Why We Get Injured

Many common injuries are preventable.  Most injuries fall into two categories, traumatic injuries and overuse injuries.  Traumatic injuries are injuries that occur suddenly like getting hit at the side of the knee in football or getting slide tackled in soccer.  Some of these injuries are not avoidable but the likelihood of them can be reduced through proper strength and conditioning.  The stronger the muscles around a joint the more likely you will be able to protect the joint in adverse situations.

Overuse injuries are injuries that come on slowly over time like tendonitis.  These injuries are caused by repetitive stress that breaks down the affected tissue over time.  But what is overuse?  Overuse can simply mean that you are demanding more of your body then it is conditioned for and not allowing proper recovery before stressing your body again with the same level of exercise.  The natural process of exercise is to stress our bodies and cause minute damage to our muscles and tendons and then allow for a proper recovery time to allow our bodies to repair that damage.  Our bodies are very smart and adaptable.  When we repair ourselves from that minute damage we fortify the tissue to be able to tolerate that same level of exercise without breaking down again.  This is how we become stronger and more “fit”.  But without a proper balance of recovery and exercise we begin to continuously breakdown our tissues more rapidly then we can repair the damage.  In this case we begin to experience pain as opposed to the typical muscle soreness that we are all familiar with after a good workout.  This type of overuse injury is easy to recover from.  All you need to do is take time off from the exercise that caused it and rest.  Sooner or later your body will repair the damage and you will be able to move on as long as you don’t “overdo it” again.

But what about the chronic injury that never seems to get better with rest or keeps coming back time and time again?  How many times have you been told to rest or reduce your activity level only to experience the same pain when you begin training again?

Overuse injuries can also occur because of poor body mechanics.  Many overuse injuries are caused when one area of the body is compensating for another part of the body that is not functioning properly.  Strength and conditioning expert Mike Boyle wrote: “The body works in an alternating pattern of stable segments connected by mobile joints. If this pattern is altered, dysfunction and compensation will occur.”  Knee pain is a good example.  The knee joint is a joint that is supposed to provide stability to the leg when we move.  The Hip is responsible for mobility.  If the hip is tight and does not have a full range of motion available to it to perform a specific task such as running or squatting then the knee is forced to become excessively mobile.  This excessive mobility that is required of the knee forces the muscles around the knee to become “overused” to perform the activity and will be more susceptible to breakdown and injury.  If you do not correct the mechanics of the hip then the knee will continue to compensate and be more susceptible to injury.  Rest and conservative treatment of the knee will alleviate the symptoms but will not fix the cause of the injury. When you resume the activity that caused the injury the injury will occur again.  Another example is plantar fasciitis.  The foot is designed to provide stability to the kinetic chain of the lower body and the ankle should provide mobility.  If the ankle lacks mobility then the foot will become mobile causing excessive stress to the plantar fascia.

If you have a chronic injury that has not been resolved by rest and conservative treatment you may need to be evaluated for mechanical imbalances somewhere other than the site of your symptoms.  Once you have identified the functional imbalance you will not only be able to finally get over your injury but you may also unlock a whole new potential for performance in what ever it is that you are training for.

Brian Loeffler, PT

How Working a Desk Job May Affect Your Running

Sitting and running in the same topic- how can a connection be made between the two?   Unfortunately, a connection exists and it’s not a positive one.  In fact, sitting is now viewed as a larger problem than once thought, not just for running but for a person’s general health.  Many of the metabolic disorders such as diabetes, heart disease and obesity have been linked to prolonged sitting.  Even if you work out an hour every day, it’s not enough to counteract the effects of prolonged sitting.  There are two excellent (and eye opening) links listed at the end of this article that cover this topic more in depth.

Runners who are employed in the nearly 70% of jobs in the U.S. that require prolonged sitting of 6 hours or more unknowingly suffer side effects from maintaining a seated posture.  When a person experiences knee or back pain during a run, they automatically attribute the pain directly to running, and why wouldn’t they, that’s when they feel the pain.  Of course there are many circumstances where running could be the direct cause of the discomfort, but more often than not the knee pain, back pain etc. is actually more directly related to the amount of sitting we do…going for a run is that so called final straw.

Our bodies, being very adaptable become reasonably efficient at what we spend most of our time doing.  Sitting for meals, commuting and after work activities are quite variable from person to person but usually involve several hours of sitting.  Unless you are one of the fortunate few that is not chained to a desk, chances are you sit an average of 6-8 hours at work- which trains your body to be good at sitting.  (Pick any skill and imagine how good you’d be at it if you could practice it for 6-8 hours a day!)  Sitting takes no physical or mental effort, so we can easily spend a lot of time doing it.  Even if you were able to run for 2 hours a day, that still leaves nearly 12 hours of potential sitting time over the course of the day.

In the sitting position, our hips and knees are each bent and held at 90 degrees.  This holds our hamstrings and hip flexors in a shortened position and stretches our glutes.  To complete the one-two punch, our running muscles are completely inactive when we sit.  Over years, disuse allows these muscles to atrophy and they slowly and imperceptively become weaker.  When we think of muscles used for running, we think of quads, hamstrings, glutes and calves, but they’re not the only ones affected by sitting.  There are many more that you’ll never hear about unless you hurt one or take an anatomy class.  These other muscles are there to help stabilize our hips and core while the quads, hamstrings etc. are in the spotlight.  Now take these weakened muscles and make them go run.  The pain you begin experiencing a few miles into your run results when the already weak muscles are no longer able to efficiently do their respective jobs of stabilizing.  Knees, low back, core and hamstrings are better trained for sitting at this point and running becomes painful.  *Experiencing discomfort that lessens as you run is another matter.

How does one combat this when you have to be at a computer or desk all day?  Here are several options:  Stand any time you’re not working at your computer such as while talking on the phone.  Find some reason to get up and move every hour.  Stand or better yet walk/stretch during your lunch break.  One of the best options, but quite a drastic change is to use a standing work station.  Alternating from sitting to standing throughout the day is probably the most realistic option versus standing all day.  Websites that sell workstations with adjustable heights are becoming more numerous.  This website- http://www.juststand.org gives additional information on the negative effects of sitting and links to workstation products.

Standing at work is not going to undo the problem by itself.  Taking a proactive approach to hip and core strength is needed to help counter the deleterious effects of sitting and eventually become preventative maintenance.  A video collection of these exercises has been added to http://therunningpt.wordpress.com on the “Hip & Core Strength” page.

Starting with a consistent strength program and spending less time sitting will have you burning more calories, running with fewer injuries and improving your general health.

These are the links to the two articles mentioned above.

http://www.menshealth.com/health/staying-active

http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/

Raymon Webster

Physical Therapist

ON TRACK, LLP

1 Main St.Suite. 102A

Burlington,VT05401

802-865-2226

ray@ontrackhealth.net

Shin Splints

Shin splints are a common injury characterized by pain along the inside or outside of the shin bone (tibia).  The medical term for pain along the inside of the tibia is periostiitis (inflammation of the periosteum) or posterior tibialis tendonitis (inflammation of the posterior tibialis tendon).  The periosteum is a sheath of tissue that connects the muscles of the calf to the tibia.  The posterior tibialis is a muscle that runs along the tibia deep to the calf muscles and attaches to the inside aspect of the foot and is partially responsible for maintaining the arch of the foot.  The medical term for pain along the outside or front of the tibia is called anterior tibialis tendonitis (inflammation of the anterior tibialis tendon).  The anterior tiablis is a muscle that runs along the front of the tibia and takes the majority of the stress when your heel strikes the ground if you are a heel runner.

            Shin splints are usually caused by over use or repetitive stress and are most common among runners.  Typically, shin splints will develop when runners increase their mileage or intensity too quickly, or don’t allow for enough recovery time between intense workouts.  The connective tissues attaching to the tibia become inflamed causing pain and can sideline the runner for weeks or even months.

            Shin splints should be treated conservatively with rest and ice to reduce the inflammation. Physical therapy is effective in treating shin splints by using ultrasound and massage to increase circulation and promote healing.  As the pain decreases, stretches and light resistance exercises may be introduced to the affected muscles.  As the healing progresses the exercises should also progress with greater resistance to restore the strength of the affected muscles and cardiovascular exercises should progress from biking to an elliptical trainer in preparation for the return to running.

            A chronic condition of shin splints may be the result of a biomechanical imbalance such as flat feet or poor running technique.  A biomechanical imbalance can cause an increased stress to the muscles of the calf which can result in overuse and an eventual breakdown of the tissue.  Be sure that you are running in the proper running shoe for your foot type.  If your running shoe is not providing you with enough support you may benefit from a pair of custom foot orthotics which would help to correct your foot mechanics and reduce unnecessary stress to the muscles of the calf.

            A video running analysis can help you determine if your running technique is a contributing factor to your shin splints.  Heel running is the most likely cause of anterior tibialis tendonitis.  Heel running is an inefficient form of running and places all of the impact stress on the anterior tibialis muscle.  It is more efficient to land on the mid foot or fore foot to allow the calf muscles absorb the impact.

            Of course, the best treatment is prevention.  Take the time to build up a good base of running before adding too much intensity or volume.  Always allow for proper recovery between intense workouts and after long workouts.  And remember that a week of rest can often save you three months of frustration.

Brian Loeffler, PT

Knee Pain

Just about every one who runs has experienced knee pain at one time or another.  Whether it’s a mild discomfort, tolerable tightness or a debilitating sharp pain that side-lines your training, knee pain is frustrating to deal with.  This article covers some of the reasons knee pain occurs and some options for correcting the problem.

With all the “parts” associated with knees- cartilage, menisci, patella, ligaments, muscles, tendons and the connective tissue that helps hold it all together, there is a lot of potential for something to go wrong and become injured.  Most runners accept this risk and even expect that something will eventually start hurting.  Experiencing knee pain however should not mean your running days are over.  In fact, the majority of knee pain that occurs with running (and has no associated swelling) has more to do with a muscle imbalance than damage to the knee itself… yes, there is hope for your knee and no, you don’t need a knee replacement   This imbalance puts excessive tension on the patella tendon, or more commonly on a structure called the iliotibial (IT) band. The IT band spans from the hip to the knee along the outside of your thigh, and causes excessive friction near the knee if it’s too tight.  In addition to IT band friction syndrome, other common diagnoses for knee pain caused by muscle imbalances in runners are patella tendonitis and patella-femoral malalignment.

Most commonly, the majority of knee pain in runners results from the hip moving in a poor alignment pattern which leads to discomfort or pain.  Here’s an analogy to help explain this better: when a car has poor front end alignment, the tires begin to wear improperly.  There is nothing wrong with the tires initially- the problem begins with the parts that are supposed to hold the tires in the proper alignment.  If left unattended, the tires will wear beyond use and need to be replaced.  Strengthening our hips is the equivalent to having our car realigned.  If left unattended, knee pain will either cause the person to stop running or lead to actual damage to the knees.  If your knee develops associated swelling in or around the joint, the muscle imbalance has progressed enough to cause irritation and in severe situations cause the patella to dislocate; in which case you should seek help from a physical therapist to correct it.

With a muscle imbalance, either the muscles are activated or recruited improperly (i.e. some muscles (quads) are overpowering other muscles (glutes)).  Anyone who has a job that requires them to sit in a chair for the majority of the day (students included) is at higher risk of developing this imbalance because the glutes are completely at rest while we sit.  Sitting also stretches the glutes and shortens the hip flexors (front top of our thighs) further contributing to the imbalance.

One way to assess an imbalance is when sitting in your chair at work, look at where your knees are in relation to your feet.  Are they closer together than your feet?  If so, your hips are in a position called hip internal rotation.  One major role of the glutes is to externally rotate our hips.  Keep your feet planted on the ground and move your knees away from each other and out over your toes.  Adjusting your position this way uses your glutes to do it…you may have felt the arches in your feet rise up too.

Another way to assess your hip and knee alignment is to stand in front of a mirror wearing shorts or roll your pants up so you can see your knees.  Notice which way your knee caps are facing, straight ahead or slightly toward the middle?  Now strongly tighten your glutes (aka: your butt muscles.)  Hold for a second or two, then relax and closely watch your knees.  Repeat.  You should see your knees slightly rotating out as you tighten the muscles.  If your knees are properly aligned, your kneecaps should be facing directly forward, which happens when you tighten your glutes.  This self assessing exercise allows you to see the correlation of hips, knees and feet– movement at one end of the chain (hip), can positively or negatively affect something at the other end (knee, arch, low back etc).  By increasing glute strength, we don’t have to consciously think about using the glute muscles and the alignment is maintained.

When is knee pain not from a muscle imbalance and therefore more serious?  The following are reasons to suspect actual damage to the knee: 

• A sudden onset of a sharp pain- These kinds of injuries usually result from twisting, falling, almost falling or jumping. 
• Any knee movement that feels like “something is in the way” and prevents full bending and/or straightening your knee.  Knees should always move freely through their full range of motion.
• Any noise (“pop” or “crack”) that is painful.  Noisy knees without pain are common.
• Your knee feels like it won’t hold you up, or other types of instability.

 

The best general advice for runners in regards to fixing/preventing knee issues is to strengthen your glutes.  Exercises that focus on the glutes when done consistently will help prevent, decrease or put an end to running induced knee pain.  There is a laundry list of exercises out there to help develop glute strength.  The top exercises are lunges, hip extensions, squats, step-ups and bridging, all of which have good demonstrations/explanations that can be found on youtube.com.  Be wary of exercises with “dynamic,” “swinging,” “plyometric” or “explosive” in their title.  These exercises work, but are more advanced and have a higher possibility of injury if performed incorrectly.  These types of exercises should be done under the watchful eye of a certified personal trainer or physical therapist to insure safety and proper form.

Strength training takes 5 to 6 weeks of consistent work to have a positive effect on knee pain.  With physical therapy intervention, a decrease in knee pain can happen in as early as 2 weeks.  Remember, knee pain from running does not need to end your running career.  Running is supposed to be fun- it helps clear our minds, build endurance, bond with others and connect us with nature.  A little time spent keeping yourself balanced will help prevent knee pain and allow you to enjoy the benefits of running.

**If you have any questions/concerns in regards to specific knee pain issues or how to properly perform any of the listed exercises, please feel free to send me an e-mail at the below address.**

Raymon Webster

Physical Therapist

ON TRACK, LLP

1 Main Street, Suite 102A

Burlington,VT05401

802-865-2226

ray@ontrackhealth.net

Injury Prevention Part 2

Running Form Part 2

Running Form

Injury Prevention