It is common knowledge that excessive and long distance running can cause problems with the low back, hip, knees and feet. So how can we protect ourselves from these ailments? In addition to other factors such as regular stretches and effective warm ups and cool downs, a good pair of running shoes is vital to protect your joints in the lower limb.

What do we expect from a good pair of running shoes: stability, support and motion control.

In order to select an appropriate pair of running shoes, one must understand the principle of pronation.

The Normal Foot
Normal feet have a normal-sized arch and lands on the outside of the heel and rolls inwards slightly to absorb shock. It’s the foot of a runner who is biomechanically efficient and therefore doesn’t need a motion control shoe. A semi-curved stability shoe with moderate control features would be best for such runners.

The Flat Foot
This has a low arch, and is an overpronated foot – one that strikes on the outside of the heel and rolls inwards (pronates) excessively leading to potential injuries. The ideal running shoes for these runners would be straight shaped, motion control shoes, or high stability shoes with firm midsoles and control features that reduce the degree of pronation. Avoid highly cushioned, highly curved shoes, which lack stability features.

Flat feet shoe
click for larger view

The High-Arched Foot
A highly arched foot is generally supinated or underpronated making the foot an uneffective shock absorber. For these runners well Cushioned (or ‘neutral’), curved shoes with plenty of flexibility to encourage foot motion is recommended. Avoid motion control or stability shoes, which reduce foot mobility.

underpronators shoe
click for larger view

Factors to consider when shopping for new running shoes:

• Your feet are at their largest in the last afternoon, and this will be the best time to shop as your feet will expand while running.
• Bring your old shoes to check where the most wear and tear on the sole is
• Bring your orthotics and usual running socks to try on with your new shoes

Useful tips to choosing your running shoes is a post from: Musculoskeletal Consumer Review

Share

The effects of over developing one muscle group i.e. your chest muscles (pectorals) in the gym, whilst neglecting your back muscles, often affect your posture resulting in neck, back, and shoulder pain

To understand why this occurs, you must be familiar with the notion that most joints in our body have two or more separate and opposing sets of muscles acting on the joint. Take the elbow as an example.

When the biceps contracts and shortens, it bends the elbow joint. As the elbow bends, the opposing triceps, must relax and lengthen to allow this movement to occur. And vice-versa, for the elbow to straighten; the triceps contracts and shortens and the biceps must relax and lengthen.

To gain a well rounded physique you must consider strengthening more than just one, if not all the muscle groups. An over developed muscle (group) will create more tension on one side of the joint. Over developed muscles are also often tighter (shorter) than normal.  The balance between muscles at the joint is lost, pulling the joint away from its mid-line and changes the angle of rotation at the joint.

Muscle balance at a joint
click for larger view

Muscle imbalance at a joint
click for larger view

The Shoulder

The shoulder is a more complicated joint, however the same principles apply.

From personal experience as a physiotherapist, one of the most common mistakes in the gym is over-training the chest muscles.  This causes an imbalance between the muscles at the front of the body and those at the back. The shoulders with time are pulled forwards as the chest muscles get stronger, bigger and shorter, making the posture more rounded, creating pain and potential pathology.
Lateral postural Picture

Rounded posture with over-developed Pecs
click for larger view

Why is a rounded posture problematic?

Rounded postures place the shoulder joint in a unbalanced position away from the ideal centred position. This unbalanced position leads to increased compression at the shoulder, resulting in pain and reduced function:

• Compression of muscles and other structures at the front of the shoulder joint, may cause pain in the neck, and or down the front of the shoulder and side of the arm. Pain is usually worse with overhead activities. If the compression of the tendons continues for long enough, tears of the tendons (rotator cuff) may occur.
• Rounded postures often lead to neck pain. A large number of muscle that attach to the shoulder also attach to the neck at the other end. If these muscles are affected (lengthened and weakened by the pull of the shoulders) the neck often tends to rest into a head forward ‘chin-poke’ position. This increases the pressure on the neck joints and also other pain sensitive structures around the neck that can cause symptoms (Szeto, 2005).
• The shoulder’s range of movement is significantly reduced as a result of having less space for the joint to move. (Bullock et al, 2005)

Additional contributing factors leading to rounded shoulders

Modern Lifestyles
Think about all your daily activities; washing your face and hair, driving, sitting at the computer.  People are becoming chair-shaped, and this keeps the shoulder in a rounded position.

Pain Response
Your body’s response to pain is another factor.  When you have neck and shoulder pain we often adapt a rounded posture.  This initially is good protective mechanism to prevent further damage for the first few days post-injury, however in the long term this posture keeps the shoulder in a poor/compressed position and will hinder healing.

How to correct your rounded posture?

As a guide, when looking from a side view your shoulders should be fairly central compared to the trunk, and the head should be central on the shoulders.  A ‘plumb line’ from the centre of the ear should fall through the centre of the shoulder.

Correct posture in sitting
click for larger view

To get into this position roll your shoulders all the way forwards, then all the way back (your shoulder blades should touch), then find the mid-point between these two position.  When you have this, gently tuck your chin in, so that your head is positioned on top of your shoulders.

Workout program to prevent the over-training

Weight-training:
If you work the chest 2 x weekly, doing 6-9 sets of 12 repetitions, then do the same amount of work, at the same load and intensity for the opposing muscle groups – the upper back muscles.  Most chest exercises involve pushing – therefore to balance this and work the upper back you must include pulling type activity.  Some ideas are provided below.

• Lat pull down
• 45 degree angle lat-pull down
• Seated row
• Bent over row
• Pull ups
• Shoulder external rotation

Stretching
As well as strengthening (which contracts and thereby shortens muscles), you should ALWAYS stretch all the muscles you have trained (lengthen the shortened muscles ) at the beginning and end of your workout to reduce tightness of these muscles. In this scenario it is therefore strongly recommended to stretch both the pecs and back muscles.

Pec stretch
click for larger view

• Hold 30 seconds
• rest 30 seconds
• repeat x 3 (4 x daily)

References:

1. Brukner and Khan. Sports Medicine
2. Bullock, M., Foster, N., Wright, C., (2005). Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Manual Therapy 10, 28–37
3. Kwok Tung Lau, Ka Yuen Cheung, kwok Bun Chan, Man Him Chan, King Yuen Lo, Thomas Tai Wing Chiu (2010). Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Manual Therapy 15 . p457-462
4. Szeto, G., Straker, L., O’Sullivan, P., (2005). A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—2: Neck and shoulder kinematics. Manual Therapy. Vol 10. p 281–291

Gym Users – Are you OVER-working the PECS? is a post from: Musculoskeletal Consumer Review

Share

2. Never twist while lifting. This is a common cause of injury to the low back. Turn with your feet so that your whole body moves around instead of just twisting your back.

3. Avoid lifting if possible. Ask for help. If you explain you have back condition, you will be surprised how helpful the airline staff will be. If your bags are small and light, it will be less of a burden to ask someone to do this for you.

4. Pick an aisle seat. Ask for an aisle seat as it is easier to get into and out of an aisle seat, and allows you to get up and move around, throughout the flight with greater ease. Quite a number of airlines now allow you to select your seat when you are making a booking online.

5. Stretch key muscles. Sitting for extended periods can cause stiffness and tension in the hamstrings (the muscles in the back of the thighs) and hip flexor muscles, which in turn puts added stress on the low back. Ask your doctor or physiotherapist to advise you on a few safe stretches you can do whilst traveling.

6. Good posture in sitting. Place a small rolled-up airline pillow, blanket, towel or lumbar pillow between your back and the seat to support the natural inward curve of your lower back. You may also use commercial low back supports if you prefer.

7. Firmly plant your feet. Bottom-up leverage from your feet is also required to support your low back. While seated, your knees should be bent at right angles. If your seat is too high, place your feet on the footrest to keep your knees at a right angle to avoid stressing the low back.

8. Get up and move. Sitting in one position for extended periods of time stiffens the back muscles, which can put stress on the spine. Get up, stretch and move around every 30 minutes if possible. Movement stimulates blood flow, which facilitates the transfer of important nutrients and oxygen to your back, and thus reducing stiff muscles and muscle aches.

Hope these tips help you have a safe journey back!

8 Tips for Back-Care When Flying is a post from: Musculoskeletal Consumer Review

Share

This article will focus on the conservative management of chronic back pain whilst not negating the importance of appropriate pharmaceutical and other interventions.

source: Image from lifedynamix
click for larger view

So what does the research say?

• Exercise therapy -the first line treatment

The current evidence suggests exercise is more effective than “GP care” for the reduction of pain, disability and return to work . No one form of exercise (e.g. Aerobic, Mckenzie, conditioning exercise) appears  to be superior to the other, although an supervised and individualised exercise programme is recommended over general exercise conducted individually. This is something that can be discussed and provided by a qualified physiotherapist following a thorough assessment of your back.

Studies comparing the effect of pilates based exercises and usual back care, has shown pilates to significantly reduce low back symptoms and disability over long term basis.

There is strong evidence showing that exercise therapy alone is not more effective than conventional physiotherapeutic techniques (e.g joint mobilisations) and therefore exercise therapy must be prescribed along side other treatment adjuncts.

• Cognitive behavioral therapy

This form of psychosocial therapy assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions (Maladaptive behavior is behavior that is counter – productive or interferes with everyday living).This treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state, allowing them to partake in exercise and all activities of daily living.
 

• Manual therapy
  

Joint mobilizations should be considered as treatment in the short term management for chronic pain sufferers to increase function and decrease pain.
The research shows that joint mobilizations carried out in physiotherapy treatments is of equal effectiveness to analgesia, normal "GP care" and physiotherapy exercises in reducing symptoms.
 

• Massage
  

Massage is not considered as an effective treatment option for chronic pain sufferers, but may be useful to treat the symptoms of muscle tightness post exercise.

• Education
  

This is vital in in helping people understand that beliefs can alter and affect their recovery from pain. Pain should not been taken for granted, and a person should seek medical advice to decrease the amount of pain as soon as possible.

Education regarding pain, and understanding that pain is an unpleasant but subjective emotional experience,  and therefore should not be used as a tool to measure the amount of tissue damage is vital.

Having less fear and anxiety will make a person more willing to return to functional activities and exercise allowing for recovery.

References:

O. Airaksinen, J. I. Brox, C. Cedraschi, J. Hildebrandt, J. Klaber-Moffett, F. Kovacs, A. F. Mannion, S. Reis, J. B. Staal and H. Ursin, et al (2006) European guidelines for the management of chronic nonspecific low back pain, European spine journal, vol 15: 193-300

Rydeard,R., Legar, A., Smith, D (2006) Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability : A randomized controlled trial, The Journal of orthopaedic and sports physical therapy, vol 36:474-484
 

Treatment Options for Chronic Pain- What Does the Research say? is a post from: Musculoskeletal Consumer Review

Share

Sock- Like knee support (Source: Well.ca) click for larger view

Knee support with Window(Source: Well.ca) click for larger view

The first type is the sock-like knee support that wraps around the knee joint works by compressing the knee cap against the joint. But wait, wouldn’t that increase the pressure behind the knee cap? Not really, it allows for the knee cap to sit in a more congruent position, spreading the pressure over a wider surface area and hence decreasing the pressure.

The second one suitable for PFPS is the knee support with a open window does not give the compressive force. It works by pulling the knee cap inwards to counter the pull from the ITB. This will again allow the knee cap to sit nicely in the groove, without the compressive pressure.

Knee Support for PFPS is a post from: Musculoskeletal Consumer Review

Share

Source: Holistic Stone
click for larger view

1. Active Recovery
2. Self Massage
3. Sports Massage

Active Recovery

Active recovery or sometimes known as active rest is to engage the athletes in light aerobic forms of exercises such as cycling, jogging, swimming or simple games after the training session. These exercises should be different from those normally performed during training. Pool work involving swimming or exercises such as running in water, is an excellent form of active recovery as the water provides a good buoyant medium to relax the muscles and joints. Research has shown that active recovery is very beneficial as it can help the athlete to recover efficiently from physical and mental fatigue.

Self Massage

It is important to loosen up the soft tissues such as muscles and fascia that get all tight and stiff after training. This is to ensure that adaptive shortening of the soft tissues do not occur, which may result in reduced range of motion, potentially affecting sports performance. Stretching is a simple and effective way of loosening up tight muscles and fascia but is unable to reach the deeper muscles or trigger point areas. In order to loosen up these deeper soft tissues, the athlete can go for a sports massage or alternatively, self massage with the use of trigger balls or foam rollers. The beauty about using trigger ball or foam roller (though not as effective as sports massage) is that you can do them daily in conjunction to stretches. To see how you can use them effectively, click on the link…

Sports Massage

During the 2008 Beijing Olympics, Michael Phelps, the winner of 8 Olympic gold medals at the event, is reputed to have 2 massages a day to maintain his body in tip top condition. Many serious athletes also engage in sports massage regularly as a form of sports recovery. While there has been no conclusive evidence on the effectiveness of massage, there are many reported benefits. These benefits include:

• Improved blood flow and circulation leading to better delivery of nutrients and oxygen to the muscles and joints, as well as more effective removal of lactic acid
• Loosening up tight muscles, fascia and trigger points thus improving muscle flexibility and joint range of motion
• More relaxed mood state

Looking at such reported benefits, sports massage is a good way for athletes to recover quickly physically and physiologically. If you are training 3 to 4 times a week, it is recommended that you get a good sports massage at least once a week or 2 weeks.

Recovery Strategies to improve Your Sports Performance (Part 3- Advance Strategies) is a post from: Musculoskeletal Consumer Review

Share

What is the secret of such elite athletes being able to push their body to the limit and perform at such high levels every other day without succumbing to serious injury?

Is it because of their natural talent or intensive strength and conditioning program?

Are such capabilities beyond the reach of an amateur but driven athlete?

Source: Plant and Food Research
click for larger view

Athletes striving to perform at high levels must push their bodies to the limit. As such they put their bodies through sessions of strength and conditioning, skills training almost every day. Such strenuous training and sometimes grueling competition schedules impose a tremendous amount of physical and mental stress to the athletes.  If they cannot cope with the demand, fatigue and physical breakdown occur, leading to poor performance and often, injuries. 

The key to allowing the allowing an elite athlete, or even an amateur like myself, pushing our bodies to the limit without breaking down, lies in a simple yet often neglected part of the training program, RECOVERY.

According to Barry Barnes, Head Coach of Australian Men’s Basketball ,in his 1996 Atlanta Olympic Report “ If there was one single factor that helped this team perform at the level they did at Atlanta, it was the recovery program that was put in place…” Tour de France Legend Lance Armstrong also remarked “Recovery is the name of the game.. whoever recovers the fastest does the best.”

RECOVERY, often mistaken as just rest, is much more than just that. It is a very crucial part of training strategy that many amateur athletes are unaware of. Athletes are always looking to train and to find new ways to train to make themselves faster, stronger and better. Yet, in order for the body to adapt to the training at the high intensity, there must be appropriate recovery strategies implemented.

In the next few series of articles, I will share with you a number of recovery strategies that has been used widely by elite athletes and their coaches successfully.  These strategies are vital to aid the athlete to optimize their training and at the same time, reduce the risk of illness and injury. They include the use of compression garments, contrast baths, appropriate nutrition, passive and active recovery, sports massage and flotation tanks.
 

Recovery Strategies to improve Your Sports Performance (Part 1) is a post from: Musculoskeletal Consumer Review

Share

Hav

Understanding Shoulder Injuries sustained from Sports (Video) is a post from: Musculoskeletal Consumer Review

Share

click for larger view

A new study from the Henry Ford Hospital found that shoulder motion after rotator cuff surgery remains significantly different when compared to the patient's opposite shoulder. What was more troubling was that patients were very satisfied with the surgical outcome (which is good) but no longer appear to be concern about the functional long-term shoulder joint stability (which is bad).

"Although patient satisfaction is generally very high after surgical repair of a torn rotator cuff, the data suggest that long-term shoulder function — in particular, shoulder strength and dynamic joint stability — may not be fully restored in every patient," says Michael Bey, Ph.D., director of Herrick Davis Motion Analysis Lab at Henry Ford Hospital. "We found that the motion pattern of the repaired shoulder is significantly different than the patient's opposite shoulder," Dr. Bey says. "These differences in shoulder motion seem to persist over time in some patients."

This is unsurprising as motion pattern is habitual. A pattern formed during the painful period will simply persist, even after the reason it formed in the first place is no longer there. A habitual pattern can only be replaced with another habitual pattern. Here is where your therapist plays a major role is helping you get the right motion pattern; both the external movement pattern as well as the muscle firing pattern to achieve the movement.

Unfortunately, this trend to resolve pain while pushing the resolution of the underlying problem is increasing. Too often this is a result of us simply not comprehending the consequences down the road. Fixing the motion of the shoulder is not an expensive endeavour but does require discipline and commitment on your part.

Reference:

1. Henry Ford Health System (2011, January 16). Shoulder function not fully restored after rotator cuff surgery, follow-up study finds.

This articles originally appeared in ShoulderStability.com

Rehabilitating Shoulder Motion after Surgery is a post from: Musculoskeletal Consumer Review

Share

photo(4) click for larger view	Lie on your side, Place your shoulder and elbow at 90 degree as shown in the picture. Slowly lower your forearm towards the bed till you feel a comfortable stretch at the back of the shoulder joint Hold the stretch for 15 seconds and repeat 10 times.
photo(6) click for larger view	In standing or sitting position, Bring your shoulder diagonally across the body with the elbow turned in. Feel the comfortable stretch at the back of the shoulder joint Hold the stretch with your opposite hand for 15 seconds and repeat for 10 times.
photo(3) click for larger view	In standing or sitting, Bring the elbow across the body horizontally Hold the stretch with your opposite hand placed at the elbow Feel the comfortable stretch at the back of the shoulder joint Hold the stretch for 15 seconds and repeat 10 times.

Posterior Capsule stretches is a post from: Musculoskeletal Consumer Review

Share