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PrintRunners: ITB Syndrome and the “Stiff” Pelvis
Useful 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
Sleeping positions
In a previous article we discussed choosing a pillow to reduce neck pain; other than the pillow there are other factors which may contribute to a poor night sleep or morning pain and stiffness.
It is very common for people to wake up complaining of neck and back pain after a night of rest. Although there are several organic causes for this including inflammation and possible disc protusion, a person with a healthy spine can still be troubled with pain and stiffness.
What does this suggest? Perhaps sleeping in awkward postures for x number of hours, can do us all harm….So what is the best sleeping postures?
Obviously modifying sleeping postures is tricky especially as we are not actively aware of what position we toss and turn into during the night. However with a help of a few pillows and some useful tip, we may be able to suggest a more comfortable and ideal sleeping position.
Sleeping postures
Sleeping on back
They key with any posture is to ensure a neutral spine. Imagine a plumb line down the nose and along the length of the spine. Your left and right side if the body should be like a reflection of each other. The ears should be parallel to the bed not kinked upwards (if the pillow is too high) or kinked downwards (if the pillow is too low).
In addition if you feel a strain on the lower back, or an increased arch, popping a pillow under the knees will alleviate the tension.
Sleeping on stomach
This posture can be the most harmful to the spine, as not only does it encourage lumbar lordosis but its also involves twisting the neck to either side.
If this position remains a favourite, try modifying it by popping a small pillow under the tummy, and ensuring the neck pillow is not too high kinking your head upwards.
Note: Although resting your head on your hands may be more comfortable for the neck it may contribute to shoulder impingement symptoms.
Sleeping on side
Similarly to the other postures, a symmetrical body is the ideal posture. Once again the imaginary plumb line should be running straight down through the nose, along the length of the spine and parallel to the bed.
Again using pillows to prop between your legs will stop the individual’s leg from dropping forward and twisting the lower spine. In addition a couple of pillows to rest your arms on, will also prevent you from rolling forward and twisting your mid back.
Needless to say posture, is important at all times of day, and therefore the same principles apply when you are at the desk, watching tv and driving.
If you have a specific condition of the spine you may want to discuss sleeping postures at length with your therapist.
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
Blackberry Thumb: 2012
Are you texting/ using your phone for lengthy emails? Are you experiencing pain at the base of your thumb?
Historically we have seen clients suffering from tennis elbow, bakers cysts, runners knee and mummy thumbs, as with the advance of technology, a new form of repetitive strain injury is fast emerging: blackberry thumb.
The thumb is designed to act as a stabilizer for pinch gripping with the fingers; and is therefore the least dexterous digit on the hand. For this reason repetitive and extensive typing can cause the thumb to muscles to fatigue and strain. Symptoms include pain, swelling and associated numbness from potential nerve damage.
Advice:
BlackBerry thumb can be prevented by use of other fingers to press buttons on handheld devices, and regularly vary which fingers are being used.
Avoid using these devices for lengthy typing
Have a break from your phone
Treatment for blackberry thumb involves wearing a splint and applying ice and Ultrasound to the affected area. Gentle exercises and massage can be recommended to relieve the tension and reduce inflammation. If the pain persists however, doctors may opt to inject the thumb area with a cortisone shot. Surgery may be required as a last resort to reduce symptoms.
Cigarettes May be Useful for Distance Runners?!? (or, How to Prove Anything with a Review Article)
Travis Saunders in Obesity Panacea:
Could smoking really be beneficial for distance runners like myself?
Here are Ken’s arguments:
1. Serum hemoglobin is related to endurance running performance. Smoking is known to enhance serum hemoglobin levels and (added bonus), alcohol may further enhance this beneficial adaptation.
2. Lung volume also correlates with running performance, and training increases lung volume. Guess what else increases lung volume? Smoking.
3. Running is a weight-bearing sport, and therefore lighter distance runners are typically faster runners. Smoking is associated with reduced body weight, especially in individuals with chronic obstructive pulmonary disease (these folks require so much energy just to breath that they often lose weight).
In the discussion, Ken goes on to point out that:
Cigarette smoking has been shown to increase serum hemoglobin, increase total lung capacity and stimulate weight loss, factors that all contribute to enhanced performance in endurance sports. Despite this scientific evidence, the prevalence of smoking in elite athletes is actually many times lower than in the general population. The reasons for this are unclear; however, there has been little to no effort made on the part of national governing bodies to encourage smoking among athletes.
Now at this point I assume that people are wondering how something this insane came to be published in a respected medical journal (as of 2010, CMAJ was ranked 9th of out 40 medical journals, with an impact factor of 9). The answer, of course, is that the point of Ken’s article was to illustrate how you can fashion a review article to support almost any crazy theory if you’re willing to cherry-pick the right data.
Posted by Robin Varghese at 11:57 AM | Permalink
Tips to cope with Chronic Pain
They say women naturally have a higher threshold for pain, partly due to the fact that we go through the process of childbirth which is deemed to be one of the most painful experience. But can women truly have a different threshold for pain? Have you ever wondered why our body feels pain? What is the purpose of pain and why some times, you get pain during activities that are not usually painful such as sitting and working on your laptop?
The purpose of pain in a healthy person is to alert the brain and body that potential damage has occurred to the bodily tissues. Pain is considered as a protective reflex response to a physical stimulus (such as trauma). Hence, the bigger the injury, the greater the pain. Traditionally, it was assumed that all pain was a symptom of an underlying organic cause. Once the cause of pain is healed/ mended, the patient should be relieved of this pain.
If the cause of pain was not found, the patient was thought to be perhaps lying or imaging this pain.
But we now know that this is not always the case, because sometimes the pain that we experience is much more complex and different from the traditional pain where there is a actual tissue injury. We may experience pain suddenly with no apparent reason, does that mean the pain is “bad”? Pain in this scenario no longer serves its traditional purpose of alerting one to tissue damage.
“Normal” or Nociceptive Pain is pain that is proportionate to the degree of actual tissue damage. A more severe injury results in a pain that is perceived to be greater than that pain caused by a less severe injury. Such pain serves a protective function. Examples of nociceptive pain include acute burns, bone fracture.
“Abnormal” or Neuropathic Pain occurs through changes in the peripheral nervous system, especially during diseases involving damage/ changes to the nerves (nerve compression/impingement, cancer or diabetes) that leads to “impulses” being sent to brain that is then perceived as pain.
Likewise, damage to the central nervous system (involving the brain and/or spinal cord) can also cause non-painful sensations from the peripheral nerves to be wrongly interpreted as pain by the brain.
Finally, prolonged or increased exposure to painful stimulus may also cause changes to the central nervous system leading to the condition called central sensitisation where pain is disproportionate to the degree of tissue damage and can also persists even in the absence of continued tissue damage. Thus, neuropathic pain serves no protective function and provides no benefit to the overall health of the person.
Neuropathic pain patients may experience certain emotions especially when doctors and other healthcare professionals are not able to appropriately diagnose and recognise the cause of their pain. Such emotions include, feeling depressed and thinking that the pain felt is actually “all in the mind”; disappointment when others are not able to empathise with their ordeal; or even defeated when management for pain has been unsuccessful. A person can begin to think they need to ‘resign themselves to a lifetime of pain’.
Every one’s pain has a different cause; fortunately here are some personal coping strategies you can apply when dealing with pain.
Coping with one’s mood and emotions especially during pain exacerbation
- Primary goals is to view pain as a controllable experience and decreasing the use of maladaptive coping strategies.
- In the case of skill development, a new skill is introduced and patients are encouraged to develop and refine the skill during low pain periods before attempting to implement the coping skill during an actual period of pain exacerbation. The skill is shaped over time, so that the skill is gradually applied to increasingly challenging (i.e. painful) episodes as the individual becomes more proficient in that skill. A similar approach is taken to the application of many pain coping skills, including cognitive or behavioral distraction, relaxation, pacing of activities, and the appropriate use of social support.
- understanding one’s cycle of pain and anticipating potential aggravating and easing factors/ actions
- being positive and minimise negative thoughts such as “I’ll never get better!”, “Everyday it’s getting worse!” and “I should just give up and suffer the pain!”
Minimising one’s disability in terms of functional activities
- start with graded exercise, and breaking an activity into segments to reduce fatigue. Once you have gained confidence in a specific part of activity, for example sitting over the edge of the bed and standing, in this case, having sufficient strength to lift your bottom over the bed, you can try getting out of chairs of different heights or bed of different firmness.
- Every little success is still a success. Start practising with common activities that you frequently do at home, such as washing the dishes, standing and ironing clothes then gradually progress to brisk walking and other gentle sports.
Cultivating health behaviours (exercise, appropriate use of medications)
- reducing reliance on medications (don’t start popping pills at the first sign of symptoms!). Frequent consumption of painkillers may gradually cause you to develop an increased threshold to its effects which leads you to increase your dosage or have to have a stronger form of medication instead.
- always aim to reduce dosage of medications gradually. For example, having to take painkillers one pill a day. This SHOULD ONLY BE DONE AFTER THOROUGH DISCUSSION AND CONSENT FROM YOUR GP.
Coping a loved one’s pain
- be supportive of your loved one’s attempts to manage their pain
- trusting that their pain is real and it is truly upsetting even if you do not understand how they may experience such pain of such intensity
- providing a listening ear to their complains may help to settle them down and increasing their confidence in managing their pain
Breastfeeding Tips
Getting neck and back pain while breastfeeding? This is a typical complaint that most breastfeeding mothers experience due to poor breastfeeding postures. The solution is simple – adopt good breastfeeding postures and have adequate rest.
Every woman wants her breastfeeding experience to be comfortable, hence, here are some tips for the Cradle hold and the Cross Cradle hold, the most commonly used breastfeeding position.
The Cradle Hold
This is a classic breastfeeding position which is used very often. However, it may not be that comfortable for newborns as newborns may need more head/neck support. In this position, you cradle the baby’s head in the crook of your elbow on the side that you would be feeding from i.e. right elbow for feeding on right breast. Your other hand will be holding the baby’s body. Bring the baby towards you and do not bend towards the baby. You may have to use your free hand to cup your breast to fit your baby’s mouth.
The Cross Cradle Hold
This position is typically more comfortable for the inexperienced mummys and babys. It may take a bit of effort to adopt this position initially, but it keeps your baby’s head in control which allow easy access to your breast.
Hold the baby’s head and support the baby’s body in the hand and arm opposite to the side you will be feeding, i.e. left hand and arm for feeding on right breast. Then lead the baby to the breast, Use the free hand (i.e.right hand) to help your baby to latch on. As you can see, this position requires you to hold the baby in one arm, hence it is not suitable for older babies.
Ergonomics Advice
Look for a comfortable place to breastfeed. If it is a place which you breastfeed often, such as in a designated chair in the corner of your room, or on your bed, try checking if it has the proper ergonomic requirements before you start your routine.
Basic requirements for good breastfeeding ergonomics in sitting:
- Experiment various breast feeding positions and decide on the one which is most comfortable for you and your baby.
- Use pillows, or a nursing pillow to support your baby- the support allows your shoulders and arms to rest. You may also use a pillow to support your back while sitting in a chair.
- Adjust the chair’s height till the back of your thighs are NOT cutting into edge of the chair, i.e. till your hips, knees and feet form an inverted “L” shape. If the chair’s height is not adjustable, use a stool to prop up your feet .
- When breastfeeding, bring the baby to the breast. Never bend towards the baby as this would strain your neck and back.
- Switch between different positions as prolonged static positions would strain your muscles and spine.
- Stretch your neck and back often in between feeding.
Whole-Body Vibration Therapy may not slow down Osteoporosis
A recent 12-month study casts doubt on the benefits of Whole-Body Vibration (WBV) Therapy on slowing down the progress of Osteoporosis. Published in the Annals of Medicine2 this month, showed no impact on bone changes when compared to non-Whole-Body Vibration Therapy; leading the researchers to conclude that for WBV Therapy for 12 months did not alter BMD or bone structure in postmenopausal women who received calcium and vitamin D supplementation.
Weight-Bearing Stress Causes Bones to Get Stronger
Osteoporosis is a skeletal system disease characterized by low bone density and deterioration of bone tissue. The idea behind whole-body vibration is quite simple. Weight-bearing physical activities such as walking and running stresses the bones. Similarly WBV also aims to do the same. Stressing the bones causes bone-cells (osteocytes) to activate two other types of bone cells: osteoclasts, which remove damaged areas of bone; and osteoblasts, which form new bone. Thus resulting in denser, stronger bones.
Low-Intensity Platforms for Osteoporosis Therapy
Another area of concern is that there is little market information separating Low-Intensity Platforms for Osteoporosis Therapy versus High Intensity Platforms for Fitness Exercise. The Agency for Healthcare Research and Quality2 in the United States have concluded that
“Safety concerns emerged from key informant discussions, including unknown long-term harms from the use of whole-body vibration therapy, and the potential inability of consumers to clearly distinguish low-intensity platforms intended for osteoporosis therapy from platforms intended for high intensity exercise. Claims about whole-body vibration therapy for the prevention and treatment of osteoporosis cannot be made without further research.”
Apart from weight-bearing exercise, don’t neglect your calcium and Vitamin D.
Reference:
- Technical Brief: Whole Body Vibration Therapy for Osteoporosis, Agency for Healthcare Research and Quality, U.S Dept of Health & Human Services
Effect of 12 Months of Whole-Body Vibration Therapy on Bone Density and Structure in Postmenopausal Women, Annals of Internal Medicine, November 15, 2011 vol. 155 no. 10 668-679
Another cause of Back Pain and stiffness: Ankylosing spondylitis
Ankylosing Spondylitis (AS) is a progressive chronic inflammatory disease that leads to gross stiffness and loss of range of movement of the spine.
In additon to Medical interventional physiotherapy intervention plays an integral role in the management of this condition.
AS is a systemic, rheumatic, progressive chronic inflammatory disease affecting the spine, more commonly affecting males than females (3:1).
The exact cause of AS remains unknown but genetic and enviromental factors are believed to play a key role in its development.
Over 90% of patients affected by this condition will be HLA-B27 (Human Leucocyte Antigen) positive. The presence of this antigen evokes an autoimmune process where the body starts to attack healthy and “self” tissue leading to inflammation of the ligament and the capsules of the spine and pelvis. This ongoing inflammation combined with the body’s attempt to repair can eventually lead to ossification of the ligaments. Over time this process can cause the affected vertebra to fuse. This has been termed as bamboo spine.
Symptoms
- The initial disease starts with intermittent low back pain and pain at the sacroilliac joints. Eventually it may progress to affect the whole spine.
- Pain and stiffness tend to be worse at night, first thing in the morning, or after prolonged periods of inactivity. It may even disturb a person from their sleep.
- The pain typically gets better with activity or exercise.
- A loss of motion or mobility in the lower spine, thoracic spine and cervicle neck. A person may also to struggle to fully expand their chest because the joints between the ribs may also be affected.
- Fatigue is also a common symptom.
Additional but less common symptoms include:
- Eye inflammation or uveitis
- Heel pain
- Hip pain and stiffness
- Joint pain and joint swelling in the shoulders, knees, and ankles
- Loss of appetite
- Slight fever
- Weight loss
The role of Physiotherapy in AS:
- Education and Advice to patient.
- Patients should be advised to avoid prolonged immobilisation or bed rest.
- Relieve and minimise pain and discomfort.
- This can be done through heat/ ice therapy, hydrotherapy, exercise therapy, soft tissue release and mobilisation of the spine.
- Maintain and increase the mobility affected joints and enhance physical endurance.
- Individualised exercise prescribed by the physiotherapist will target the affected joints and muscles. Endurance exercises involve working the muscles against a light resistance with high repetition.
- Prevent and correct deformity.
- Rounded and stooped postures may develop if patients are not exercising and attending to their posture.
- Increase chest expansion and vital capacity.
- Breathing exercises should consist of apical breathing exercises,Diaphragmatic breathing exercises, Lateral costal breathing exercises and Ballooning exercise. These ought to be in addition to thoracic/ rib mobility exercises.
- Attention to posture.This includes work ergonomics and sleeping postures.
