 BST
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An essential part of injury management will be to look back over your previous training to explain why an injury like this has occurred. Why one leg and not the other? Are the muscles on the affected side weaker or stiffer than on the other side? Why this week and not last week? Is the particular type of training to blame? Has there been an attempt to increase training intensity too quickly?
Reasons for shin pain
Pinpointing the exact anatomical structure that is causing pain around the shin can be tricky. To really get to the source of the problem may require careful examination by a sports doctor or physiotherapist. However, the reason why the problem has arisen is usually easier to work out. Often there will have been a sudden change in training. This could be a change in training surface, a sudden increase in either the quantity or quality of training, a change of footwear or even progressive loss of cushioning in an aging pair of trainers.
In running a mile, there are around 700 strides potentially producing stresses on each leg. With each stride the body somehow has to absorb a force equal to around 2-3 times body weight. If the calf muscles are tight and/or there is excessive pronation of the foot there will be increased pulling of the muscles against their origins on the main bone of the lower leg, the tibia.
Types of shin problems
Although the biomechanical problems leading to the different types of shin problem may be similar, the exact type of injury will depend on the weakest link in the chain. Thus the bone itself may be affected producing a stress fracture. If the stress and strain is felt more where the muscle attaches to the bone, medial or lateral tibial stress syndromes (more commonly referred to as ?shin splints?) will be the result.
Groups of muscles are contained in tight packages of connective tissue forming four fairly inflexible compartments. Compartment syndromes occur when the muscles are overused, swell up within one of these compartments and become compressed by the surrounding tough fibrous tissue. Finally, the muscles themselves may suffer from simple strain if too a great a demand is being made on them over time.
How does it start?
These injuries can occur in any sports that involve significant amounts of running (e.g. football, rugby). Pain around the shin doesn?t usually occur suddenly. More usually it starts off as a dull ache near the inner edge of the lower shin-bone. Initially, this might disappear once you are warmed up but re-appear after your training session. With subsequent sessions, the pain may persist for longer and eventually it is present all the way through a session and may even be felt during everyday activities.
Which of the shin problems is affecting you?
The pattern of pain described above would be fairly typical for ?shin splints?. By pinpointing the exact location of the pain your physiotherapist will have some idea of which muscle attachment is to blame. This can be confirmed by moving the ankle and foot joints into different positions until the appropriate muscle is stretched and by asking you to move your foot against resistance in the same way. Knowing which muscle is mainly to blame will help to identify the mechanical problem causing the symptoms and therefore which muscles need to be stretched and strengthened to prevent recurrence.
Stress fractures of the tibia will also produce this so called ?crescendo? pattern of pain but in this case pain is not usually present at rest and doesn?t usually disappear after warm-up. Stress fractures, although starting off as a hairline crack can progress to a full fracture of the bone with separation of the bone on either side of the fracture. It is therefore important to stop activities which provoke the pain if a stress fracture seems to be a possibility.
Compartment syndromes produce a different pattern of pain. Here the pain tends to get worse and worse as the session progresses. In addition, there may be numbness in the foot and weakness of muscle groups due to the effects of increased pressure on nerves running through these various compartments. There may also be noticeable swelling. In very severe cases the circulation can be affected causing white or blue discolouration of the feet and requiring emergency treatment.
Treatment
First of all, try and identify why the problem has occurred. Has something changed in your training recently? Is it time you replaced your running shoes? Are some of your lower leg muscles tighter or weaker than they should be? Pain in the muscles on the outside of the shin bone (or their attachment to the bone) suggests weakness in the muscles that lift your foot up towards you (the dorsiflexors). Weakness here will often result in the foot making a slapping sound on the ground and you will hear these runners coming! You can stretch these muscles by kneeling down and sitting back on your heels (if your knees will let you!). They can be strengthened by looping a weight over your foot whilst sitting on a table, lifting your toes up towards you. Try a bag with a few tins in it. Walking around on heels, keeping the toes off the ground will also strengthen these muscles. Stop if this brings on the pain.
Pain on the inside of the shinbone (often just in behind the bone) may be due to relative weakness or tightness in the muscle which rolls the sole of the foot inwards and helps to maintain the arch of the foot and also pulls the foot down (plantar flexion). This muscle will be particularly stressed in over-pronators. Tightness in the deeper of the two main calf muscles (soleus) may also be a factor. Exercises to improve flexibility around the ankle and foot joints may help but often the solution will be a running shoe which provides appropriate stability or even orthotic inserts worn inside the running shoe.
Recurrent episodes of compartment syndrome may need surgery to relieve the tight compression.
Stress fractures require at least relative rest. A plaster cast can usually be avoided but it may be necessary to avoid weight-bearing. Certainly running activities should be curtailed while the bone heals, although cross-training will allow the runner to maintain a reasonable level of aerobic fitness. A wet-vest floatation device will allow the running action to be carried out in a swimming pool whilst the bone is protected from any weight-bearing stresses.
Prevention
Movements in all planes around the ankle and subtalar joints help to keep the lower leg muscles flexible. Varying day-to-day footwear helps to spread out the load. Running shoes should be replaced every 500 miles or so as the cushioning provided by the midsole gradually deteriorates. Over-pronators should wear running shoes which provide adequate support on the medial (inside) aspect of the foot for their running sessions. However, supporting a weak structure will not make it stronger. There is also a case to be made for carrying out short foot-strengthening running sessions in bare feet. At the very least make sure that some of your calf-stretching exercises are done in bare feet, letting the foot over-pronate as you do the stretch. Stretching and strengthening exercises for the lower leg muscles should also take account of side to side and rotational movements of the foot. If stretching is always carried out whilst wearing supporting stabilising running shoes, the resulting stretching will be limited to only those planes of movement permitted by the shoe.
Remember
Always think back to identify what may have caused the injury. Depending on the severity of symptoms, cut back on mileage and consider cross training. Regarding prevention, never increase the quantity and quality of training at the same time. Don?t increase the weekly mileage by more than 5-10% at a time. Try going barefoot for short spells
Malcolm
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