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PrintEccentric ankle evertor muscle strengthening is better than concentric strengthening after a lateral ankle sprain
Higher Risk of Low Back Pain for Competitive Youths
A recent study published in the American Journal of Sports Medicine by researchers from the Institute of Clinical Medicine, University of Tsukuba in Japan found that excessive exposure to competitive sports activities during youth was associated with low back pain and symptoms in the lower extremities, with the severity varying with the sport.
The researchers suggested that to reduce low back pain in youth, factors that may be causing low back pain, such as sport-specific postures and motions, thought these suggestions need to be investigated.
Reference:
- Relationship between low back pain and competitive sports activities during youth., Am J Sports Med. 2010 Apr;38(4):791-6. Epub 2010 Jan 5.
Understanding changes to an expectant woman’s body
Extensive physical and physiological changes take place in an expectant woman through the actions of the hormones, oestrogen, progesterone and relaxin. These changes create challenges, which should never be undermined, and hence it is important to understand the effects on the woman’s body during pregnancy to learn to cope with the challenges.
Respiratory system
The demand of oxygen is increased because the basal metabolic rate and the mass of the expectant woman increase as well. It is estimated that a woman will require about 20% more oxygen than normal at term. She also exhales more carbon dioxide which triggers the already sensitive respiratory system to increase the respiratory rate slightly. Hence, it is this lowering of the carbon dioxide that leads to pregnant women to become breathless on activity. Also, many expectant women will experience the ascending uterus which progressively obstructs the descent of the diaphragm, which is needed for deep breathing. It can force the diaphragm upwards by at least 4cm towards the end of pregnancy. Hence this rising pressure pushes the rib cage out sideways and forwards, resulting in pain in the front of the lower ribs, also known as ribflare. Furthermore, rib-flaring make expectant women breathe with the top part of her chest, thereby causing breathlessness even during mild exertion during pregnany but especially so, towards the end of term.
The cardiovascular system
During pregnancy, a woman’s blood volume increases by at least 40%. However, the plasma volume increases more than the red cells, hence possibly resulted in dilution anaemia, leading to tiredness in the early weeks of pregnancy. She may also feel faint when lying on her back. This is due to enlarging fetus compressing the aorta and inferior vena cava against the lumbar spine, thereby restricting blood flow. This condition is known as pregnancy supine hypotensive syndrome and can be relieved by turning onto her side. Such a condition tend to happen more in the 3rd trimester, though it can occur any time after the 4th month of pregnancy.
Varicose veins of the legs may occur during pregnancy or worsen during this period. This is due to reduction in vascular tone and changes in collagen structure in the body (due to progesterone and relaxin) .
For the same reason, “water retention” or swelling in ankles, feet and hands in late pregnancy may lead to joint stiffness and nerve compression syndromes, such as carpal tunnel syndrome.
The musculoskeletal system
The hormone, relaxin, is produced about 2 weeks into pregnancy. Relaxin alters the composition of collagen, which exist in joints, ligaments and connective tissues. As a result, the modified collagen is more elastic and flexible, leading to more movement in joints, and thus less stability of the system. The weight bearing joints, such as the pelvis, bear the brunt of the increased stress and loading during pregnancy, and with the instability that relaxin cause, the pelvis is susceptible to injury and pain, one of the conditions known as symphysis pubis diastasis. Also, ligaments of feet become lax and with the additional weight of pregnancy, causes discomfort. This results in aching and flat feet. Hence, comfortable yet supportive foot wear is strongly recommended during this period.
Posture-wise, her centre of gravity will move forward, leading to increased lower back curvature, compensatory curving of the upper back, rounding of shoulders and forward chin position. This incorrect posture exerts excessive strain and fatigue on her body, particularly in the spine, pelvis and other weight bearing joints (i.e. knees), resulting in aches and pains, such as lower back, with the pain spreading to the buttocks, thighs and down the legs.
Other muscular changes, such as the separation of the abdominal muscle, known as rectii diastasis, is associated with low back strain, as the abdominals are no longer able to support core and the spine as efficiently as before.
Therefore, with all the extensive changes in the expectant woman’s body, it is obvious that the healtier and fitter she is both before and during pregnancy, the more easily she can cope with pregnancy. If possible, she should prepare to be fit physically and emotionally before each pregnancy and maintain the fitness during the pregnancy, thereby enhancing recovery after delivery. In the next article in this series, we will look at the common physical problems affecting women during pregnancy and it’s solutions.
The Mechanics of Barefoot Running
Dr William Roberts, "The Sports Doc" over at Runner's World recently wrote about barefoot running and the mechanics of it. Read his whole article here, "The Mechanics of Barefoot Running"
It complements our two articles, Running Economy and Professor Daniel Lieberman's video (The Barefoot Professor: by Nature Video)
Tiger Wood’s real source of championship withdrawal – Inflamed Cervical Facet Joint
Recently Tiger Wood's unprecedentedly withdrew with a sore neck in Round 4 of The Players Championship, 2010. Rumour mills have been suggesting he wasn't playing to expectation and pulled out to save him from further embarrassment or maybe the sore neck came from the infamous car crash.
Regardless, an inflamed cervical facet joint as was confirmed by his MRI can cause symptoms serious enough for a typical office worker to take sick leave, let alone a professional athlete playing at the highest level.
Symptoms from an inflamed facet joint are limited range of motion due to pain and stiffness especially in rotation, muscle spasms and radiating pain. Cervical headaches can also occur as described in a previous article. http://mcr.coreconcepts.com.
So what caused Tiger's injury?
As explained by Tiger previously, he ramped up his training intensity to get himself ready for the Master's 2010 but his body was not conditioned enough to withstand the demand of high level sports. Similar to our weekend warriors, playing at a high intensity when the body is not conditioned to the sport causes excessive wear and tear and as a result, overuse syndrome.
How does a facet joint get inflamed?
A facet joint gets inflamed from excessive wear and tear especially when the joint mobility is limited or stiff. Limited joint mobility either from being in a prolonged static position like a deskbound job or when the muscles are tight and inflexible, limiting joints from moving through its full range. In fact most neck pains are caused by stiff facet joints which explains why the deskbound worker forms the largest proportion of our neck pain clientele.
Physiotherapy treatment for would include mobilisation techniques to the affected stiff facet joints to encourage mobility, stretching and strengthening exercises. Aggravating factors like prolonged static sitting position will have to be avoided and proper ergonomics advise will be given to prevent a recurrence.
Nathan Luies
Nathan Luies
Education
- Bachelor of Physiotherapy, Curtin University of Technology, Australia
Career Highlights
- Physiotherapist at Core Concepts Group
Quick Facts
Nathan is a Physiotherapist with Core Concepts. His area of interest is the spine, sports and hand injury rehabilitation
Hand Infections
When discussing about sports injury, we tend to focus on the big traumatic stuff like fractures, broken bones, dislocations, torn ligaments or massive swellings. Minor injuries are often brushed off especially with the more physical contact sports. After all, isn't discipline and perseverance part of the game?
As a result we tend to overlook hand infections, particularly lacerations (cuts and grazes) and for the more contact sports, bite wounds are not uncommon.
Lacerations
Cuts and grazes to the hands and fingers are a common occurrence in sports as a result of accidental contact with equipment, playing surfaces and between players or participants.
All cuts and grazes have the potential to become infected and should therefore be taken seriously.
Standard practice should be wash and clean all cuts and grazes hygienically with antiseptic solution monitored carefully for a number of days for any signs of infection.
If an infection develops the following signs symptoms may be present:
- severe , throbbing pain
- fever
- movement of fingers reduced with pain
- swelling and redness in the hand
If two or more of the above signs and symptoms are present then the risk of an infection is high and you should immediately report to the nearest doctor or hospital.
Bite Wounds
Skin of the hand broken by human teeth is a particularly dangerous wound. Human saliva contains such high levels of bacteria that these injuries should always be presumed to be contaminated. Skin is broken either from a punch to the mouth or a bite wound.
It is highly recommended that a course of a broad spectrum anti-biotic be administered by a doctor immediately and the wound not covered over or closed.
Why taken lacerations and bite wounds seriously?
Because due to the continuity of tendons of the hands into the wrist and forearms, infections can spread rapidly if not treated. Consequences can be highly destructive and hand infections frequently require hospital admissions for more specific anti-biotic therapy and or surgical intervention. In serious cases the tissue can become necrotic and die.
So please do take these sometimes rather innocuous and minor wounds seriously and seek medical treatment immediately if required.
Cervical Spine and Disc Anatomy
In this post, we will look at what are the musculoskeletal structures in our neck.
Running Economy
Can you run faster AND easier? Yes you can, by improving your running economy.
What is Running economy?
Running economy is about how efficiently you run. A runner that uses less oxygen to run at a certain pace is said to be more economical or efficient.
One method to improve running economy is to minimise energy loss; by releasing stored potential energy to help propel your body forward.
Your body have several such potential energy stores that may not be fully utilised. To minimise energy wastage, you should make full use of
- your Achilles tendon as a trampoline,
- your core muscles as a winding mechanism,
- your legs as a pendulum and
- your body’s flight trajectory like the flight of a javelin.
Achilles tendon
Bouncing on a trampoline pushes the body upwards via the stored potential energy from the elastic fabric. If the trampoline is too soft or elastic, you will not get a good bounce up because energy is lost by the shock absorbing effect of a soft surface. If the trampoline is too stiff or inelastic, a lot of impact forces go through the legs and body, you also will not get a good bounce and put yourself at a higher risk of impact injuries. Once you “catch” the rhythm of bouncing on the trampoline, it is almost effortless to remain bouncing. This rhythm is known as the resonant frequency, a phase where stored potential energy is easily transferred to kinetic energy with no loss of energy. In reality, there will be some loss of energy and the key is to minimise this loss.
Our Achilles tendon stores energy and transfers it to push the foot off via a stretch-shorten cycle similar to a trampoline. Like the trampoline, the Achilles tendon should not be too flexible or there will be too much dampening or shock absorption. In addition, the calf muscles should be strong enough to stiffen the Achilles tendon and withstand the impact of landing on the foot; at the same time, pushing off with the recycled energy.
Core muscle
Imagine wringing a thick elastic band in a clockwise direction and then releasing it. The elastic band will unwind in the opposite direction and then get wound up again before unwinding again. The rotation and counter rotation will carry on until all the energy is lost. The core muscles of our trunk act just like this elastic band as they wind up to store energy, and release it by unwinding and rotating the trunk in the opposite direction. Unwinding of a "wound" up set of core muscles is easier if the core muscles is stiff, like a stiff spring coil. In contrast, a soft coil of rope doesn't explosively uncoil when released. This trunk winding-unwinding movement helps swing your pelvis forward, making it easier to take longer strides, covering longer distances with each same step.
Foot
As your foot swings in mid air during the flight phase, it acts like a pendulum to swing the foot further forward. Ideally, the leg should not go pass beyond the horizontal. If your foot is kicked up higher pass the horizontal, the pendulum effect will not be as effective because of energy lost. The foot tends to go higher either because of your running style or tight hamstrings.
Body
A common running fault often observed is where the body moves excessively in the vertical plane, thus not maximising energy moving forward in the horizontal plane instead. Like a javelin thrown too high, it covers a long travel distance but doesn't travel very far forward..
Have someone look at your running technique and look out for the above faults. Stretch your hamstrings (hypelink to article) and strengthen your core and calf muscles to run faster with less effort.
More Essential Stretches for Swimmers
Stretching is an important part of any warm up and cool down. Sport specific stretching allows you to warm up the specific muscles required for the sport. In swimming, the four competitive strokes are:
- Butterfly
- Backstroke
- Breastroke
- Freestyle
These strokes encompass the use of practically all the muscles in the body, the main muscles that are responsible for the movements that make up a stroke are called the primary muscles. Primary muscles used for all strokes are:
Other muscles that allow for controlled smooth movements are secondary muscles these are:
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There are many different types of stretches that a swimmer can use. The main types of stretching are:
- Static Stretching – Holding a position that stretches the muscle for ~ 30 seconds.
- Passive Stretching – Similar to static, but someone else holds the position for you.
- Dynamic Stretching – Controlled leg and arm swings that gently take you to the limits of your range of motion. It mimics the action of the muscles during the event. Often used in warm ups or in preparation for an event.
- Ballistic Stretching – Forcing a joint beyond its normal range of motion by bouncing into a stretched position. Unpopular these days due to the high risk of injury associated with it.
- Active Isolated (AI) Stretching – Using a muscle to stretch the opposite muscle by contracting one muscle and moving the opposite muscle in a stretched position.
- Isometric Stretching – Alternatively stretching a muscle and contracting it to facilitate its relaxation.
- Proprioceptive Neuromuscular Facilitation (PNF) – Combination of passive and isometric stretching.
A combination of these stretches is appropriate for swimmers. Try them out and see which ones help you most. Regular stretching improves force, and speed. One bout of stretching won’t make a difference.
Here are some examples of stretches that are particular the primary muscles used in swimming.
| Anterior deltoid, serratus anterior and pectorals stretch – Rotate your body so that you can feel a stretching sensation over the front of the shoulder and chest. | |
| Triceps stretch – With your opposite hand, pull your elbow downwards and towards your head so that you feel the stretch over your upper arm | |
Posterior shoulder stretch 1 – Pull the arm towards the chest Posterior shoulder stretch 2 – Some traction can be applied by leaning the body away from the hand. Posterior shoulder stretch 3 – All your body weight should be positioned over your shoulder; your opposite hands helps to push the arm down towards the floor. The shoulder angle is kept at 90 degree, and so is the elbow joint. This stretch is felt at the back of the shoulder. | |
Latissimus dorsi stretch 1 – Accompany this stretch with breathing exercises. As you exhale, lean a little further over the side. Latissimus dorsi stretch 1:1 – Starting in a forward position, crawl your fingers towards to maximise the stretch, hold this position, then change your direction to one side to feel the stretch over the opposite side. Latissimus dorsi stretch 1:2 – Starting in a forward position, crawl your fingers towards to maximise the stretch, hold this position, then change your direction to one side to feel the stretch over the opposite side. | |
Hip stabilisers stretch 1 – To stretch your right hip, put the right leg diagonally behind the left, lean over to the left side, so as to increase the length and stretch over the right side. Hip stabilisers stretch 2 – Cross your right leg over a straightened left leg, and rotate to your right. You will feel this stretch through your lower back, but predominantly through your right hip. Hip stabilisers stretch 3 – This will stretch your right side, holding onto your left knee, gently pull it in towards your chest to feel the stretch on the outside and back of your right hip. Hip stabilisers stretch 4 – This will stretch your right side, holding onto your left knee, gently pull it in towards your chest to feel the stretch on the outside and back of your right hip. | |
| Quadriceps stretch – Keeping your knees and thighs together, stretch the front of your thigh by standing up straight and pushing your hip forwards. | |
| Hamstrings stretch – You don't need to flex your foot to stretch your hamstrings, let it relax and lean forwards from your hips, your back should not be overly arched. |
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