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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
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!
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.
Management for ITB friction syndrome
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.
Tips to Run Pain Free
Recently our physiotherapist, Lenia, was featured in Shape magazine Jan 2010. Here is an excerpt from the article.
Shin splints are caused by weak shin muscles or faulty running biomechanics while plantar fasciitisis the result of tight calf muscles that reduce the foot's ability to absorb shock. Here are some tips to stay on track. (more…)
Osteoarthritis Knee
Osteoarthritis (OA) of the knee is a degenerative condition where the cartilages of the knee wear away. Pain, stiffness and swelling are common symptoms of an OA knee. In this article, we look at the three factors that lead to the development of OA knee – Aging, Physical Attributes and Muscular Causes. Of which two of these factors, Physical Attributes and Muscular Causes, can be addressed with physiotherapy management. We will focus more in detail on the exercises and treatment for OA knee in a follow-up article.
Aging
OA Knee
Physical Attributes
The three key physical attributes are:
- Obesity - A heavier person will load their knee joints more, wearing out their cartilages faster than a lighter person.
- Knee alignment – A bow legged or knock-knee appearance will cause an uneven compression of the knee. Either the outer or inner compartment knee respectively will take up most of the load upon weight bearing and cause more wear and tear.
- Foot type -
- People with flat feet or whose feet over pronate tend to roll their knee inwards upon weight bearing similar to a knock-knee above.
- A person with high foot arch or whose feet under-pronate absorbs less impact with each foot fall. More impact goes up through the leg and the knee will have to work harder to cushion the impact.
Muscular Causes
When the muscles around the knee do not contract strong and fast enough in a coordinated fashion to absorb the impact of walking or running, the knee joint takes up the remaining forces of the impact.
- Tight muscles pull joints closer to each other.In an OA knee where the joint space is already reduced, tight muscles will increase the compression of the joint space. Muscles with reduced flexibility are also less coordinated and slower in reaction time. The muscles that tend to be tight are the quadriceps, hamstrings and calves.
- Weak muscles. The quadriceps muscles is the main muscle group that help to support the weight of the body and off loads the knee joint. It is very common for this muscle to atrophy because of disuse. The knee pain deters the patient from loading the knee and this will gradually lead to weakness of the knee which will affect the ability to cushion the impact. This pain, disuse, weakness cycle will continue without treatment.
Weak gluteus medius muscle can aggravate the degeneration of knee cartilage because its function is to keep the hip joint stable, especially in walking. This is often seen as a waddling gait where the hip sway with big movements side to side. The thigh muscle have to work a lot harder to stabilise the wobbly hip and if they are unstable, the knee joints will have to bear the weight.
The management of these factors are summarised in the following table. In our upcoming article, we will further discuss the specific exercises and treatment for OA knee.
Physical Attributes | Management |
| Weight | Weight loss programme |
| knee alignment | - training of muscles – orthotics |
| foot type | - orthotics |
| Muscular Causes | Management |
| Tightness | Stretch Quadriceps, Hamstring and Calves |
| Weak | Strengthen Quadriceps and Gluteus Medius |
Q angle and knee pain
What is Q angle?
The Q angle describes the angle of the knee from a frontal view. The Q angle gives an idea how the thigh muscles functions to move the knee and also how the knee cap (patella) tracks in the groove of the knee joint. A normal knee cap should move up and down within the groove with flexion and extension of the knee. When the Q angle is excessive, the knee cap tends to track out of alignment and hence causes wear and tear (degeneration) of the cartilage behind the knee cap.
What is the normal Q angle? The normal Q angle measured in standing is about 15 degrees and anything more than that is considered a risk factor for knee injuries. Ladies tend to have a wider Q angle due to their wider pelvis compared to their males.
Q-angle
How to measure Q angle? The Q angle is an intersection of two lines. First line joins the ASIS (bony protrusion in the front of the pelvis) to the middle of the patella. Second line runs from the protrusion on the top of the shin bone (tibial tuberosity) below the patella and upwards through the middle of the knee cap.
Common injuries related to a wide Q angle:
- Iliotibial band friction syndrome (ITBFS)
- Anterior knee pain or Patella Femoral Pain Syndrome (PFPS)
- Anterior cruciate ligament injury (ACL)
Injuries because of an excessive Q angle can be categorised into 3 main reasons.
1. Muscle imbalance :
A large Q angle pulls the knee cap outwards due to the stronger lateral pull from the quadriceps and tight ITB. Coupled with a weakness of the inner aspect of the quadriceps (Vastus Medialis Oblique, VMO) the knee cap will track laterally instead of smoothly up and down within the knee groove. This maltracking causes the cartilage behind the knee to wear off or degenerate and hence the pain.
2. Biomechanical compensation:
An excessive Q angle can alter the movement pattern especially in the foot. The knee will tend to point inwards (valgus or knock-knee appearance) which encourages the foot to roll inwards (pronates). Over-pronation can lead to a number of injuries especially in runners.
3. Joint laxity/instability:
When the knee point inwards, the ligaments on the inner aspect of the knee gets overstretched and lax, therefore compromising the stability of the knee joint. The Anterior Cruciate Ligament (ACL) also undergoes a lot of stress in this position. Interestingly the larger Q angle in females has been attributed as a main reason why females are at a higher risk of sustaining an ACL injury.
How to manage a wide Q-angle?
You can reduce the risk of injuries by targeting the reasons above.
Muscle imbalance: Stretching on the ITB, strengthening the VMO and Glut medius to enable proper tracking of the knee cap.
Biomechanics: Get a customised orthotics to control excessive pronation and reduce the stress to the knee.
Joint Laxity/Stability: Balancing exercises to train knee proprioception and stability.
