Running

This contains information about running

Can the inclusion of a plyometric training program improve performance in middle to long distance runners?

The importance for runners to achieve their personal best, whether this be in a quicker time or longer duration, how they get there has always led to much debate between runners, coaches and health professionals. The inclusion of strength training programs has been met with much resistance in the running community, with many runners fearing it will make them “too bulky” or it will “slow them down” with regard to maximal strength training where mass and strength are the main goal, this may be the case, however there are many ways to incorporate strength training into a schedule to actually enhance performance. A recent study by Ramirez-Campillo et al (2014) evaluated the effects of a 6-week plyometric training program on competitive middle to long distance runners. Participants were split into two groups (Group 1: Plyometric group performed 30mins 2x week of plyometric training alongside their normal training regime, and group 2: a control who continued training as normal). Prior to commencement of the 6 week intervention all individuals performed 4 athletic tests and were encouraged to perform all out. the plyometric group were then instructed on the plyometric drills. the groups were then retested at the end of the 6 weeks. The study found a significant improvement in performance in the plyometric group compared to the control (3x) in all 4 performance tests. the results of the Ramirez-Campillo et al (2014) study demonstrated that including as little as 60 mins of explosive strength training per week (i.e plyometrics) will have a positive impact on running performance without taking anything away from overall training intensity and frequency. the results of this study support the inclusion of a plyometric based intervention alongside a running schedule to improve performance, it is important to seek professional advice before beginning any form of strength training to ensure proper form, reducing the risk of injury.

Ramirez-Campillo, R., Alvarez, C., Henriquez-Olguin, C., Baez, E. B., Martinez, C., Andrade, D. C. and Izquierdo, M. (2014). Effects of plyometric training on endurance and explosive strength performance in competitive middle and long distance runners. Journal of strength and conditioning research, 28(1), 97-104

Core exercises

A strong core is essential to optimal performance and the reduction of injury.

Attached is a beginners program to strengthen the core.

Core training program

Upper body Stretches

Sports Injury Scotland

 

 

 

 

 

Stretching should form an integral part of any training regime. Research suggests the best time to stretch is after exercise, making sure the muscles are warm. stretching a cold muscle can lead to potential muscle damage.

Attached is some stretches focusing on the main muscles of the upper body.

Upper Body Stretching Program

Stretching programs for the lower body and core can also be found on the website.

Initial Management of an Acute Injury

Once an injury occurs, whether to muscle, bone or ligament, it is imperative that you seek the most appropriate treatment for this. Injury often varies in severity, and therefore symptoms will differ. The most common signs of inflammation are heat, redness, swelling, pain and loss of function, not all of these symptoms may be present and some may even appear at a later date.

When you suspect you have sustained an injury to soft tissue (Muscle or Ligament) you must first minimize the symptoms of inflammation. The first 24 hours following the initial injury are critical in management. The following acronym is designed to control the bleeding and thus reduce inflammation and scar formation.

R: Relative Rest

I: Ice

C: Compression

E: Elevation

Relative Rest

Following any musculoskeletal injury, depending upon the severity, may require some immobilization, generally research suggests that a short period of reduction in motion can result in a stronger scar, which will be able to withstand more force, thus improving tissue regeneration and promotion of parallel alignment (Brukner and Khan 2012).

It is important however not to rest the injured area for too long, extended periods of immobilisation can weaken not only the injured tissue but also the surrounding areas, making return to activity a slow process.

Ice

One of the most important components of inflammation recovery, is the application of ice, Ice has been thought to reduce tissue metabolism, thus reducing blood flow and accumulating fluid, which results in reduction of swelling. Application of ice should happen as soon after injury as possible and should continue for the first 48 hours.

Two application procedures have been suggested, continuous and intermittent.

Continuous: 20 mins every 2 hours

Intermittent: 10 mins, with 10 mins rest then another 10 mins ice every 2 hours.

There are a number of ways to apply ice, with the most common being reusable packs (which can be kept in the freezer and used when required), Chemical ice packs (these are one use, disposable packs which are good for travelling, can be an expensive long term option tho), and frozen veg (frozen peas** have been found to be a good alternative to ice, as they conform to the body easily and can be re frozen for further uses).

** Mark bag with do not eat.

Prolonged exposure to ice can cause burning or nerve damage.

Compression

To reduce bleeding and swelling compression should be applied to the injury site, this should be used during and after ice application. The pressure should be firm but not to tight that it causes pain.

When using a bandage pressure should be initially applied distal to the injury and with slight overlap move proximal to one handbreadth above the injured area.

Elevation

The injured limb should be, where appropriate be raised above the heart, to reduce the pressure within the injured structure. This will also help in reducing the accumulation of fluid into the area, which will therefore reduce swelling.

Precautions in the Acute Stages

During the initial 72 hours there are a number of things that the injured person should avoid

Heat: Which will increase blood flow to the injured site, therefore increasing swelling,

NO hot baths, showers, saunas etc

Alcohol: this can mask the level of pain and severity of the injury

Aggravating Activity: Can result in worsening of the injury or re-injury

Massage and aggressive manual therapy: can increase blood flow, thus increasing swelling and risking further injury.

Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome: Common Cause of Shin Pain

What is it?

Medial tibial stress syndrome (MTSS), commonly referred to as “shin splints” has received a lot of attention within the literature, often found to be a difficult condition to manage. Shin Splints is a term which has been used to encompass all causes of shin pain including, compartment syndrome, stress fractures and MTSS. It is therefore understandable why such a term can become misleading as to the nature of such a complex and painful condition. The tibia (shin) is the larger of the two long bones located at the front of the lower leg.

Causes

MTSS is a chronic overuse syndrome, extremely common in activities, which involve weight bearing such as running. It has also been described as a common source of shin pain in military personnel. Pain associated with MTSS is often as a result of the following:

  • Over pronation: during the stance phase of gait the foot pronates to absorb shock and to adapt to uneven terrain, it is the soleus muscles job to resist unwanted pronation, therefore when the foot over pronates it places a repetitive stress on the tendons insertion on the tibia.
  • Training Errors: New training programs, sudden changes or increases to training, and inadequate recovery can all impact the repetitive overuse placed on the shinbone. Gradual progression and training increases will allow the musculoskeletal system to adapt to the loads imposed on them.
  • Muscle imbalances in strength and flexibility: It is all too common in runners to focus solely on their running and to neglect the strength and flexibility of their muscles. Tightness and weakness of the lower limb muscles can cause improper mechanics increasing the likelihood of developing MTSS.
  • 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

  • Pain due to MTSS is typically of gradual onset, pain is typically only associated with activity which often goes away once warmed up, that can often return when activity has stopped. The longer the injury goes untreated the more chronic the issue becomes, individuals may begin to notice pain during normal daily activities.
  • Pain is usually diffuse felt along the medial (inside) border of the tibia (shin bone). When a more focal area of tenderness is felt there may be a possibility of a stress fracture.
  • The pain felt can often be quite sharp, which may often be too painful to continue activity

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the tibia and leg musculature. 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 gastrocnemius/soleus complex and the anterior shin muscles. Beginning a proprioceptive training program will assist in regaining stability in the foot and ankle.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon. Altering the direction of your routes to ensure you are not running on the same cambered pavements.
  • 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 MTSS, 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.

 

Plantar Fasciitis

Plantar Fasciitis

What is it?

The plantar fascia is a broad band of connective tissue, which not only supports the arch of the foot, but also plays an important role in normal foot biomechanics. The fascia is designed to support the longitudinal arch of the foot. It attaches at the base of the heel bone and runs the length of the foot to insert into the bases of each toe. The plantar fascia is placed under tension during preparation for toe off during gait; the fascia is designed provide static support by tightening to stiffen the foot to allow affective propulsion.

Causes

Plantar fasciitis is a common overuse injury, particularly seen in runners with research indicating can account for 8-10% off all running injuries. This has been though to be due to repetitive microtrauma at the point of insertion. Some of the most common risk factors include:

  • Pes Planus (Flat feet): this causes excessive mobility in the foot, placing additional strain on the fascia due to increased stretching forces and reduced arch support. (Over pronation)
  • Pes Cavus (High arch): generally causing increased stiffness within the arch, and subsequently reducing the shock absorption properties of the foot. (Excessive supination)
  • Training errors: increases in mileage, changing terrain and inadequate recovery can place the individual at increased risk of developing plantar fasciitis, new runners who take on too much too soon are particularly at risk.
  • Muscle imbalances in strength and flexibility: research has suggested that tightness in the posterior muscles (hamstrings, gastrocnemius and soleus) may contribute to developing this condition. Poor strength and conditioning of the hip flexors, abductors and tibialis anterior muscles have been found to possibly contribute to the development of plantar fasciitis.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause excess stress on the plantar fascia. Wearing adequate footwear will enable the foot to function more effectively, which will subsequently reduce the impact on the more proximal structures.

Symptoms

  • Pain associated with plantar fasciitis is usually of gradual onset; it is typically painful at the beginning of activity, which often eases, only to return once activity ceases. If left untreated the pain increases to the point where weight bearing is painful and made worse with activity.
  • Pain is usually described as being worse in the morning, this is due to the foot being held in a plantarflexed position which when standing this movement is rapidly reversed.
  • Pain is typically felt on the medial (inside) aspect of the heel at the insertion to the calcaneus.

Management

As with any overuse injury, early management is essential, the longer it goes untreated the more difficult treatment would be.

  • In the initial stages it’s best to avoid any aggravating activities, any activity, which doesn’t cause pain, can be performed, for example swimming, cycling and cross trainer.
  • Anti inflammatory medication and ice may be beneficial in the early stages
  • Initiation of a strength and flexibility program, with particular emphasis placed on stretching the posterior muscles and strengthening of the hip flexors and abductors.
  • 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.
  • Self massage to the plantar fascia with a massage ball.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with plantar fasciitis, 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.

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