Category Archives: Physiotherapy News

New developments in physiotherapy, injury management and assessments.

Runner’s Calf Strain Rest or Keep Training? That is the Question

The patients I often see come to physiotherapy telling me:
“I’m a runner and have pain in my calf. How long will it take to heal? Can I keep training? If I keep training will it get worse? How do I know if I have a tear or even worse, a DVT?”
A very common injury among runners is a condition called Biomechanical Overload Syndrome. It is characterised by the gradual development of an achy tight calf during a run and settles largely on ceasing activity. There is no bruising or swelling and scans are clear.
These injuries usually occur following an increase in training load particularly speed. Change in footwear is another contributing factor, more specifically minimalist shoes. Progression to forefoot running increases calf load by over 10% and should also be considered.
The good news is, for most runners they will be able to continue running but will need to address the factors that have contributed to this fatigue failure induced disorder. An experienced physiotherapist will be able to assist identify whether the issue is a result of increased load placed on the calf or a decreased capacity for the calf to manage load, and inturn put in place an effective management program.

Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction

The Sacroiliac Joint is an Axial Joint between the bones of the Sacrum (which is

a continuation of the spine) and the Ilium (part of the pelvic bones).

Only a small degree of movement, about 2-4 mm in each direction is available in the

SIJ, and enables load transfer between the upper body and lower limb.

Causes:

Dysfunction often occurs in the SIJ for four main reasons:

Inflammation– Inflammatory conditions from autoimmune disorders

Hormonal – During pregnancy the ligaments become lax and create excessive movement and alter the biomechanics of the joint.

Biomechanics– Altered forces around the SIJ due to muscle imbalances, leg length discrepancies, poor ergonomics, foot wear or repetitive and prolonged forces.  Injury typically occurs in response to combined vertical forces with rapid compression.

Trauma– A fall onto the buttock.

 

Sacro Illiac Joint Pain

SIJ pain is noted on palpation of the joint.  Pain may be noted as sharp or as an ache.  Activities that aggravate SIJ pain are rolling over in bed, lying on the effected side, putting on shoes, bending forward, moving into standing afer prolonged periods of lying or sitting.

Recommended Treatment

Treatment includes rest from the aggravating activities and activity modification, ice, and compression using an SIJ best can be very beneficial particularly for pregnant women.  Taping, correct foot wear, addressing possible leg length discrepancies, and strengthening weak areas and stretching tight muscles.

Techniques that may be usefull are dry needling, Muscle Energy Techniques, pilates, core training and ergonomics.

Recovery Time

During an acute episode recovery can take up to 2-3 weeks.  Long standing chronic pain may take 3-6 months to address the underlying strength deficits and develop core control sufficient enough to positively effect pain during the aggravating activity particurly if the activity requires significant load transfer.

Failure of conservative management may necessitate the use of Cortisone Injections and in desperate cases- joint fusion

Wrist Pain (at the base of the Thumb)

 

De Quervain’s Synovitis

A common cause of wrist pain at the base of the Thumb is known as De Quervain’s Tenosynovitis.  This injury mainly effects the thumb and the wrist and manifest itself as pain on gripping and pinching, and movements of the thumb particularly extending the thumb.  Swelling and redness over the effected tendons may be visible.

Causes:

It is thought that the injury results from either  repetitive movements or a direct impact to the outside of the wrist, but it may in some circumstances be idiopathic (no known cause).

Anatomy:

The tendons of Abductor Pollics Longus (APL) and Extensor Pollicis Brevis (EPB) are effected.  These tendons run parallel to each other and pass under the Extensor Retinaculum ( which is designed to hold the tendons in place at the wrist joint and prevent bow-stringing.

As the tendons become inflammed and thickened through either repetitive movements or a direct blow they become impinged as they pass under the rigid retinaculum.

base of thumb

Symptoms:

Pain on movements of the thumb: pinching, wringing, making a fist, moving the thumb towards the base of the little finger, drawing the thumb away from the hand (stretching outwards) and during activities like opening a jar.

 Diagnosis:

The main test used for diagnosis is Finkelstein’s Test.  The test in performed by holding arm out straight with thumb side up,  tuck the thumb into the centre of the fingers and make a fist.  Slowly bend wrist towards the floor (Ulnar deviation).  A positive test is indicated when pain is felt over the tendons of the APL and EPB.

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Treatment:

RICE (An acronym for Rest, Ice, Compression and Elevation).  Therefore using ice packs up to 3 times per day for a period of 10 minutes.

Anti Inflammatory medication may be a usefull method of decreasing inflammation, check with your Doctor which one is most suitable.
Activity Modification involves reducing the amount of aggravating activity, performing the activity in a different way or taking frequent rest breaks.
The use of a Night Splint to the thumb and wrist to rest the tendons is essential.
Soft tissue releases to the involved muscles are usefull physiotherapy techniques
A stretching program for the muscles of the thumb and wrist, and finally

A graduated Strengthening Program for the involved muscles.

Prognosis:

If the injury is responding well to the conservative treatment regimen, a positive change in pain and function should be noted after 4-6 weeks, permanent task modification may be required with continued use of the splint.  Surgery may be indicated if pain continues to be debilitating

Exercise Program:

Spirit Fingers- Place rubber bands around fingers and open hand  (3 Sets, 12 Reps)
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Wrist Stretch -Flexion -Bend Wrist downwards assist with other hand. (Hold 10 Seconds, 3 Repeats)

 

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Wrist Stretch – Extension -Bend Wrist downwards assist with other hand.  (Hold 10 Seconds, 3 Repeats)

 

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Number Four Sign-Hold thumb towards base of 5th finger.  (Hold for 5 seconds, Repeat 5 times)

 

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Wrist Extension Strength- using light weight 1/2 -2 kg , curl wrist upwards beginning in a palm downwards position. (3 Sets, 12 Reps)

 

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Radial Deviation Lowering -using light weight 1/2 kg , in hand shake position, curl thumb side of wrist upwards beginning in a downwards position. (3 Sets, 12 Reps)

 

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Grip- using a tennis ball, or soft ball or theraputty (Hold for 10 seconds, Repeat 5 times)

 

 

 

 

 

 

Running Technique: Running Drills – Part 6

Running Drills

 

Sadly, having good flexibility and strength does not miraculously result in good running technique.  Whilst strength training programs should be as specific as possible nothing quite prepares the body for running like running itself.  If your hip stabilizers or core have been your major strength deficit then strengthening these muscle groups will help but unfortunately unless you actually use them during your run your wont be achieving the improvements as effectively as you could.

Forefoot Landing

Running in Place/ Marching on the Spot Landing on the forefoot

 

Stance Leg Stabilization

Landing on leg and stabilizing through knee/ ankle and hip

 

Stance Leg Power

straighten leg, push off toe, activate glut

 

Pelvis and Core and Balance

raising up onto toe with stride action- maintain balance, pelvis stable and aligned

 

Knee Drive

after foot strike focus on driving knee forward

(video to follow)

Running Technique: Stretching for Running – Part 4

Stretching Before Running

The best stretching to do before running is Dynamic Stretching ie performing leg swings etc to gently warm up muscle and working them through range.

Calves:

Mountain Pose Alternate Calf Stretch

Hamstrings:

Leg swings

Adductors:

Cross Leg Swings

Quads:

Bum Kicks

Glutes:

Cross Legged Squats

Lumbar Spine:

Rotations

Shoulders:

Arm Swings- forwards, side ways, and horizontal

Neck:

Rotations and Side to side

(photos to come)

Stretching After Running

static stretching

Calves:

Knee to Wall

Leaning wall stretch

Quads:

Prone heel to butt

Rectus Femoris:

Proposal Stretch with rear leg up wall

Hip Joint:

Figure of 4 Stretch

Glutes:

Pigeon Pose

Hamstrings:

Seated on bench single leg stretch

Lumbar Spine:

Reverse Rotation

Abdominals:

Cobra Stretch with Knee Stretch

Chest:

Arm against wall

Bicep:

Arms behind

Tricep:

Hand to shoulder

Torso:

Mermaid Stretch

(photos to follow)

Running Technique: Good Form – Part 3

What is Good Technique?

  • Landing on the Forefoot

  • Placing the foot under the centre of the hip

  • Feet Landing either side of a straight line down the centre

  • Landing with a slightly flexed Knee

  • Pushing off from and extended Hip

  • Maintaining Consistent Hip Position

  • 5 degree lean forward (from the feet)

  • Soles of the Feet in vertical plane when viewed from behind

  • Head held upright and steady

  • Slight rotation of the Torso

  • Shoulders connected with the core and a good distance from ears

httpv://www.youtube.com/watch?v=rflLmtUWnrA&NR=1&feature=fvwp

Running Technique: Common Injuries – Part 2

Some of the common bio-mechanical faults and their resultant injuries are:

1. Over Striding the foot landing in front of the centre of gravity (the line from the centre of your pelvis to the ground)- For distance runs (not sprinting) the foot should land directly under the hip, otherwise if your over striding it is like Fred Flintstone applying his manual breaks every time you are taking a step.

Possible injuries: shin pain, calf tightness, hamstring strains, plantar fascitiis

2. Landing on the heel
this fault is when  the heel is first to strike the ground. The aim is to land on the fore-foot, somewhere between the toes and heel and then allow the heel to kiss the ground.

Possible Injuries: Shin and Heel Pain, Foot Stress Fractures

 

3. Pelvis Drop-when taking a stride forward the pelvis should maintain a relatively level position. When watching stills of runners who are unable to control pelvis position  it can appear as though the runner needs to go to the bathroom. Often a result of weak pelvic stabilizers and core.

Possible Injuries: ITB Friction Syndrome, Patello-Femoral Pain Syndrome, Lumbar Spine Pain, Hip Pain

4. Splaying of the Feet– looking from behind, this is seen as the toes pointing outward.  Ideally, the length of the sole should be vertical to the running surface. Again often a result of weak pelvic stabilizers not controlling the internal rotation of the femur.

5. Tight Rope Running feet landing in a straight line. Weak pelvic stabilizers not controlling the abduction of the body on the stationary femur (leg).

Possible Injuries: hip pain, calf strain, stress fractures of the feet

6. Flexed Hips- looks as though there is an imaginary chair under the runner.  This position does not optimise the powerfull gluteal action of extension and results in excessive work to be achieved by the hamstrings and calves.  May be a function of weak gluteus maximus aka your butt or tight hip flexors, and or weak core.  You will often see this technique accompanied by the appearance of a saggy belly and overly pushed out chest.  As this runner attempts to use a strongly held extended back as substitute for a lacking core.

Possible Injuries: Knee pain, Calf and Hamstring strains

7. Rounded/ hunched shoulders.  The shoulders should have some “connectedness” to the core.  If the shoulders are narrowing the space underneath the ear there is a good chance that there is not a lot of core stability going on.  To rectify this, work needs to be done on the shoulder stabilizers, and correct any core deficits, there may be some pectoral tightness also creating this poor alignment

Possible Injuries: Neck strain, Shoulder Pain, Mid upper back pain

8. The Bobbing Head- side ways or up and down.  The head should stay centred between the shoulders if this is not achievable the runner should work on the factors for point 7. listed above.  If the head is bobbing up and down so that a line  tracing  head movement in space looks like an inch worm,  there is too much effort going into jumping upwards and not enough on moving forwards.  Factors to consider are  forward body lean, it is generally thought that a 5 degree lean  the foot to the head is recommended for flat running.  Often runners misinterpret leaning forward as a lean from the hip and thus run bent over.

(coming up- a summary of good running technique, strengthening and stretching for running and running drills)


 

Running Technique: Analysis – Part 1

Running Technique: The Rationale and the Initial Analysis

The Argument

Running is a popular sport and activity for all ages, but in any given year 75% of runners will sustain an injury. Certainly the high impact loads of running contribute to this but equally, poor running technique.

I can not tell you how many times I have heard runners protest that each individual is suppose to run in anyway that they find natural, and that running more frequently results in improvements in technique. I not sure which mechanism enables the incorrect repetition of skill or movement enables improvement. Granted as the body strengthens and increases in fitness some issues may be ironed out but it would seem that repetition of many movement pattern results in a greater reproduction of that pattern to the point it becomes automatic.

Could you ever imagine being given a bag of golf clubs and ball and pointed in the direction of the hole and tasked to develop your own swing? As a runner how are supposed to know what movement patterns you are aiming for?

Thorough bio-mechanical analysis has lead to technique improvement in an endless number of sports ie. tennis, golf, gymnastics, and swimming, and running is no exception.

Where to start

Begin with taking a video of your running. Include :

1. Up Hill
2. Down Hill
3. Training Pace
4. Racing Pace
5. the last 1/4 of your race length run

Analyzing your run:

1.Start at the feet.

a) How do they land? What strikes the ground first? the heel, the forefoot or the ball?

b) Does the Foot strike the ground in front of the body, directly underneath,or behind? (to visualize this think of dropping a plumb-bob directly from the centre of the hip towards the ground)

c) Do the feet cross each other as they land, almost like walking on a tight rope or do they strike either side of a centre line?

d) When looking from behind, are the length of the soles of the shoes vertical with the ground,  angled inwards or outwards? (Foot Splay)

e) When viewed from the front, how much of the soles of the shoes are visible?

2. The knees

a) Are the knees straight or bent on landing?

b) As the foot lands, do the knees move forward over the centre of the foot, inwards or outwards?

3. Hips

a) is there a noticable drop of the unsupported hip during foot strike?

b) are the hips flexed throughout the gait cycle? (like sitting in an imaginary chair)

c) hips sway side to side ( like doing the hoola)

4. The Core

a) protruding stomach

b) none, some or excessive rotation of the upper body on the lower body?

5. Shoulders

a) hunched?

b) bouncing, causing a head bobbing movement side to side?

6. The Head

a) Held centred or forward over the chest?

b) Bobbing up and down as if on a trampoline?

 

(coming up next: Good Running Form and Bad Running Form and the injuries that result)

httpv://www.youtube.com/watch?v=YjuD1uZWE3E

 

 

 

 

 

 

Running Technique: Strength training for running – Part 5

Specific Strength Training for Running

The following is a generalized program for improving specific deficits in strength.
Firstly one needs to assess from analysis of running technique where the weaknesses may lie, then with musculo-skeletal testing of the possible causes, identify if in fact these weakness are apparent. With this information a strength program (along with a stretching regimen) is formulated for each individual. Without working through this process it would be like taking another persons medicine: sometimes counterproductive, unnecessary or conflicting with your specific needs.

 

 

Calves:

Balancing Calf Raises- double leg, single Leg

Quads:

Standing Lunges, Bench Lunges

Hamstrings:

Head on Ball, Single leg bridge

Gluts:

Wall Exercise from weight shift to single leg squat

Core:

Planks with arm raise, Side Planks

Core/Pelvis/Balance:

Running Motion Standing on Bosu

Arms:

Theraband Punches