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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)

 

 


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!

 


Health, running

5 Must Know Expert Tips For Trail Running

February 16, 2015 • By

trail running shaun clark physioprescriptionExperienced runners have learnt these lessons the hard way and I wish I’d known them at the start. If you are new to trail running or want to improve further, these tips will give you a great head-start.

Trail running is something I love doing, for a few reasons: The mental challenge or the long runs, the variation in terrain (meaning less chance of over-use injury) and the awesome scenery. But the thing is that it can make you sore, going down hill can play havoc on you knees and back and transitioning from the flat to going up and down repeatedly is tough, plain and simple. These next 5 tips will really help you keep going and improving with this awesome sport but really aims to decrease the load on your knees and run with better economy – Give them a go on your next few training runs and no doubt you will find them a lot easier once you get used to it.

 

1. Cash in down hill

Heading down hill is your chance to, 1. Catch your breath and 2. Make up time. Gravity is on your side here so don’t fight it – increase your pace as much as is comfortable on downhill. It is important to train for the downhill just as you would for attacking the uphill slopes – This builds the eccentric strength of your quads so that they can handle the load. Lastly – Enjoy running downhill, it is a lot of fun, a great chance to run fast and a great training alteration.

Don’t battle against the terrain. Use it to your advantage.

2. Upright torso, don’t cramp up your diaphragm

Going uphill is hard but we often make it harder on ourselves by looking down at the ground and bending our torso forward.

So to make uphill running a lot easier and open up our lungs better – maintain an upright torso and look up the slope.

 

3. Sit back and cycle downhill

This is so important, and will allow you to do number one a lot easier and with less pain afterwards! Here is what you need to do on the downhill:

  • Don’t over-stride – This will cause you to land with your foot in front of your knees and your leg straighter – basically acting like a brake, slowing your pace and stressing your knees and back big time.
  • Increase your cadence, this the turn over rate of your feet. Increase your turnover, taking quicker steps.
  • Visualize your feet landing behind you, this will help your feet land under your torso.

This is often called downhill cycling as you are taking faster steps and sitting back into it a little (leaning back).

Tip: If you want to slow down or be in more control, don’t brake through straight legs, sit back or lean back more – this will help slow you down and put you  in control.

 

4. Conserve uphill

Walk when you need to on the steep bits and keep you feet turning over and heels kicking up for the rest of the up-hill – remember you are going to make up the time on the flat and downhills!

 

5. Cadence and kick your heels up to trip less.

Maintaining an economical cadence helps get you through those longer runs and maintain a good technique. When on the flats, try to maintain a cadence of around 90 steps per minute on each foot. This cadence means less force up your shin because you are landing with your foot below your knee and not in front and it means you are kicking your heels up more and taking shorter strides – which ultimately means that you are in more control and there is less chance of tripping and ending up being very sore.

 

Above all, enjoy yourself and smile – it makes it a lot easier.

 


Health, running

Running Myths Busted

December 8, 2014 • By

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From heel landing, stretching to make you faster and shoes for different arch heights, we aim to clear up these murky waters with 5 of the biggest running myths busted.

running myths busted

It is estimated that over 35 million people run in the USA alone for exercise or for sport(1). Runners are living in a confusing, challenging and ever-changing world. There are so many conflicting opinions out there about what shoe you should wear, how your foot should be landing, whether you should lean forward or not, stretching is bad for you… I could go on but, but I’m sure you get my point!

This conflicting information needs to be cleared up. For you, the runner – whether it be for fitness or competition – and for us health professionals, because we as often as anyone else are always on the look out for the exciting new bit of research, the next quick fix or magic bullet for running injuries. With the incidence of running injuries ranging from 26% upwards, we need to be doing the right things and know what will and will not help us.(2)

 

So what are the biggest 5 running myths busted?

1. Buying running shoes based on arch height help prevent injury

pronated foot - 5 running myths bustedWhether you have high arches, low arches or neutral feet – Having shoes prescribed for this does not reduce your injury risk. Between us we all have such a great variety of foot shapes,  which obviously can’t be nicely placed into 3 boxes(6).

You can read more here.

 

2. Stretching helps prevent injury

Even though this is the factor most often thought of as the cause behind running injuries, it is simply not true(3). There is a very common belief around the world that stretching before, during or after exercise decreases the chance of injury and improves recovery, but in actual fact it has been shown that stretching is not protective of running injuries (4). Static stretching could even affect your performance.(12)

It does need to be mentioned though that often stretching is mistaken for warming up. Warming up is defined as a period of prepatory exercise to enhance subsequent training or exercise(5). Warming up does help and has been shown to significantly reduce the risk of injury.

 

Mo-Farah-core strengthening3. Runners don’t need to strength train

Good, run-specific strength and conditioning can really help your running.

Your joints will be better protected, you will have less injuries and you will run faster! Ideal (7, 8, 9, 10).

Just remember, it isn’t all about the strength, you need to have neuromuscular control. This means making sure that you training is functional and running specific.

 

4. Minimalist/ Barefoot shoes make you run better

It isn’t about the shoe, it is about HOW you run. Yes, landing on your mid-foot when running reduces the load though your lower limb and reduces risk of injury, but this is altered through your technique (such as increasing your cadence or driving through with your knee) and not through shoes.(11)

First, look at you running technique, then your shoes.

 

Mo Farah5. One running pattern is right for everyone

As Bryab Heiderscheit writes “There is too much heterogeneity among runners to believe that one running pattern is universally ideal”(13). For example, changing running style to promote forefoot or mid foot strike may unload the knee and shin pain but it would be wrong for someone with  for example a stress reaction or inter-metatarsal bursitis.

Rather, this paper suggests that we may be better off showing people how not to run, giving a couple of things that do lead to poor economy and increased injury risk. These would be things such as not over-striding (foot landing well ahead of the center of mass) and not bouncing up and down too much.

You simply cannot put everyone into the same box – but there are some aspects that do benefit the majority, and these should be promoted.

 

So there are your 5 running myths BUSTED – what do you think? Surprised?

 

 

It is important that we embrace an approach that is not one size fits all, and that is holistic in nature, that takes into account nutrition, goals, ability etc. The other big thing that needs to be looked into further is training error, which has been estimated to account for over 70% of running injuries. This is a huge amount of injuries that are due to training error (running too far, too fast, too long, too soon) – Maybe more needs to be done to place some guidelines around training progression and the best way to go about this. Especially for beginners as they have a 2-3 x higher risk of injury.

 

I would love to hear your thoughts and feedback on these running myths, see the comments section below or find me on twitter.

 

Yours in good health,

Shaun