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Health, running, Thigh

Hamstring Injury and why Biceps Femoris gets a bad rap

June 27, 2016 • By

Hamstring injury happens frequently in running-based sports such as athletics, football and rugby – But over 80% of these occur in the outer hamstring when the leg is swinging through – why is that?

It is often thought that hamstrings are injured from changes in direction, pushing off and explosive movements but in reality, most hamstring injury happens when the leg is swinging through, just before the foot touches down.

Here is a quick few stats and anatomy refresher to ground you:

Hamstring injury

The hamstrings are made up of three muscles

  • The Biceps Femoris, which has two parts to it. The long head which cross’ both the hip and then knee joint and the short head which only crosses one joint
  • Semitendinosus
  • And Semitendinosus at the inner thigh

There is a huge difference between how much each these muscles get injured. The Biceps Femoris long head (BFlonghead) is involved in a huge 80%hamstringirng injuries.(1)

As well as this, most hamstring injuries are thought to happen in late swing phase of running, just before the foot lands. So how does the BFlonghead taking the brunt of injuries and this mechanism of injury link in? Check out the video below first of all to ee how the hamstring works in walking:

 

As you can see in the video, the hamstrings fire into action before, during and after the foot lands. At this point when the knee is extended, the muscle is working while at it’s peak length and at maximal force development working hard eccentrically to slow leg swing down.

Note: An eccentric contraction is where the muscle controls lengthening out, which is far harder on the muscle than a concentric contraction where it contracts to push-off.

Recent studies have shown that the Biceps Femoris is more active, along with the other hamstring muscles when the hip is extending, rather than the knee flexing. The semitendinosus, however, is more active in knee flexion where it works to bend the knee. This means that as well as the BFlonghead working harder with eccentrically slowing the leg down, it is also not often strengthened as well as the other hamstrings because of this.

nordic curls - hamstring rehab and strengthening exerciseA lot of hamstring strengthening is done at the knee (nordic curls, hamstring curls etc) which has been shown to be more the work of the medial hamstrings than Biceps Femoris.

 

 

 

 

Hamstring chair bridges

Credit irunfar.com

So there you have it, the BFlonghead of the hamstrings works harder eccentrically slowing down the momentum of the leg swinging forward and often gets missed in strengthening sessions – Stuck between a rock and a hard place! This gives athletes and health professionals better guidance as to what rehab exercises to add in post injury and also in injury prevention programmes depending on injury, leading to decreasing the nearly 30% re-injury rate.(1)

 

 


Foot pain

The Human foot – Amazing video of foot mechanics

August 5, 2015 • By

Foot mechanics the natural human footThe human foot is an amazing thing and something we rely so much on – It shouldn’t be taken for granted. This is a great video by the BBC that demonstrates and discusses our amazing natural foot mechanics of our feet and how it works to keep us moving efficiently.

There is some dissection in the video so be warned if you are a bit squeamish, but it is well worth it!

There is also a great explanation in here of the plantar fascia and windlass mechanism and how this natural spring mechanism helps us move – you will be surprised how complicated our feet are!

 

What do you think about our foot mechanics? Pretty bloody lucky aren’t we.


Health, running, Shin Pain

Shin Pain and Stress fractures – Heal strong and fast

July 16, 2015 • By

marathonTreating your shin pain and foot pain from stress fracture the right way, as soon as possible, means you heal faster and stronger. In this series on stress fractures, I will tell you what a stress fracture is, what causes them and most importantly what rehab exercises and self-treatment you can do to get it right.

Following on from the first post in the series which detailed what stress fractures and stress reactions are and why endurance athletes are so prone to shin pain and foot pain and what to do initially, this post gives you the rehab to help it heal faster, by covering phase 2 and 3 of stress fracture rehab.

Phase 2 – Strength, conditioning and rehab

When to start: Phase 2 of rehab from stress reactions starts when general activities of daily living (walking, hanging out washing etc) can be done without symptoms – Pain is an indication of overload to the bone in many cases, so we need to listen to our bodies.

The main three aspects that need to be covered in home rehab of stress fractures are:

  1. Exercise to maintain cardiovascular fitness and prevent muscle loss
  2. Rehab exercises to address cause behind the injury

So let’s address those:

1. Maintain fitness

It is important to note that in most cases you don’t have to completely rest – there is always something you can do, and very important not to lose fitness. So with that in mind, and the fact that exercise actually boosts healing, here are some things that you could do:

  • Pool training – this can start light, treading water in the deep pool and swimming, progressing to jogging in chest-deep water.
  • Stationary bicycle or exercycle – this is a great way to keep up the fitness without causing pain
  • When poor walking etc is pain-free, begin going for short walks and build this up. Eventually you should be able to walk without pain for 30 minutes at the end of this phase

Tip: Remember, you cannot return to loading the bone until the bone is pain-free to tap on and touch

2. Rehab exercises

These should aim to:

  • Increase muscular endurance
  • Improve core and pelvic stability
  • Work on balance training
  • Address flexibility issues
  • Re-train running pattern

Here are some great options to work on:

Heel raises to build calf endurance

Calf raise, calf exercise, heel raiseLevel 1: Start these on two legs, aiming for 3 sets of 10 reps

Level 2: When comfortable and pain-free, progress to single leg heel raises

Level 3: Goal: 30 heel raises in a row

 

 

 

One leg squats to retrain pelvic and lower limb stability

Single leg Squat, hip stability and strength

Aim for 3 sets of 10 reps.

These need to be done with good technique so it can help to do them in front of a mirror

 

 

 

 

Wobble board balance re-training

Bosu ball, wobble board ankle and calf re-training rehab quick

 

Re-training your balance and coordination of the muscles is very improtant, and easily done with either a wobble board or a Bosu ball.

Aim for at least one minute on each leg.

If you can’t get a wobble board, try rolling up a towel firmly and standing on this

 

 

Stretching:

Calves

calf stretch , soleus, gastroc - self treatment for shin splints

Hang one heel at a time off a step and hold for 30 seconds

 

 

 

 

Hamstrings

doorway stretch

 

MTSS shin splints self treatmentStretch out your hamstrings up a doorway of wall as shown here and hold for at least 30 seconds each side

Alternatively you could use a foam roller to loosen up your hamstrings and calves!

 

 

Tip: Continue to ice after exercise and exercise should always be pain-free – a return of shin pain or foot pain can’t be taken lightly.

Phase 3: Safe progression back to full activity

Before starting this phase, you need to be able to do all the previous exercises and painfree and ideally be cleared by your physio or doctor.

When returning to running, a good guideline is to increase activity by no more than 15% to 20% per week. You should also be able to walk for 30 minutes comfortably and you can build this up the same way.

A good starting point, is to run 500m followed by a day of rest or a short walk. If this is pain-free, then you can jog 3 x weekly, ensuring that there are rest days

The distance above is just a guideline but basically start with a short distance and if this is pain-free, slowly increase this, never increasing by more than 15% per week. This is because bones take time to adapt, heal and get stronger – you need to give them this time and only increase in small amounts so as not to overload them.(1)

Numb feet when running lace up properlyTip: when returning to running, it is important to have the right technique – pay a visit to your local sports physio or appropriate professional to have this looked at and also to get some advice on footwear for you as this is very individual (but maybe stay away from minimalist or “barefoot” footwear and aim for motion controlled footwear initially (2)).


Foot pain, Health, running, Shin Pain

1 in 5 people will get a Stress Fracture Running

July 2, 2015 • By

Stress fracture shinA huge 20% of runners get stress fractures – often when building to a big race! Find out here the most up-to-date information on what they are, why runners are so prone to them and also how to get them better, faster.(3)

What is a stress fracture?

A stress fracture is, as the name suggests, a small fracture in a bone. It is a partial or incomplete fracture caused by the build up of stress to a localised area of bone. So they aren’t your usual fracture that happen due to a big fall or collision, they are due to repetitive strain, which is why runners are so at-risk, but more on that soon.

What causes a stress fracture?

Bones get stressed when there is a load placed through them, whether this is from the shock of your foot landing on the ground or from your muscles pulling on the bones to move you and absorb the shock. Stress fractures can basically be classified into two types:

1. Fatigue; This is caused by an abnormal stress (more than the bone is used to) to a normal bone.

2. Insufficiency; These fractures arise from the application of normal stress through a bone that is abnormal – such as mineral deficient or abnormally rigid. This is most prevalent in nutrient deficient and older population with osteoporosis and arthritis.

The type that is most common in the active population, as you can guess I’m sure, is the fatigue stress fracture. Generally the “abnormal force” that causes this bone-fatigue is due to increasing training intensity or distance, wearing inappropriate shoes or not progressing into new shoes, training on hard surfaces or due to poor alignment of the feet. The problem with bones is that they adapt a lot slower than muscles – when muscles can adapt and improve within a few weeks, bones can take a few months! This means that as your muscles improve and your lungs do too, you can go further and faster. The only problem with that is that your bones are still trying to adapt to the initial increase in training.

stress fracture cycle

Romani et al. Journal of Athletic Training 2002;37(3):306–314

Think of bone remodeling like renovating a house: Winter hits, and without thick walls it is bloody cold. So you adapt and decide to insulate the walls. Your bones are the same, they get an increase in stress through them and think hey, I need to get stronger, but before your bones get stronger, just like insulating your walls, the current walls need to be taken downs first. The problem is if you increase training load or intensity in this time when the bone is actually weaker, when trying to remodel, you can push it over the edge and cause a stress fracture.

In fact, there’s even a window of about a month where bone becomes weaker after an increase in training stress because of the way the body remodels bone, as described above. Your body first tears out some walls in the bone structure before it can put in new ones, much like remodeling your house.

Where do they happen?

Stress fractures in runners are most common in the shin bone, the navicular bone in the foot and the 2nd and 3rd metatarsals (long bones in the foot) – stress fractures through these three bones make up over 50% of all stress fractures.(1)

Note: Shin splints does not mean stress fracture. Shin splints is a generalised, umbrella term that is used to describe pain in the anterior shin – this can be a number of things so be sure to have your shin pain diagnosed by a professional.

Why are runners so at risk for stress fractures?

Stress fractures account for a massive 20% of athletic injuries and are very common in endurance activities, especially distance running. This is hardly surprising as running requires thousands of repetitive steps on every run – now if you do any of these for example:

  • Increase training mileage too fast (more than 30% in two weeks for example)
  • Start using new minimalist shoes all of a sudden
  • Increase training intensity

Just to name a few! This will be putting more load through your bones than they are used to. If they then aren’t given time to adapt to this and get stronger – they will actually suffer repeated micro trauma and will fracture

A stress fracture typically feels like an aching or burning localized pain somewhere along a bone. Usually, it will hurt to press on it, and the pain will get progressively worse as you run on it, eventually hurting while walking or even when you’re not putting any weight on it at all. Sometimes, if the stress fracture is along a bone that has a lot of muscles around it, like the tibia or femur, these muscles will feel very tight.

 

So what can you do to help it heal strong and fast and get back to running ASAP?

Firstly, get it diagnosed by a professional. The vast majority of stress fractures heal within 8 weeks, but it is important to have it diagnosed as soon as possible so that yo know for sure what it is.

Secondly, rehabilitation of a stress fracture can be split into three phases:

Phase 1: Relative rest (rest and protect phase)

The goal in the first phase is to rest the injured area to give it time to heal, while maintaining aerobic fitness. This is the main goals:

  • RICE injury treatment, heal strong and fastRest the injured area: No running or loading up the area. Listen to it, if it hurts, stop. A moon boot may be needed and will definitely help you heal strong.
  • Maintain fitness through swimming and cycling
  • Seek treatment from a physio – This does help as it is important to maintain full range of motion and to unload the injured area
  • Ice to decrease inflammation and limit secondary damage
  • Do not take anti-inflammatory medication if you can help it (you don’t want to stop inflammation and slow healing)(2)

Phase 2: Strength, conditioning and rehab

In this stage we need to ensure the causative factors behind the injury are sorted out. Things such as, tight muscles, muscles with poor endurance or controlled and training error. This is the phase that you will enjoy as unlike the first phase, it isn’t all rest and unload – You can take control of your recovery by doing the right rehab exercises to ensure the stress fracture heals strong and fast. Your exercises need to address these areas:

  • Increase muscular endurance (calves, glutes and hamstrings)
  • Improve core and pelvic stability
  • Work on balance training (proprioception)
  • Address flexibility issues
  • Re-train running pattern

Phase 3: Safe progression back to full activity

This is where you ease your body back into it while allowing the bone to strengthen and heal – without overloading again.

In the second blog post in this stress fracture series, I am going to detail phase 2 and 3 – the exercises that you can do to help speed up recovery and have you healing strong. These are all exercises that can be done at home so there is no excuse for them not being done!

 


Heel pain

Plantar Fasciitis Exercises – a superior new approach

June 11, 2015 • By

Heel pain, plantar fasciitis exercisesHeel pain is incredibly common and one of those injuries that can take months to years to heal. So the more that you can do to help it at home the better right? Recently there has been a shift in thinking in rehabilitation soft tissue injuries and this has brought with it a new plantar fasciitis exercises that significantly speeds up recovery.

Mechanotherapy has recently been brought back into the limelight and more focus has been put on this. Mechanotherapy is basically looking at how tissue reacts to the forces that are put through it. If you put the right progressive loading through a tissue, it will adapt and change according to that load – The body is an awesome thing and we can use this adaptation to loading to give injuries a push in the right direction to heal heal pain strong and fast.

A good explanation of mechanotherapy can be found here for more information.

In the past, the treatment for plantar fasciitis (which should really be called plantar fasciopathy) has been quite passive with footwear, stretching and injections being the go-to options. these definitely help, and I have written a post in the past with some great rehab exercises in it, but new research has added another dimension to treatment of plantar fasciitis that we can add to this.

A recent new study, looking at 48 patients with plantar fasciitis, compared two treatment options which basically had one group stretching the plantar fascia and using shoe inserts and the other group doing plantar fascia specific high load strength training and shoe inserts. The results at the 3-month review mark showed a much better improvement for the patients that were doing the simple progressive exercise every second day.

New findings like this can’t be ignored as who wouldn’t want to be pain-free faster!

 

So what is this new progressive exercise regimen that you can add to your rehab exercsies?

The exercise is a simple single leg heel raise with a towel rolled up and put under the toes to put the windlass mechanism on stretch. You then do a heel raise, taking 3 seconds to go up, a 2-second pause at the top and then a 3 second lowering down again.

Do 3 sets of 10 reps every second day.

As pain improves and it becomes comfortable to do for after two weeks, you can add weight to the exercise by putting some weight in a backpack (e.g. a few books or a brisk or two) to progress the exercise and progressively add more force.

Note: This exercise needs to be done slowly as described to decrease the risk of flaring up the injury

For more detailed/technical info, see Running-physio’s blog where the author explains the study in more detail.

 

The main thing is with plantar fasciopathy is to persevere, keep at your treatment and rehab exercises as it does get better.