Stretching

This contains information about stretching

Is Self Administered Proprioceptive Neuromuscular Facilitation (PNF) Stretching superior to Static Stretching at increasing Range of Motion and Flexibility?

An important component to overall fitness is good flexibility, which is the ability to move and bend joints through a full range of motion (ROM). Adequate flexibility allows minimal stress to be applied to joints, allowing them to function more efficiently. Research has documented many benefits to improved flexibility including a reduced risk of injury, performance improvements and improved coordination and stability. Many methods of stretching exist, however choosing the most appropriate is often challenging. Two common methods of improving ROM is by static stretching (taking the body into a position and holding for a prescribed timeframe) and PNF (Where a muscle is taken to end range and held, with intermittent isometric contractions, also known as hold-relax). PNF has always been thought of as time consuming due to the need of a partner to perform the exercises, however recently it has been suggested that self administered PNF may yield the same improvements as partner assisted PNF. A recent study by Wicke et al (2014) compared self administered PNF to static stretching to evaluate the effects on ROM and flexibility. The study included 19 healthy college aged individuals. Pre measurements of hip ROM (Gonniometer) and hip, back and shoulder flexibility (sit and reach test) were taken and retested post intervention. The participants were split into 2 groups (group 1: static stretching – 2x40sec holds and Group 2: PNF – 2x40sec holds with intermittent contractions) both groups stretched the hamstring muscle and completed 2xweekly for a period of 6 weeks. following the 6 weeks individuals had a 1 week break before switching protocols for another 6 weeks. The study found improvements in overall flexibility in both groups, however only the PNF group had significant improvements in hip ROM. the results of this study suggest that self PNF may be used in place of static stretching due to not requiring a partner. The study results, while interesting the individuals were under direct instruction with regard to protocol, therefore it may be difficult for an inexperienced individual to develop this technique, and as static stretching did improve overall flexibility levels, this method should not be overlooked. The study also utilised hamstring in the PNF group, inclusion of other muscles need to be examined before further conclusions can be made.

Wicke, J., Gainey, K. and Figueroa, M. (2014). A comparison of self administered proprioceptive neuromuscular facilitation to static stretching on range of motion and flexibility. Journal of Strength and Conditioning Research, 28(1), 168-172.

Foam Rolling during the warm up: an added benefit or waste of workout time?

Over the last decade self myofascial release has become a popular modality to relieve muscle soreness following exercise. Recently it has begun to appear in the warm up, with individuals postulating the potential benefits following the restoration of the normal length tension relationships. Despite the increase in popularity there appears to be a lack of clinical evidence to support the claims. A recent study by Healey et al (2014) evaluated the effects of myofascial release with foam rolling on performance, using healthy recreationally active (Exercises 3-5x week) college individuals. Participants were split into 2 groups (group 1: foam rolling for 30 secs each muscle group, and group 2: planking for the same time as the foam rolling group). Following warm up individuals performed 5 athletic tests and commented on levels of muscle soreness and fatigue. The study found no significant differences between both groups with respect to the 5 athletic tests, there was no improvement in performance found in either test group. with regard to levels of fatigue the foam rolling group noted significantly lower levels than the planking group. ultimately individuals are looking for the most effective way to improve performance, with regard to foam rolling it was not found to be of any additional benefit to performance, however if the individual is suffering from muscle soreness and fatigue the addition of foam rolling may give them a psychological edge, allowing them to perform a little longer during the session.

Healey, K. C., Hatfield, D. L., Blanpied, P., Dorfman, L. R. and Riebe, D. (2014). The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research, 28(1), 61-68

Back and Core Stretching

Lower Back Stretch

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 Back and Core.

Back Stretching Program

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.

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.

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