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PrintUseful tips to choosing your running shoes
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.
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.
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
Recurrent Hamsting injuries?
Footballers and sprinters- you must be wondering what your doing wrong? What is causing you to have recurrent problems with your hamstring?
Now as with any injury, you should always consult your GP and or physiotherapist before commencing any new exercise…
So a big mistake when rehabilitating the hamstring is the lack of eccentric work… people tend to stretch and concentrically strengthen muscles which does not protect the hamstring when it is under the most strain. Eccentric contraction involves contracting a muscle in a lengthened position- in the case of the hamstring this would be from knee flexion through to knee extension. This differs to concentric muscle activity where muscles are both contracted and shortened at the same time, this would be the equivalent of performing a hamstring curl
Nordic hamstring exercises are found to be quite useful in strengthening the hamstring muscle
Look out on MCR for a detailed hamstring rehabilitation programme in the coming weeks
Another source for shoulder pain: Could it be the AC joint?
Rotator cuff tears, frozen shoulder and impingement are all very common and well known conditions that may produce dysfunction at the shoulder. Less common but still potentially problematic and therefore another important consideration when determining the source of shoulder pain is the Acromion clavicular (Ac) joint.
Anatomy
The clavicle (collar bone) has 2 joints a medial (to sternum) and lateral end (to the acromion of the scapula-shoulder). The Ac joint refers to the lateral articulation with the acromion of the scapula. The joint is stabilised via the acromioclavicular, coracoacromial and coracoclavicular ligaments and the upper and middle fibers of trapezius muscles aswell as well as the deltoids.
Injuries
Ac joint dysfunction is a result of a sprain, dislocation, fracture or osteoarthritis at this joint
Dislocation and sprain
The Ac joint is usually injured by a direct fall onto the top of the shoulder, cycling injuries, or associated with over head throwing (Javelin) athletes. The shoulder blade (scapula) is forced downwards and the clavicle (collarbone) appears prominent. The degree of injury at the joint is classified by the separation of the joint and damage to ligaments supporting it. A sprain suggests ligament injury whereas a dislocation refers to the clavicle moving upwards and backwards out of its normal alignment. The degree of this separation between the clavicle and acromion is graded on a 6 point scale, with grade 3-4 or higher requiring surgery.
The altered position of the clavicle, disrupts the normal rotation action of thr clavicle that is required to achieve end range forward flexion (overhead ROM). Pain will occur as a result of over stretched/ ruptured ligamemts (depending on the severity) and a stretched joint capsule. As a protective mechanism, pain tends to lead to altered postures which may comtribute to neck pain and altered muscles activity of muscles that attach to the clavicle; such as the pecs, trapezius and sternocleidomastoid.
Fracture
The fracture may occur at the distal end of the clavicle following contact sports injuries, bicycle and car accidents.
Arthritis
The incidence of arthritis at this joint has been shown to be about 50% in MRI studies of elderly populations, however these people may be asymptomatic.
Just like any arthritis this refers to degeneration of the cartilage at the ends of the clavicle and acromion. Normal day-to-day activities that require repetitive arm motion can cause cartilage loss (primary osteoarthritis). In addition arthritis may be due to cartilage degeneration after an injury to the joint (post traumatic arthritis). Regardless of the cause, predominately the normally smooth cartilage, as well as the meniscus between the bones breakdown leading to pain, due to increased friction and thus creating an inflammatory response at the joint.
Signs and Symptoms
Arthritis
Pain and stiffness of the joint is a common symptoms as is catching and “clicking” at the shoulder. Usually, these complaints are worst with overhead activity or with positioning the arm across the body. These are both common positions of the arm- from daily activities such as brushing your hair or reaching your back pocket, putting a shirt on, to sports activities such as a golf swing.
Dislocation and sprain
Pain initially may be widespread throughout the shoulder until the acute phase resolves, following this stage the person will demonstrate specific tenderness at the site of the end of the clavicle. Swelling and depending on the the extent of the injury a step-deformity may be visible. This is an obvious lump where the joint has been disrupted (as in the case of a dislocation) and is seen in more severe injuries. Similar to arthhiritis the individual will report pain on moving the shoulder, especially with overhead activities and across your body motion.
Treatment
Acute injuries will respond to ice therapy, anti-inflammatory medications and a sling is often used.
Electrotherapy could be utilised to prevent the formation of scar tissue in the ligament and promote healing and decrease swelling.
Exercise therapy to restore strength and range of motion of both the neck and shoulder is vital. Strengthening exercises include lateral rotator work, as well as shoulder blade pinching exercises.
Taping can be applied to offload and realign the Ac joint.
Mobilisation of the Ac joint (clavicle) at painful ranges is also a common intervention used by physiotherapist to restore normal and pain free alignment.
If your not too sure whats causing your shoulder to hurt- book in to see a therapist for a shoulder assessment and treatment.
4 Simple ways to increase your Explosiveness in Sports
If you have watched professional sports such as the NBA or World Cup Soccer, you would have noticed that professional sportsmen such as Lebron James and Messi are so explosive and quick in their movements.
You are right in thinking that genes and professional sports training play a vital part in their physical prowess. But the truth to explosiveness and agility in sports, is that they can be trained and therefore very much within the reach of any recreational or amateur athlete like you and me.
Of course, you may probably never be as good as Lebron James or Messi , but hard work and effective training will definitely give you an edge over your opponents in your game.
In this article, I will introduce you to four simple but effective ways to mprove your explosiveness and speed.
Stairs Run
Running up stairs is a great way to improve your quickness and speed, and has the added advantage of giving you an intense cardiovascular workout.
Choose a HDB flat that is at least 20 storeys high.
Start by walking up the stairs 1-2 steps at a time during the first set to warm up.
Walk / jog down the stairs slowly to recover your breath. Alternatively you can take the lift down.
Run up the stairs 1-2 steps at a time for the next 4-5 sets (up to 8 sets if you are already conditioned to the form of training)
Interval Sprints
Interval sprints can help to improve your speed and quickness and closely simulates the action in an actual game. There are many variations to this form of training.
Basic sprint: Start by jogging for about 20m followed by a quick sprint for the next 20m. Repeat the process 5-8 times.
Change of direction sprint circuit: Set 6-8 Cones (or improvise with brightly coloured objects as markers) 15m apart in a haphazard manner. Do the Sprint and jog intervals through the circuit set by the markers.
Advanced change of direction sprint circuit: This circuit is similar to the above. However, you vary your sprints in the form of running backwards, sideways. At the same time you can add spin around moves at some of the markers to simulate dodging.
Having a partner to call out random moves or actions will increase the difficulty of the circuit and help further improve your reaction time and quickness.
Slope Sprint
Up Slope:
Running up a slight slope strengthens your leg muscles and improve your explosiveness.
Slopes can be found in some overhead bridges (of course for yours and others safety, only use it when there is very little human traffic)
Keep the distance short, about 10-15m and repeat 6-8 times
Ensure sufficient rest between sprints.
Down Slope:
Similarly, downslope training is a good form of speed training. In this instance, you are building your speed and co-ordination.
Keep the distance short, about 10-15m and repeat 6-8 times
Down slope training is a separate training from the up slope sprint.
Plyometric jumps
Plyometric jumps are widely used by top athletes to build power and speed, and are very effective if performed properly. There are many variations but I will focus on one of the more popular techniques which is easily performed.
Stand on a stable raised platform (eg stairs) which is knee height. Jump off the platform and immediately jump as high as you can once your feet touch the ground.
For basketball players, jumping down from a box followed by quick explosive jump to touch the rim of the basket is tremendous motivation!
Gradually increase the height to waist level.
Perform this for 3-4 sets of 8 repetitions.
Hope you find these pointers useful, any queries please contact our sports physiotherapists for further advice!
Stretches, Trigger ball and Foam Roller exercises for runners
Muscle tightness and stiffness are the unwanted constant companions of runners, especially after a long, hard run. They can affect the recovery of muscles, which means despite training hard, if not managed regularly and appropriately, can give rise to potential injuries such as ITB syndrome, low Back Pain, and even affect the your running mechanics.
In this article, I will introduce you to 3 effective ways to reduce muscle stiffness and soreness, aiding in the recovery of your fatigue body.
Stretching out the kinks
Stretches for runners, would mainly be stretching out the back and leg muscles
Low back
Quadriceps
Hamstrings
ITB (Ilio-tibial band)
Calves
Gluteal muscles
Trigger point release with spikey ball
Trigger points are described as painful, tender spots in muscles that are can be felt as knots of bands of muscle fibres. These knots , when tightened after an exercise, can often lead to pain and loss of some mobility in the muscles. Common areas of trigger point tightness are found in the muscles of the low back, gluteals, ITB, hip flexors and between the shoulder blades in runners.
Low back
ITB
Gluteals
Between shoulder blades
Hip flexors
Muscle release with Foam Roller
Foam rollers, as the name implies, are large cylindrical rollers that are made up of foam (various densities) that are used widely to aid in stretching out tight muscles. Basically, the roller is placed under the muscle being released and rolled along the length of the muscles.
ITB
Quadriceps
Hamstrings
Calves
It is important to support your neck, and consider neck alignment as you complete such stretches to avoid causing other problems. If your unsure feel free to run by and check your techniques.
Pilates and Physiotherapy
What is Pilates?
Pilates is a unique body conditioning exercise designed to rebalance the body, bringing it, into its correct neutral alignment whilst targeting the deep postural muscles (Transverse abdominals and muscles of the pelvic diaphragm). In essence pilates challenges the core muscles and builds strength from the inside out, helping a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension. The phenomena of pilates is a popular and growing trend in western countries amongst athletes and celebrities, as well as in the treatment of peripheral and spinal musculoskeletal dysfunction. Today pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.
Background
Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever and this fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York and soon went on to open the first pilates studio attracting elite actors, dancers and athletes.
Clinical Pilates vs Pilates
Clinical pilates is used to treat people with musculoskeletal injuries and is conducted by a physiotherapist certified with Clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a cause or a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.
In addition certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class, which does a combination of both flexion and extension exercises.
Not only is it important to select the right type of pilates exercise, it is also necessary to ensure that the correct and appropriate level is prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist having tested your muscle strength and range of movement, will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery.
The added benefit of clinical pilates to routine pilates is not only is it more individualised to the person and their problem, it can also be more functional. If the person for example is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football and not just in static postures.
Peripheral injuries
When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating Pilates based exercises to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries.
Spinal Injuries
Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.
Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. In the long term these muscles without exercise will continue to waste further and subsequent muscle spasm in the global and more superficial muscles is experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.
In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.
Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.
In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.
If a person is new to pilates one- to one sessions with a physiotherapist or very small classes is initially strongly recommended, this is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be a little tricky and can easily be done incorrectly and therefore close supervision is required to prevent faulty patterns learnt.
The benefits of Pilates
• General fitness and body awareness greater strength and muscle tone
• Improved flexibility
• A flatter stomach
• Improved efficiency of the respiratory, lymphatic and circulatory systems
• Better posture and awareness
• Less incidence of back pain
• Increased joint mobility
• Lower stress level
Which clients would benefit from Pilates?
• Males and females
• Pregnant: Pre and post natal
• Athletes and dancers
• Amputee and stroke rehabilitation clients
• Elderly
• Children 12 years-old +
Clinical pilates therefore targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates therefore looks at treating the cause as well as selecting the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.
If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!
PFPS- Knee pain: Cause and solution!
If you notice a gradual dull aching sensation in the knee with intermittent sharp pain especially with negotiating stairs, along with crepitus in the knee when you bend and straighten the knee, you may be suffering from Patella Femoral Pain Syndrome (PFPS).
PFPS which used to be known as Chondro-Malacia Patella (CMP) , Anterior Knee Pain and Runners’ Knee are all very similar conditions. These conditions and symptoms can occur due to a varying degree of wear and tear (degeneration) of the cartilage behind the knee cap, also known as the patella femoral joint.
What are the main contributing factors?
Three main factors attributed to cause increased degeneration of this cartilage are:
1. Muscle tightness:
The quadricep muscles and the Ilio Tibial Band (ITB) tend to be tight in people with PFPS. If the quadricep muscles are tight, it has a tendency to pull the knee cap much closer to the thigh bone. This increase in pressure leads to grinding of the knee cap against the thigh bone causing the degeneration of cartilage.
The ITB has attachments to the outer side of the knee cap via a connective tissue known as the lateral retinaculum. The knee cap tends to sit comfortably in a congruent position within the thigh bone. However when the ITB is tight it pulls the knee cap in an outward direction shifting the knee cap away from, and out of its natural groove.
This slight shift or tilt increases the pressure or loading behind the knee cap leading to degeneration of cartilage and pain.
2. Muscle Strength:
Imagine jumping and landing on a straight knee compared to a bent knee. There is definitely more impact that goes through the knee in the first instance because your muscles are not helping to absorb the impact whereas a bent knee allows the muscles to contract and dampen the impact on the joint.
Similarly if the quadriceps, are not strong enough, your knee joints takes the slack with every step that you walk, run, or stairs that you climb.
The knee joint in this situation will be grinding excessively as muscles are not effectively stabilising the joint and supporting a person’s body weight.
3. Biomechanical faults:
Flat feet (poor arches), knocked knees, knee cap position (rotation/ tilt) and increased Q angle are all factors that result in an imbalance of muscles around the knee joint and mal-alignment of the knee cap, that may accelerate the degeneration of the cartilage in the patellafemoral joint.
So what can you do to solve your knee pain?
Treatment for PFPS would entail stretching exercises for the quadricep muscles and ITB and strengthening exercises for the muscles around the knee joint in particular the quadriceps. In addition getting appropriate footwear to support the arches of your feet or considering customised orthotics to correct your biomechanical faults would also be strongly recommended. If your keen athlete, or struggling with pain, you may even want to consider a knee support for symptoms reduction and control.
Recovery Strategies to improve Your Sports Performance (Part 4- Advance Strategies)
Are you searching for other options on Sports Recovery apart from Active Recovery and Massages mentioned in our previous series?
In this series, we will continue to share on other types of Advance Recovery Strategies that include Compression Garments, Hot/Cold Immersion Bath and Floatation Tank.
Compression Garments
It is common nowadays to see more and more athletes training in tight fitting, eye catching wear. They come in many forms i.e. long or short sleeves, knee length or full leg length and varied designs. Compression garments is quickly gaining popularity for its purported benefits in aiding sports recovery and a fashion statement as well. There have been a number of recent researches that demonstrated the effectiveness of compression garments in enhancing sports recovery after strenuous training by facilitating the removal of lactic acid and reducing the effects of delayed onset muscle soreness (DOMS) in the days after a heavy workout. Research also highlighted several other benefits:
- Improving muscular strength and power (especially lower limbs)
- Improved proprioception
- Improving blood circulation to peripheral limbs
- Enhancing warm up
With such reported benefits and a space tech looking suit that is impressive to behold, it makes one difficult to resist laying hands on one.
Hot/Cold Immersion Bath (Contrast Bath)
The Romans might have been the first people since 60AD, to understand and make use of the healing properties of alternating hot and cold water immersion therapy. Archaeologists found cold bath situated within the roman temple which was built around a hot spring spa. Indeed, sports scientists in our era have found that by immersing your whole body or part of it (especially the legs) repeatedly in cold and hot baths, athletes recover faster from their physical and psychological fatigue. By alternating the immersion between hot water (38-40 deg Celsius) and cold water (10-15 deg Celsius), repeated about three to four times, each immersion lasting about two to three minutes, the blood vessels constrict and expand repeatedly, bringing about the following effects:
Hot Phase: blood vessels of the peripheral muscles expand, allowing in more oxygen rich blood from the heart to nourish the muscles.
Cold phase: blood vessels of the peripheral muscles constrict, draining away the lactic acid, and improve blood flow back to the heart at the same time.
The repetitive constriction and expansion of blood vessels thus act like a pump, improving blood flow around the body, thus facilitating the removal of waste material from the muscles and delivery of nutrients to them as well.
Floatation Tanks
Imagine yourself floating totally naked on water in a lightless, soundproof coffin like structure. It sounds like a scene right out of a horror movie. Yet, this is actually what sports psychologists get top athletes to do to help them relax and improve their focus! The floatation tank is such an equipment containing water which has salt added to increase its density, thus allowing the athlete to float unaided. It was developed in 1954 by John C. Lily, a medical practitioner and neuro-psychiatrist during his experiments on sensory deprivation. Since then, sports psychologists have adapted its use as it had been found to have the following benefits to athletes:
- Reduction of pain and stress
- Lowered blood pressure
- Improvement of sports performance through visualization and self hypnosis
It is used locally by our sports psychologists at Singapore Sports Institute to help our elite athletes recover from psychological fatigue and improve performance.
This concludes our series on strategies on sports recovery. We hope it had been useful for you, whether you are a recreational athlete or athlete aspiring to maximize your potential. You may not have access to all the strategies discussed, but if you are able to adhere closely to the strategies listed in the fundamental strategies and advanced strategies I, you will still be way ahead of others in optimizing your recovery, reducing injury and thus improving your sports performance!
6 Important Tips for Open Water Swim (Video)
Are you an amateur open water swimmer?
Are you looking for tips to improve your swim in your open water race ( E.g. aquathlon/biathlon/ triathlon) ?
If yes, click on the following link to find out the 6 important tips you need to know for open water swim.
Recovery Strategies to improve Your Sports Performance (Part 3- Advance Strategies)
In this series of the Sports Recovery Strategies, we will talk about three types of Advance Strategies which will enhance your Sports Performance.
They are as follow.
- Active Recovery
- Self Massage
- 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.
