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

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.

Recipe

Ingredients
110g oats
300ml skimmed milk
2 scoops of vanilla whey protein powder (optional)
128g wholewheat flour
1 large egg
200g blueberries

Method
Soak oats in mild for 5 mins

Mix in egg

Mix in flour and protein

Fold in blueberries

Cook in skillet for 5 mins each side until golden brown. Can be frozen and toasted in the morning for a quick and healthy breakfast.

Recipe

Dry Ingredients
1.5 cups Wholewheat flour
2 scoops of vanilla whey protein powder
1 tbsp baking powder
1/2 tsp salt
1/2 cup stevia or xylitol sugar

Wet Ingredients
2 egg whites
1 cup skimmed milk
1/3 cup applesauce

Cinnamon sugar
1/3 cup xylitol
2-3 tsp cinnamon

Directions
Preheat oven to 200 degrees
Prepare a loaf pan with either grease proof paper or loaf pan liner

Combine the 1/3 cup xylitol and cinnamon and set aside

Combine the dry ingredients

In another bowl combine the wet ingredients and add to the dry.

Pour a 1/3 of mixture into the loaf pan to cover the bottom, add a layer of the cinnamon sugar, add another 1/3 of the mix and add another layer of the sugar mix then add the remaining sugar mix ensuring it is covered.

Take a knife and draw through the mixture to add a marble effect. Bake in the oven for 25-30 mins until it is cooked through. Let the loaf cool, bread will have a doughy consistency.

Slice up and serve with berries for a yummy breakfast.

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)

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

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

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

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

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

Sports injury Scotland are pleased to welcome a new partnership with Nathalie Jones, a highly qualified and sought after dietitian, Nathalie is registered with the Health Professions Council, qualified in 2003 and has worked with people suffering with a wide variety of conditions and health problems. Nathalie has worked within the NHS and private practice, her expertise are often called upon by local and national radio, newspapers, magazines and television.

For further information on how to book an appointment with Nathalie visit www.nathalie-jones.co.uk or email nathalie.jones@ntlworld.com.

If you would like to find out more about the services Matt offers, you can contact him directly at matt@sportsinjuryscotland.co.uk and to make an appointment call 0141 221 4300.

For more information on the services she offers you can contact her directly at janis@sportsinjuryscotland.co.uk and to make an appointment call 0141 221 4300.