Stretches For New Runners
March 20, 2010
It is important to include some stretching exercises before your running routine. If done correctly, stretches can help to improve your flexibility and joint range of motion, and can decrease your risk of injury to joints, muscles, and tendons while running. In this article, we will show you top 5 stretches to do before a run.
Disclaimer: Note that stretching is not warming-up. It is a common misconception that warming-up equates to stretching. ‘Warming-up’ literally means raising your core body temperature. It is advised that before you begin on your stretches and run, a general warm-up such as brisk walking between five to ten minutes be performed to prevent injury to your ‘cold’ muscles. (see To stretch or not to stretch before an event?
Top 5 stretches:
Hamstrings Stretch
|
|
|
Calf Stretch
Quadriceps Stretch
Iliotibial Band (ITB) Stretch
Glueteus (Buttock) Stretch
Why is my MCL strain not getting better? Because it is Pes Ancerinus Tendinitis.
March 18, 2010
When long-distance runners complain about knee pains, it is often complaints about pain in the front of their inner knee, below the knee cap. Pain comes about especially when climbing uphill or up stairs. Given the location, this pain is sometimes misdiagnosed as a MCL (medial collateral ligament) strain when it is actually Pes Anserinus Tendinitis.
What is Pes Anserinus Tendinitis?
It is essentially a inflammation of the tendons between your shinbone and muscles that form parts of your hamstring and thigh, .Three tendons (Semitendinosus, Sartorius1 and Gracilis) join up to form the pes anserinus tendon. Pes anserinus in latin means 'goose feet' roughly describing the webbed look of the three tendon coming together.The pes anserinus tendon joins to the shin bone where the pain is usually felt.
Is it often mis-diagnosed as MCL or medial-menicus strain because of the close location of the pes anserinus tendon to the MCL and medial menicus.
What strains the Pes Anserinus Tendon?
Things that strain the pes anserinus tendon are
- Severe pronation of the feet – this causes the tibia (one of the lower leg bones) to rotate inwards which strains the tendons
- Weak hamstring muscles – when combined with an intense running programme, the hamstrings may not be able to cope with the high workload. This is often an overlooked areas in a runner's strength training regime.
- Tight thigh muscles (quadriceps) – weakens the opposing hamstring muscle. Muscles tightness here is further encouraged if you have a deskbound job that requires you to sit at the your desk all day long.
- Sudden change on the volume and intensity of training
Diagnosing Pes Anserinus Tendinitis
Patients typically complain about pain climbing stairs, squatting, running and in severe cases, standing from a seated position.The pain would also appear gradually and for runners, following an increase in their training volume and intensity (uphill, or running faster).
However, even if your symptoms match those listed above, it is advisable to ensure that it is not other possible condition such as Patellar-Femoral Pain (PFP), MCL strain and medial-menicus strain
Treating Pes Anserinus
During the initial inflamed painful stage, your doctor may prescribe NSAIDs to help reduce the swelling and inflammation and recommend rest for the first 24-48 hours. Ice or cyrotherapy can help speed up the recovery by reducing the inflammation.
Once less painful, your therapist may suggest the following treatment depending on your cause of the tendinitis as list above.
- For severe foot pronation – orthotics can help correct over pronation of your foot
- To strengthen the weak hamstrings – see Hamstring Exercises for Long Distance Runners
- Release tight thigh muscles with sports massage and a stretching programme.
- A training programme that appropriately increases your training volume and intensity.
1 Ed note. The Sartorius is the longest muscle in the human body
Heat or Ice? When to use which?
February 17, 2010
When should you use heat or ice therapy? The answer is – it depends. In general, heat therapy is for chronic conditions and ice is useful in acute situations.
If you recently sustained an injury or aggravated an old injury, ice should be applied for a period of 15mins each time for the first 3 days. If you feel your muscles are feeling tight and stiff, a hot pack on the muscles will help to relieve the tightness.
This spectrum of acute to chronic looks at the duration since injury. If the injury is sustained within 36 hours, it is considered to be in the acute stage. At this stage the inflammation process is ongoing. Ice will help to bring down the inflammation and swelling so that the injury can heal better. Note that applying heat to this stage will increase the blood circulation, inflammation and hence swelling.
There are 2 common scenarios that cause pain, making you reach for that heat/ice pack. One of them is the acute injury (for example a fall, twisting movement or direct blow that is immediately painful) and the other is the chronic injury (happened over a period of time or from an acute injury that failed to heal). Each scenario requires a different approach to reducing your pain and speeding up your recovery.
Acute Injuries
It might be that you have just sprained your ankle playing soccer, shut your fingers in the car door or fractured your hand. All these are examples of acute injuries and will show the following signs:
- Sharp, severe pain
- Swelling
- Redness
- Increased warmth
- Restricted joint movement
- Unable to put weight through the structure (e.g. leg, ankle, wrist etc).
Flickr: Kyle May
There are many ways of applying ice like using an ice pack; wrapping ice cubes in a wet towel or using a bag of frozen peas (sometimes that is the only thing on hand!). The cold agent should be in contact with the area for up to 20 minutes at a time and re-applied every 2-3 hours for around 3-5 days or until the swelling settles.
How does ice work?
1. Decreasing the pain
There are a few proposed theories regarding how ice decreases pain and it is possible that a combination of some of them can cause pain relief.
- Decreased nerve transmission in pain fibres
- Cold reduces the activity of free nerve endings
- Cold raises the pain threshold
- Cold causes a release in endorphins
- Cold sensations over-ride the pain sensations
2. Reducing swelling
Ice cools the surface of the skin and its underlying tissues, causing narrowing of the blood vessels. This narrowing leads to a decrease in the amount of blood delivered to the area and subsequently reduces the amount of swelling. After a few minutes, the blood vessels re-open allowing blood to return to the area. The narrowing and opening repeat in cycles.
The decrease in swelling also allows more movement in the area and lessens the loss of function associated with the injury. Pain is also reduced as pressure from the swelling lessens. Chemicals that intensify the pain are released into the bloodstream when tissues are injured, thus the narrowing of the vessels help to minimize this release and pain.
3. Decreasing metabolic rate
Ice reduces the metabolic rate and oxygen requirements of the cells. Thus, even with the decreased blood flow and oxygen delivery that comes with narrowing of the vessels, the risk of cell death will be lessened. This prevents further injury.
Sub-acute phase
A few days following an acute injury, the pain and swelling may have decreased so much that there may be no sign of the original injury. However, the tissues are still in the process of recovery and will still benefit from modifying your activities (less vigorous) as well as using both ice and heat alternatively. This means to apply ice for 10 minutes, followed immediately by 10 minutes of heat.
How does this work?
Doing this will cause massive increases in blood flow to the area as the narrowing caused by cooling is reversed when heat is applied, resulting in an influx of blood to the damaged tissues. The increased blood flow to the area provides proteins, nutrients and oxygen for better healing. It also helps remove the products of inflammation and reduce residual swelling.
An important point to note is to ensure that inflammation has stopped before applying this technique. That means that the area should not be red, and should not be warm to touch.
Chronic Injuries
Flickr: Capture Queen
In order to treat these, heat should be used to help relax tight, aching muscles and joints, increase the extensibility of ligaments and tendons and promote blood flow to the area. Heat can also be used before exercise in chronic injuries to warm the muscles and increase flexibility.
Heat can be applied to the area in the form of heat packs, a warm damp towel, hot water bottles or heat rubs. If using a heat pack or hot water bottle, ensure a suitable layer of protection is placed over the skin to prevent burns. The heat should be applied for 15-20 minutes.
How does heat work?
Heat applied on the skin increases the temperature of the skin and the underlying tissues. This in turn opens up the blood vessels like your ateries, allowing more blood to flow into the area. This increase flow helps to remove waste products from cells and deliver more nutrients, relaxing tissues. The increased temperature of the blood also warms up surrounding tissues. Heat also has an effect of increasing flexibility of the soft tissues.
Both heat and ice are cheap, easy to use and effective ways of speeding up recovery when used correctly. Besides managing your injuries with these modalities, it may be a good idea to consult a physiotherapist in helping you rehabilitate and/or prevent the same injuries from occurring.
When is Achilles Tendonitis not Achilles Tendonitis? When it is Retrocalcaneal Bursitis
February 13, 2010
Do you experience pain at the back of your heel? Is the back of your heel red and swollen? And you were told that it might Achilles Tendonitis? But so far treatment for Achilles Tendonitis does not seem to be working? You might be suffering instead from Retrocalcaneal Bursitis.
Background
www.merck.com
This condition is often mistaken for Achilles tendinitis but it can also occur in conjunction with Achilles tendinitis.
Signs and Symptoms
In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.
What leads to Retrocalcaneal bursitis?
There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.
How do we tell that it is not Achilles Tendonitis?
Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon.
Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.
Management
- During the initial acute phase of the condition, patients should apply ice to the back of the heel for 15 to 20 minutes and follow the R.I.C.E.R regime. Avoid activities that cause pain.
- Gradual progressive stretching of the calf muscle and Achilles tendon is also advocated.
- Changing the footwear. Wearing an open-backed shoe may help relieve pressure on the affected region. For those whose symptoms were caused by a sudden change from wearing high-heeled shoes to flat shoes, the temporary use of footwear with a heel height in between may be helpful.
- Inserting a heel cup in the shoe may help to raise the inflamed region slightly above the shoe’s restricting heel counter and relieve the pain. It is advisable to also insert the heel cup into the other shoe to avoid any leg-leg discrepancies that can lead to other problems.
- Training frequency and intensity should be gradually progressed with adequate rest between trainings.
Tips to Run Pain Free
January 10, 2010
Recently our physiotherapist, Lenia, was featured in Shape magazine Jan 2010. Here is an excerpt from the article.
Shin splints are caused by weak shin muscles or faulty running biomechanics while plantar fasciitisis the result of tight calf muscles that reduce the foot's ability to absorb shock. Here are some tips to stay on track. Read more
Osteoarthritis Knee
December 25, 2009
Osteoarthritis (OA) of the knee is a degenerative condition where the cartilages of the knee wear away. Pain, stiffness and swelling are common symptoms of an OA knee. In this article, we look at the three factors that lead to the development of OA knee – Aging, Physical Attributes and Muscular Causes. Of which two of these factors, Physical Attributes and Muscular Causes, can be addressed with physiotherapy management. We will focus more in detail on the exercises and treatment for OA knee in a follow-up article.
Aging
OA Knee
Physical Attributes
The three key physical attributes are:
- Obesity - A heavier person will load their knee joints more, wearing out their cartilages faster than a lighter person.
- Knee alignment – A bow legged or knock-knee appearance will cause an uneven compression of the knee. Either the outer or inner compartment knee respectively will take up most of the load upon weight bearing and cause more wear and tear.
- Foot type -
- People with flat feet or whose feet over pronate tend to roll their knee inwards upon weight bearing similar to a knock-knee above.
- A person with high foot arch or whose feet under-pronate absorbs less impact with each foot fall. More impact goes up through the leg and the knee will have to work harder to cushion the impact.
Muscular Causes
When the muscles around the knee do not contract strong and fast enough in a coordinated fashion to absorb the impact of walking or running, the knee joint takes up the remaining forces of the impact.
- Tight muscles pull joints closer to each other.In an OA knee where the joint space is already reduced, tight muscles will increase the compression of the joint space. Muscles with reduced flexibility are also less coordinated and slower in reaction time. The muscles that tend to be tight are the quadriceps, hamstrings and calves.
- Weak muscles. The quadriceps muscles is the main muscle group that help to support the weight of the body and off loads the knee joint. It is very common for this muscle to atrophy because of disuse. The knee pain deters the patient from loading the knee and this will gradually lead to weakness of the knee which will affect the ability to cushion the impact. This pain, disuse, weakness cycle will continue without treatment.
Weak gluteus medius muscle can aggravate the degeneration of knee cartilage because its function is to keep the hip joint stable, especially in walking. This is often seen as a waddling gait where the hip sway with big movements side to side. The thigh muscle have to work a lot harder to stabilise the wobbly hip and if they are unstable, the knee joints will have to bear the weight.
The management of these factors are summarised in the following table. In our upcoming article, we will further discuss the specific exercises and treatment for OA knee.
|
Physical Attributes |
Management |
| Weight | Weight loss programme |
| knee alignment | - training of muscles – orthotics |
| foot type | - orthotics |
| Muscular Causes | Management |
| Tightness | Stretch Quadriceps, Hamstring and Calves |
| Weak | Strengthen Quadriceps and Gluteus Medius |
Train Proprioception to Prevent Sprains
December 17, 2009
Hi, I hear from my personal trainer that i need to train my proprioception because of my ankle sprains. What is proprioception and how is it relevant to my ankle problem? – John Koh
What is Proprioception? Read more
Q angle and knee pain
November 25, 2009
What is Q angle?
The Q angle describes the angle of the knee from a frontal view. The Q angle gives an idea how the thigh muscles functions to move the knee and also how the knee cap (patella) tracks in the groove of the knee joint. A normal knee cap should move up and down within the groove with flexion and extension of the knee. When the Q angle is excessive, the knee cap tends to track out of alignment and hence causes wear and tear (degeneration) of the cartilage behind the knee cap.
What is the normal Q angle? The normal Q angle measured in standing is about 15 degrees and anything more than that is considered a risk factor for knee injuries. Ladies tend to have a wider Q angle due to their wider pelvis compared to their males.
Q-angle
How to measure Q angle? The Q angle is an intersection of two lines. First line joins the ASIS (bony protrusion in the front of the pelvis) to the middle of the patella. Second line runs from the protrusion on the top of the shin bone (tibial tuberosity) below the patella and upwards through the middle of the knee cap.
Common injuries related to a wide Q angle:
- Iliotibial band friction syndrome (ITBFS)
- Anterior knee pain or Patella Femoral Pain Syndrome (PFPS)
- Anterior cruciate ligament injury (ACL)
Injuries because of an excessive Q angle can be categorised into 3 main reasons.
1. Muscle imbalance :
A large Q angle pulls the knee cap outwards due to the stronger lateral pull from the quadriceps and tight ITB. Coupled with a weakness of the inner aspect of the quadriceps (Vastus Medialis Oblique, VMO) the knee cap will track laterally instead of smoothly up and down within the knee groove. This maltracking causes the cartilage behind the knee to wear off or degenerate and hence the pain.
2. Biomechanical compensation:
An excessive Q angle can alter the movement pattern especially in the foot. The knee will tend to point inwards (valgus or knock-knee appearance) which encourages the foot to roll inwards (pronates). Over-pronation can lead to a number of injuries especially in runners.
3. Joint laxity/instability:
When the knee point inwards, the ligaments on the inner aspect of the knee gets overstretched and lax, therefore compromising the stability of the knee joint. The Anterior Cruciate Ligament (ACL) also undergoes a lot of stress in this position. Interestingly the larger Q angle in females has been attributed as a main reason why females are at a higher risk of sustaining an ACL injury.
How to manage a wide Q-angle?
You can reduce the risk of injuries by targeting the reasons above.
Muscle imbalance: Stretching on the ITB, strengthening the VMO and Glut medius to enable proper tracking of the knee cap.
Biomechanics: Get a customised orthotics to control excessive pronation and reduce the stress to the knee.
Joint Laxity/Stability: Balancing exercises to train knee proprioception and stability.
ITB friction animation
November 20, 2009
Iliotibial band friction (ITB) syndrome is a common running injury due to a tight ITB. In a previous article, we explained the reasons why the ITB tightens up. To make it easier to understand how a tight ITB causes friction and inflammation, click here to see an animation of ITBS.
Areas of Physiotherapy
November 6, 2009
Physiotherapy is an extremely wide field of study. It can be classified into different areas of focus, patient age groups, gender and type of activities (or sub-specialties). As a result, people often get confused about what it is, who it is for and what it does. Most often one gets to learn about physiotherapy you come into contact with it for your own health matters or know someone close who is undergoing treatment. We will look at some of the basic classifications to help clear some of the confusion around this wide and complex field.
Main Areas of Physiotherapy
Source: Flickr jasonvance
- Musculoskeletal – This is the area that deals with injuries related to the muscles, bones and joints of the human muscle and skeletal system. Conditions such as back pain, tennis elbows and ankle sprains fall into this category. Private clinics outside of the hospital setting typically focus on this area. This area is sometimes referred to as Orthopaedics.
- Cardio-Respiratory – This area deals with conditions related to the lung and circulatory system (e.g. heart). Conditions such as fall into this category are bronchial asthma, chronic obstructive lungs disease and pneumothorax. Generally, this is an in-patient area. Meaning patient are still warded in the hospital such as after cardiac surgery. Out-patient care such as chest percussion treatment is sometimes called upon for patient who suffers from attacks of chest congestion and find it difficult to breath.
- Neurology – This area deals with rehabilitation of patients recovering from neurological condition such as stroke, cerebral palsy. Stroke depending on its severity often lead to partial paralysis of some part of the body. Neuro-physiotherapy helps the patient to recover some of the mobility and control of these body parts. This is often confused with the Musculoskeletal area of physiotherapy as it includes improving muscle strength and control. The key difference here is the source of the muscular dysfunction.
Patient Demographics
Each of these areas can be further broken down into three broad age classification – pediatrics, adult and geriatrics.
Pediatrics deals with young infants and children. Teenagers typically are classified as adult though these age group do have specific needs that needs to be managed separately such growth spurts in the bone structures.
Adults are the largest group of patients for physiotherapy as they represent the bulk of the population. However, with a rapidly aging population, geriatric physiotherapy for older adults is increasingly playing a larger role in the community.
Gender Classification
Men and women sometimes have different requirements when treating certain conditions dues to the difference to their physiology. Some are clearly visible such as the bone structure. One example is women having wider hips than men. This difference plays an importance role in the treatment of knee pains.
Other differences are not as visible such as hormonal difference such estrogen and its impact on bone density as women age.
Activities and Sub-specialties
With each area, there are further sub-specialties such as sports physiotherapy. Sports physiotherapy is a sub-specialty of the Musculoskeletal area. It can be further classified to the various patient demographics. Treating young children and teenagers the same as adult with sports physiotherapy can led to irreparable damage to their growth and subsequently adult musculoskeletal frame.
Another example of sub-specialty is women health and in particularly pregnant women and post-natal women.
So the next time, if you get confused with an explanation of what is physiotherapy, remember that the other person is most likely talking about another area of this wide field and that you are both most probably right!
-
Popular Articles
- Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women
- Nerve Stretches
- 5th Metatarsal Fractures
- Sports Taping - Knee
- Multifidus - Smallest Yet Most Powerful Muscle
- Myofascial Release
- See a Therapist
- Sports Taping - Wrist
- Jaw Pain - What other causes besides the teeth and jaw?
- Manual Therapy - Spinal Vertebra Mobilisation
- Pregnancy - Changes and Aches
- Belt Up Your Unstable SIJ
- Does Bad Posture Lead to Scoliosis?
- Patellar Tendinitis
- Lumbar Spinal Stenosis
- Pain Relief Medications: An Overview
- Iliotibial Band Friction Syndrome
- Sports Taping - Ankle
- Simple Exercises For Plantar Fasciitis Sufferers
- The Buckling Knee
See the Therapist
For an appointment to consult with one of our physiotherapist for treatment, kindly call us at : +65 6226-3632 (4 Lines)
or SMS us at +65 9232 2661 or email us at enquiry@coreconcepts.com.
Find out more about our various divisions at group.coreconcepts.com.sg/divisions.
Ask the Specialists
"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing... Read more »
If you have an question, feel free to drop us line. If the answer to the question is something more than a few people would be interested in, we will feature it.
-
RSS Feeds
Editorial Team
Editor
Chng Chye Tuan, B.Hsc(physio)
Accreditation
|
|
Blog Listing
Top pain blogs
