Coaches Corner

New addition to the Sports Injury Scotland website is our Coaches Corner, where we will post information on training and nutrition. If there is a particular topic you would like us to cover please contact us

Calf Strains

Calf Strains

What is it?

The calf muscle is part of a group of muscles called the triceps surae, which includes the gastrocnemius, soleus, and plantaris muscle. The gastrocnemius has 2 heads and acts on the knee and ankle joint, the deeper soleus acts only on the ankle. The triceps surae group share a common tendon, the achilles which attaches into the calcaneus (heel bone).

Causes

Strains to the gastrocnemius are more common than soleus, injury to this muscle group is most common on medial aspect (gastrocnemius), lateral aspect (soleus) and can also occur at the musculotendinous junction (Where muscles join to achilles tendon). Injury to the triceps surae group is most often the result of the following:

  • Sudden acceleration from a stationary position or sudden eccentric contraction, i.e. stepping onto a kerb and the heel suddenly drops.
  • Previous injury: a previously poorly managed strain will have resulted in the build up of scar tissue, which is characteristically shorter and weaker than normal healthy muscle tissue.
  • Training Errors: Taking on too much too soon, ignoring warning signs, taking inadequate rest can all contribute to calf injury.
  • Poor flexibility and muscle conditioning: inadequate strength and flexibility can affect the overall function of the muscles and joints. Poor balance in the musculature can cause overload to occur increasing an individual’s risk of injury.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions

Symptoms

  • Individual often complains of a sharp tearing sensation in the muscle at or near the musculotendinous junction.
  • Often painful to walk/run, stairs and hills may often cause pain.
  • There may be swelling and bruising present depending on the extent of the tear.
  • There is usually pain while stretching and contracting the muscle.
  • Depending on the grade of injury (Grade 1: few fibres torn, minimal pain and disruption to gait; Grade 2: anything from a few fibres to just before a complete rupture, usually significant pain and disruption to activity and Grade 3: Complete rupture, often reduced pain due to complete rupture of nerve endings, there will be significant disruption to activity) will depend on the management of this injury.

Management

  • Reduction of any pain and swelling is essential, rest from aggravating activity, and the use of ice, compression and elevation are essential in the early stages (first 24-48 hours). Non-steroidal anti-inflammatory medication may be used at this stage to minimise pain.
  • Cross training as soon as pain allows (Swimming, cycling, cross trainer)
  • Initiation of flexibility and strengthening program as soon as the pain has reduced. Progression through non-weight bearing to gradual weight bearing to full to single leg exercises will ensure the muscle is appropriately loaded.
  • Correction of any training errors.
  • Self massage with a foam roller (only when pain and swelling have gone completely to avoid further injury)
  • As over pronation and under pronation can significantly affect the function of the foot, wearing the correct footwear is essential, visiting a specialist footwear store such as run 4 it will ensure you are measured correctly for the most appropriate shoe for your running style. N.B. It is not advisable to get fitted for running shoes if you are experiencing pain and discomfort following injury, as this may alter your normal running technique.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with calf injury, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Iliotibial Band Friction Syndrome


Illiotibial Band Friction Syndrome

What is it?

The iliotibial band (ITB) is a thickening of the fascia that envelops the thigh, it acts as a lateral stabiliser of the knee and is an extension of the tensor fascia late and gluteus maximus muscles, which then travels down the outside of the thigh to insert into the front of the tibia (shin).

Causes

ITB friction syndrome has been described as a non-traumatic overuse injury, which is extremely common in runners. Injury to this structure in runners is most often due to:

  • Training errors: Generally when runners take on too much too soon, i.e. increasing their distance too quickly, doing more sessions than their bodies can handle and inadequate recovery periods between sessions can all contribute to pain at the ITB. New runners are particularly vulnerable to this as it is often easy to embark on a new running program without fully understanding the progressions.
  • Muscle imbalances in strength and flexibility: a common mistake in runners is the sole focus on improving their running, without focus on the strength and conditioning of the muscles and joints required. Adequate strength will give the joints stability which when running, which will reduce pressure on structures like the ITB. Recently researchers have discovered that poor conditioning of the hip musculature can increase an individual’s risk of developing ITB friction syndrome.
  • Surface and terrain: repetitive running on the same routes and surfaces with various cambers can cause alterations in an individual’s biomechanics, leading to imbalances.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions. Wearing adequate footwear will enable the foot to function more effectively reducing the impact on the more proximal structures.

Symptoms

  • Initially the pain is of gradual onset; often not sever enough to notice, which often goes ignored. Around the outside of the knee can become tender and may be warm and swollen.
  • The pain is typically described as coming on at a specific distance or time during a run.
  • Pain can increase when running down hill, coming down stairs and with any repeated flexion and extension exercise of the knee.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the ITB. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the hip, and core musculature is essential to reduce the pressure of the ITB.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with ITB pain, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Online Coaching

A relatively new service to Sports Injury Scotland, the online coaching service is a personalised programme to enable individuals to achieve the most from their training and competitions, while minimising the planning and management of the program detail. the Sports Injury Scotland coaching programme is an individualised service, taking into consideration the individuals life/work commitments as well as correctly periodising an often tricky race schedule. All components of training will be covered, ensuring the risk of overtraining, weaknesses and imbalances are minimised. For more information regarding our coaching service please click here.

Knee Pain in Runners: Are more proximal structures to blame?

Two of the most common injuries to present to the sports injury clinic in runners are iliotibial band friction syndrome (ITBFS) and Patellofemoral pain syndrome (PFPS) (Brukner and Khan 2007 and Ellis, Hing and Reid 2006).  ITBFS is characterized by pain and tenderness on the lateral aspect of the knee, which is usually due to repetitive flexion/extension movement where the iliotibial band pops over the lateral femoral condyle, causing increased friction (Pettitt and Dolski 2000). PFPS has been described as pain and tenderness on the anterior aspect of the knee, this is thought to be due to a maltracking of the patella as a result of tightness/weakness in the quadriceps muscle group (Crossley, Bennell, Cowan and Green 2004). The iliotibial band begins as an expansion of the gluteus maximus and tensor fascia late muscles and runs down the lateral aspect of the knee to insert in to the lateral aspect of the tibial condyle (Palastanga, Soames and Palastanga 2008). The Patellofemoral joint is the articulation between the posterior surface of the patella and the patellar surface of the femur and the architecture of this joint allows a mechanical advantage in the quadriceps (Vastus lateralis, medialis, intermedialis and the rectus femoris) (Palastanga et al 2008). The gluteus maximus, tensor fascia late and the rectus femoris are 2 joint muscles in that the act upon the hip and the knee, thus weakness within these muscles can impact the function of the knee joint (Hamill and Knutzen 2010).

Pain in both of these structures is common in runners, and may be due to training errors, incorrect footwear, and structural weaknesses/imbalances in the lower limb and pelvis (Brukner and Khan 2007).  For year’s therapist have tried to determine the best treatment for ITBFS and PFPS (Crossley et al 2004 and Ellis et al 2006). Recently researchers have begun to investigate the relationship the hip musculature in particular the abductors have with these two conditions (Ferber, Kendall and Farr 2011, Powers 2010 and Wilson, Kernozek, Arndt, Reznichek and Straker 2011). Weakness in the gluteus maximus, medius and tensor fascia late will impact on the ability to stabilize the pelvis while running (Burnet and Pidcoe 2009 and Powers 2010). Contraction of these muscles on the weight bearing side, keep the opposite side level, to avoid pelvis drop, which subsequently leads to a rotation at the femur and increased heel lift to ensure the foot clears the floor, thus placing additional stresses at the knee joint (Wilson, Kernozek, Arndt, Reznichek and Straker 2011). The forces experienced in the lower limb while running can be as great as 8X the body weight with each stride taken (Hamill and Knutzen 2010).

Individuals suffering from knee pain will generally experience pain either on the outside of the knee (Iliotibial Band) or the front of the knee (Patellofemoral joint). pain generally starts as a dull ache typically at a specific time or distance in the case of iliotibial pain and generally near the end of the run with patellofemoral pain, Correct diagnosis is essential in the management of either condition. examination typically involves testing the hip/knee joints, with treatment focusing on strengthening areas of weakness and stretching areas of tightness.

Unfortunately without treatment this type of pain will most likely recur, therefore it is essential to seek advice about the best way to manage this. below are a couple of preventative exercises that will assist in keeping your lower body strong and conditioned for running.

Squats with Band around the knee

Side Lying Leg Lifts

Clam

Hip Hikers

Single leg squats

Step ups

The above exercises can be done at home with minimal equipment and should be performed 2-3 times per week performing 2-3 sets of 10-15 repetitions per side where appropriate.

For anyone looking for more information on the above, I recently gave a presentation on the relationship gluteus medius weakness has on patellofemoral pain syndrome. I have attached this here.

Gluteus Medius Weakness and Its Relationship with Patellofemoral Pain Syndrome

 

Importance of Stretching

Lower Back StretchAbdominal StretchHip Flexor Stretch

Increases in societies sedentary lifestyles mean we are becoming less and less active, inactivity can lead to muscle stiffness, weakness and imbalances, which can have a negative impact on daily life.

Low back and neck pain are among of the most common outcomes of poor flexibility and poor working postures. We are sitting at our desks for longer, therefore maintaining postures for extended periods, which can subsequently reduce flexibility in certain muscles and increase length in others creating imbalance. it is important to not only asses seated posture but to perform regular stretching exercises to minimise pain and dysfunction.

Reductions in flexibility can have a negative impact on performance, a reduction in gastrocnemius (calf) muscle length and dorsiflexion (Toe towards the knee) can increase the need for hip flexion to lift the knee higher so the foot can clear the ground, therefore placing additional stress on those muscles, which subsequently increases stress on the lateral hip and lower back. Pain may not necessarily show in the gastrocnemius or ankle, but may present in the hip and/or lower back. Like all methods of training flexibility should form part of an overall program.

Sports such as running may appear not to have massive range of motion requirements, however research has demonstrated that it may not be large single joint range required but the combination of joints working together. Gait (walking/running) forms one of the most complex series of actions that the body goes through. performing a stretching routine following all exercise sessions will limit the risk of further imbalance, therefore reducing the likelihood of injury.

This Stretching Program is a general list of stretches that will cover all aspects of the core and legs. For more information on the types of stretching you should be doing and when please contact us on info@sportsinjuryscotland.co.uk also if you are struggling with an injury and would like an appointment, please call 0141 2214300

References

Glynn, A. and Fiddler, H. (2009). The Physiotherapists Pocket Guide to Exercise: Assessment, Prescription and Training. Churchill and Livingston, China.

O’Hora, J., Cartwright, A., Wade, C. D., Hough, A. D. and Shum, G. L. K. (2011). Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstring length after a single session. Journal of Strength and Conditioning Research, 25(6), 1586-1591.

Chen, C. H., Nosaka, K, Chen, H. L., Lin, M. J., Tseng, K. W. and Chen, T. C. (2011). Effects of flexibility training on eccentric exercise muscle damage. Medicine and Science in Sport and Exercise, 43(3), 491-500.

Perrier, E. T., Pavol, M. J. and Hoffman, M. A. (2011). The acute effects of a warm up including static or dynamic stretching on counter movement jump height, reaction time and flexibility. Journal of Strength and Conditioning Research, 25(7), 1925-1931.

Wong, D. P., Chaouachi, A., Lau, P. W. C. and Behm, D. G. (2011). Short durations of static stretching when combined with dynamic stretching do not impair repeated sprints and agility. Journal of Sports Science and Medicine, 10, 408-416.

Top 5 Exercises for Calf Pain

Gastrocnemius and Soleus Muscle

The gastrocnemius and soleus muscle are part of a powerful group of muscles located at the back of the lower leg. Both muscles insert into the calcaneus (heel bone) via the powerful Achilles tendon. The Gastrocnemius (commonly known as the calf) muscle is the largest of the 2 muscles and is located on top of the Soleus, it has 2 heads, which originate above the knee. This muscle is responsible for flexing the knee and planterflexion (pointing the toe) of the ankle. The Soleus muscle which is located under the Gastrocnemius, originating below the knee joint. The Soleus is responsible for planterflexion of the ankle and inversion of the foot.

Pain within this area can be due to a number of reasons, including muscle tightness through training, pain following a tear or Achilles soreness. General muscle soreness through exercise can be alleviated through stretching, strengthening and adequate recovery. Injury to any structure should be evaluated by a sports medicine professional.

Exercises

3 Point Calf Raise (on or off a step)

Calf Raise with toes inwardCalf Raise with toes centredCalf Raises with toes outward

The above exercises ensures you will target the entire gastrocnemius/soleus complex, as well as hitting the medial and lateral portions.

In the early stages this exercise should be performed on two feet and on the floor as you strengthen you can progress to doing this off a step and then move onto single leg adding weight as you improve.

Alphabet mobilisation

Alphabet Mobility for the ankle joint

While the typical action of the ankle is plantarflexion (point the toe), dorsiflexion (toe toward knee), inversion (sole of foot inward) and eversion (sole of foot outwards) the foot/ankle performs a highly complex series of movements to enable locomotion. Stiffness in the ankle joint can cause pain not only at the joint but also within the gastrocnemius and soleus muscles, which may limit performance. Performing mobility exercises such as the alphabets will ensure the ankle is put through a wide range of motion including combination movements, which is more true to real life.

Sitting on a stable surface, isolate the ankle as shown and trace the alphabet with your foot/ankle joint. using small letters first progressing to large letters as this gets easier. ensure each letter is done individually.

Gastrocnemius Stretch

Gastrocnemius Stretch

Standing against the wall, put the leg you wish to stretch behind you, keeping both feet pointing forwards, bend your front knee and shift your body weight forwards, till you feel the stretch in your calf.

Try to maintain a straight line from your shoulder to your heel.

Soleus Stretch

Achilles Stretch

Half Kneeling, place hands on the floor. Bring the ankle to be stretched close to your bottom keeping the sole of your foot on the floor.

Bring your chest forwards, and shift your weight over the sole of your foot. Keep your heel on the floor.

Tibialis Anterior Stretch

Tibiallis Anterior Stretch

Kneeling, sitting on your calves, ensure your feet are flat and lean backwards. if you do not feel this stretch you can put a rolled up towel under your toes. You should feel the stretch along the front of your shin.

Some of the most effective exercises can be added easily into your normal training regime, it is also important to note that preventing the injury from occurring in the first place will ensure you continue your training with minimal disruption. Below is some common exercises to stretch and strengthen this often injured area. Stretches should be held for 30-45 seconds and repeated on both sides. position should be taken to a point of stretch and not pain.

For any further information on the above please contact us at info@sportsinjuryscotland.co.uk or to book an appointment call 0141 2214300