Tibial Stress Syndrome (Shin Splints)

June 2018

Introduction

Tibial stress syndrome is a term that encompasses any overuse or repetitive overload injury of the posteromedial shin (medial tibial traction periostitis) or anterolateral shin (lateral tibial traction periostitis). The inside shin pain is more common and is usually termed in the general population as shin splints.

Incidence

  • 10-15 % of runners
  • Up to 60% of lower leg syndromes
  • Females have a higher incidence rate when compared to males

Risk factors

  • History of previous lower leg injuries
  • Improper running technique/form
  • Less than optimal running cadence
  • Training errors
  • There is suggestion regarding foot type and dynamic foot movements during running

Causes

  • Muscular imbalances around the hip, knee and ankle
  • Traction injury to the outside of the bone caused by the muscle pulling excessively

Symptoms

  • Diffuse pain localized to the inside of the lower shin (medial tibial traction periostitis)
  • Made worse by running initially but when the area warms up it tends to improve
  • Once the exercises is ceased the pain returns and is usually higher in intensity
  • It can also be aggravated by jumping or high intensity ballistic type exercises

Treatment

  • Activity modification initially
  • Keep a thorough training dairy with emphasis on symptom resolution
  • Physiotherapy modalities addressing muscle imbalance and core activation
  • Running technique retraining (if appropriate)
  • Corticosteroid injections (if appropriate)

Possible complications

  • If not addressed appropriately then recurrence can be high and progression on to a tibial stress fracture is possible

What should you do next?

If you are feeling pain, discomfort and/or stiffness in your calf, shin or lower leg region then I recommend you get in contact with us at the clinic and we will be able to help you moving forward with your rehabilitation.

#Acceleratephysio #ShinSplints #RunStrong #MTSS

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”

 


Pilates Services

As a Pilate’s clinic, we offer different Pilates-based services. These include mat classes of varying levels, equipment based exercise classes and one on one appointments focusing on tailoring a Pilates programme suitable to your ability.

One of the main aims of Pilates is to ensure the stabilising muscles to the spine are effectively working during exercise and functional daily activities. We will aim to prevent fatigue which is caused by unwanted muscle activity and limit any incorrect movement patterns. Pilates also focuses on flexibility/muscle length.

What are some key concepts of Pilates?

  1. Breathing: The most important rule when it comes to breathing is to not hold your breathe! It is important to follow your instructor’s guidelines about your breathing technique. If you can breathe comfortably during exercise and maintain activation of the ab line, this will often translate to activation of this muscle during normal daily activities
  2. Neutral spine: This refers to the position of the spine which is halfway between fully flattened on the mat/ground and fully arched
  3. The ab line: Engaging the ab line refers to activation of the transverse abdominis muscle. This muscle is crucial in supporting the spine and should be working all the time at a low intensity

What are some benefits that can be gained from Pilates: 

  1. Increase in core strength
  2. Ensuring correct movement patterns are developed
  3. Increasing flexibility
  4. Ensuring correct breathing technique during core exercises

 

We hope to see you soon! The Accelerate Pilates Team 🙂


Do you currently or have you in the past had Achilles pain?

April 2018

What is the Achilles tendon?

The Achilles tendon is the largest and strongest tendon in the human body, it attaches the calf muscles to the heel bone (calcaneus) and is integral for everyday life activities, including (but not limited to) walking, going up and down steps and running.

How does it work?

The Achilles stretches and stores potential energy when the foot hits the ground, then it is used to generate over 50% of the positive work done at ankle during running. Interestingly the Achilles tendon can be exposed to forces up to 6 times body weight during running. Given that optimal running cadence is 90 steps per leg per minute, the total force the Achilles has to endure is considerable.

How can it be injured?

Injury to the Achilles is usually caused by 1 of 3 (or a combination of) things – issues with tensile loading, shearing compressive forces or hyperthermia of the tendon itself.

  • Tensile load can be compared to a tug-of-war scenario. Imagine the calf muscle is one team and the heel is the other team, the Achilles is the “rope” that each team is pulling on, if the pull is to great or the rope (Achilles tendon) is to weak then you will have a failure of the rope
  • Shearing and compressive loads can be compared to a rope (Achilles tendon) going over a pulley. If you take the example as above about the tensile load being a tug-of-war, as the rope goes over the pulley the compressive load comes from where the rope is contacting the pulley and pulling down into it. This happens where the Achilles attaches into the heel.
  • Hyperthermia of the Achilles tendon occurs when the tendon becomes too warm during activity and the heat loss could potentially lead to a change in loading dynamics and lead to injury

 

 

 

 

 

 

 

 

 

How can it be injured?

Injuries to the Achilles tendon can be acute (1st time injury – pushing of at squash and feeling your Achilles “go”) or chronic (persistent) whereby you have a niggle there all the time and it has been there for several months to years. Given the important part that your Achilles plays in everyday walking and activity it is very easy for the acute injury to progress to a more persistent injury if the loading and activity modification is not monitored in the early stages. Interestingly, your body maybe trying to tell you that and injury is coming as 1 in 5 people report calf tightness/soreness prior to injuring their Achilles tendon. Improper running technique can lead to excessive loading through the Achilles and result in an early injury during the training calendar.

How likely are you to get it?

The incidence of an Achilles injury in runners varies from 8-10% of all running injuries and there is some evidence to suggest a small genetic predisposition. Potential risk factors for runner developing or having an Achilles injury include: biomechanical, environmental, age, sex, neuromuscular recruitment and the level at which they are performing their running. Slower paces for recovery and endurance runs have been shown to be less loading on the Achilles while people that run at close to race pace that don’t allow adequate recovery time show increased incidence of Achilles injuries.

What should you do next?

If you are feeling pain, discomfort and/or stiffness in your calf, Achilles or heel region then I recommend you get in contact with us at the clinic and we will be able to help you moving forward with our rehabilitation.

#Acceleratephysio #Achillespain #RunStrong

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Pregnancy and the Pelvic Floor

As many of you will already know, pregnancy has many effects on the body. Probably one of the most well-known are those changes that occur to the pelvic floor. Yes ladies, those pelvic floor exercises are very important to complete both during and after pregnancy.

So how does pregnancy really affect the pelvic floor?

During pregnancy, the body has many hormonal changes occurring. It can be a time where women may experience bladder leakage for the first time due to hormonal changes softening the pelvic floor muscles which normally assist with holding in urine. As the foetus grows, more pressure is also placed on the already changing pelvic floor which can contribute to developing weakness. During the birthing process, the pelvic floor muscles stretch dramatically, up to 250 times their normal limit. This contributes to weakness post-partum and can also lead to muscle tearing.

What can occur with pelvic floor dysfunction?

  • Muscle weakness
  • Incontinence
  • Muscle tearing during the birthing process: the degree of tearing can vary from a first, second, third or fourth degree tear
  • Prolapse
  • Loss of ability to control wind

How can physiotherapy help pelvic floor dysfunction during or after pregnancy?

A pelvic floor physiotherapist will be able to set appropriate exercises for you and discuss important considerations regarding diet, exercise, and toileting routine. Up to 33% of women completing pelvic floor exercises are completing these incorrectly which is where seeking the guidance of a trained physiotherapist is of immense benefit.

So if you are pregnant or have recently given birth and have any concerns regarding your pelvic floor, make an appointment see to one of our pelvic floor physiotherapists today.

 

 


PINC & STEEL Move Over Cancer Night Fundraiser

Cancer…the word no one likes to hear as the cause of their pain and symptoms! Cancer affects tens of thousands of Kiwi’s every year! The data released from the Ministry of Health in December 2017 showed that in 2015 there was 23,149 New Zealanders newly diagnosed with Cancer and the split was roughly 50% between male and females. How can we as a community help? Bring on PINCSTEEL!

Who is PINCSTEEL and what do they do?

PINC&STEEL are a cancer rehabilitation trust set up to assist people affected by cancer through physical rehabilitation, the PINC helping the ladies and the STEEL helping the lads.

Move over cancer is a Nationwide Challenge to help fund raise for the PINC & STEEL.

The team here at Accelerate Physiotherapy are joining forces with Emma Ferris (Physiotherapist, Breathing Coach and the Founder of the Butterfly Effect) and putting on a fundraising night to support such a wonderful organisation. The evening will consist of a 1 hour Pilates class followed by an insightful talk from Emma. Emma will be talking on the Power of Effective Breathing and how this helps patients recover from dysfunctional breathing patterns, injury, stress, chronic fatigue, hyperventilation, depression and chronic pain – all things that people with cancer can be inflicted with as part of their cancer journey!

The details:

Where: Ascot Park Hotel

When: 8th May 2018

Time: 7pm for Pilates and speaker or 8pm for speaker only

Cost – Pilates plus speaker – $35 or Speaker only – 20$ (with all funds going towards supporting the PINC & STEEL trust)

Tickets: Available from          www.thebutterflyeffect.online or at Accelerate Physiotherapy on 60 Deveron Stret Invercargill, Ph: 032186583

From the team here at Accelerate we really hope you tell all your friends and family to come along to an evening out to support a wonderful organisation and raise some much needed funds for the people currently (and in the future) living their journey through cancer! We hope to see YOU there!

 


Hamstrings – the long and the short of it!

March 2018

The hamstrings are a collective term used for the group of muscles that sit at the back of your upper leg. They include the:

  1. Biceps Femoris
  2. Semimembranosus 
  3. Semitendinosus

The Primary functions of the hamstrings are to extend the hip – move the leg backwards and flex the knee – take your heel towards your bum. They are important in everyday life for walking around, to riding your bike to running down the road. The incidence of injury is related to non-modifiable and modifiable risk factors, with previous hamstring injury having a >30% recurrence rate.

Non Modifiable risk factors include:

  • Age > 23 year of age
  • Previous hamstring injury (34% recurrence)
  • Spinal changes to load

Modifiable risk factors include:

  • Hamstring weakness
  • Lack of flexibility
  • Fatigue and muscular imbalance of muscle of the lower limb
  • Excessive pelvic tilting
  • Core muscle weakness and reduced endurance
  • Adverse neural tension

The two main ways the hamstring muscle gets injured is:

  1. Closed chain – When the foot is in contact with the ground and you lunge forward
    • Example – Lunging in squash
    • These injuries are normally higher up the back of the thigh and usually take longer to get full rehabilitation
  2. Open chain – with the shin and foot is moving and not in contact with the ground
    • Running, dancing or kicking movements
    • In running, one of the main roles of the hamstrings is to slow the shin down as you prepare for foot contact with the ground. This is called eccentric control and means that as the muscle contracts to slow the movement it also lengthens at the same time. This requires a lot of control and unless trained specifically for this, injury may ensue.
    • Usually lower down the back of the thigh (not always) and usually a quicker rehabilitation occurs

Rehab focus

  • Early establishment of goals and time frames
  • Pain & swelling management
  • Facilitate tissue healing
  • Restore normal muscle length, neural movement and walking patterns
  • Regain strength
  • Retrain the bodies awareness of where it is in space (what your brain thinks it is doing)
  • Running retraining and sport specific rehab

Rehab the mind as well as the body!

  • Use imagery early on
  • Make use of goal setting
  • Fear avoidance (of re injury) retraining
  • Reducing Catastrophizing of re injury

If you currently have tightness or pain in your hamstring, or have had an injury in the past, it pays to focus on this and get it sorted early on so that further recurrence doesn’t limit your goals in the future! 🙂

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Tapering – what is it? And how do you do it?

February 2018

What is it?

Tapering is a term used in the sports science and training scene and with runners is used in the lead up to a specific target event or race they have in their training calendar. It involves a portion of the training program that has reduced volume and increased intensity in an attempt to manage the appropriate training load, in order to have peak performance at the specific moment in time on race day.

Types of Tapers

  1. Linear – gradual smooth decrease in overall training load
  2. Exponential slow decay – slower decrease in volume
  3. Fast decay – quick reduction in load that then slows with time
  4. Step – large initial drop that then plateaus for remainder of program

 Components of a Taper

  1. Duration
    1. 2 weeks for a 3-5km and 3 weeks for 10km upwards
    2. However the level of fatigue going into the taper is the key determinant of the duration
  2. Volume
    1. 40-60% reduction in volume over 2 weeks is a good starting point
  3. Intensity
    1. Should remain the same or even slightly higher with focus being on recovery
    2. The most intense session should be 5-14 days prior to 5-10km race and up to 30 days prior to a marathon
  4. Frequency
    1. Reduce frequency by no less than 80% for elites and by no less than 50% for the less trained

How does tapering effect performance?

  1. Improves oxygen carrying capacity
  2. Improved training recovery
  3. Improved glycogen stores and muscle oxygen capacity (mitochondria)
  4. Improved muscle strength and power
  5. Reduced muscle and overall body stress (reduced cortisol produced)
  6. Improved psychological and energy states
  7. Reduced rating of perceived exertion

Research suggest that improvements in performance are in the vicinity of between 2-5% and the recommendations for how much to taper depends on the volume, intensity, frequency and duration of your current training program.

Practical Applications

The following guidelines are recommended when considering a taper for long distance athletes.

  1. Use a period of between 1 and 4 weeks
  2. Shorter periods (1-2 weeks) appear to be better for 3km-5km.
  3. Longer periods (3-4 weeks) appear to be better for 10km and above
  4. Reduce normal volume of running 40-80%
  5. Maintain or increase intensity of efforts. (Example –  increasing the speed of running, reducing the recovery between efforts)
  6. For 5km and 10km perform the most intense session 5-10 days before competition
  7. For the Marathon perform the most intense session up to 30 days
  8. Reduce frequency of running sessions by 20-50%

Things to monitor and learn from in regards to your tapering (you will need some baseline measures to compare to)

  • Heart rate – resting, during and between efforts
  • Running form, cadence, energy levels, sleep quality, weight, mood and appetite – just to mention a few

It is very important to use recommendations and things that you read as a guide and to get to know your body and its training response. I hope that this gives you a little “food for thought” and allows you to tailor your training program to best suit your own personal needs.

Recap – General Guide to tapering for distance runners (5km-Marathon Distance)

  1. Duration – 1-4 weeks taper
  2. Volume – reduce by 40-80%
  3. Frequency – 20-50%
  4. 4Last difficult session – 5-10 days prior to race (5-10km) and up to 30 days (Marathon)

 

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Motivate to Elevate

December 2017

Why do I exercise? When do I exercise? Where do I exercise? How do I exercise? What drives and motivates me to exercise? This is what I am wondering about myself as I stand at my desk and stare outside at the sunny southland sky. So when I came to answer these questions for myself, I thought it might be a good idea to put it out into the interweb to help others think about there what, when, where, why and how’s of exercise.

I like to think of motivation as the forces within and/or around each person that account for the level, direction, and persistence of, or absence of effort. This can be influenced by how people differ in their personalities, abilities, self-concept, values, and needs.  There are different overarching types of motivation those being intrinsic and extrinsic, being internally “pushed” or externally “pulled” respectively. There is no right or wrong… there just is 🙂

Once again this blog is about thought provocation in the pursuit of self-betterment. Do you exercises to help manage and curb the inner angst and turmoil associated with a hectic lifestyle? Is it to avoid the “bad” and get the “good” benefits for health, daily homeostasis and self-existence? Is it for solidarity, comradery and social interaction? Or is it a complementary exercise or for a competitive advantage? Fundamentally at our core, most of us have a desire and drive to be a better existence of ourselves, but what ever your reasons, the good thing is you’re out exercising (and if you’re not then it’s a GREAT time to start) and getting the myriad of benefits associated with it.

Over the past few years there have been a growing number of outdoor events or exercise in natural environments – the trail running boom, godzone (and the like) races, colour runs and tough mudda courses and the term Green Exercise (not specifically the colour but more so the co-existence of nature and exercise) has come about. Research shows that green exercises has additive psychological benefits when compared to other activities and these include enhanced mental wellbeing and reduced psychophysiological stress. Green exercise helps shift attention to external cuing like the trees, birds, waterfalls etc. rather than internal cues like fatigue and perceived exertion.

So whatever your reasons, whether you are pulled or pushed the reasons are yours to embrace.  I look forward to seeing you out and about getting your exercise groove on :). If your think you might start or do something new tomorrow, just remember, TODAY is yesterday’s tomorrow!

 

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”


Does your breathing limit you performance?

November 2017

Have you ever been exercising and felt the burn and inability to get enough air into your lungs..? We all have 🙂 ! Unlike the picture below, this is generally a sign of cardiovascular fitness and that the task was demanding more of our heart and lungs than we could deliver. Historically it was believed that a person’s breathing pattern was not a limiting factor in athletes due to the apparent breathing reserve (1). Whilst there is limited research into altered breathing mechanics and its effect on performance (2), more recent research suggest that this may not be the case and that working on breathing pattern and sporting performance could be of benefit.

Most of us take no notice of our breathing, which I must add is NORMAL! And the majority of us have a normal breathing pattern at rest and during exercise. However some of us may have an ineffective pattern when we exercise which leads to an overall reduced performance. So what is the cause and effect of an ineffective breathing pattern?

Cause (2)

  1. Pathological factors – for example exercise induced asthma
  2. Emotional factors – anxiety and stress (we all have it to some extend when we compete)
  3. Biomechanical factors – posture during chosen sport
  4. Physiological factors – changes to your breathing rate beyond the normal respiratory response to exercise and poor breathing mechanics at rest

Effect – all negative to performance

  1. Increasing breathing rate at the expense of maintaining your volume of air per breath (3)
  2. Continually breathing at higher (than normal) lung volume during performance (4,5)
  3. Increased work of breathing – muscles that control breathing fatigue earlier (6-8)
  4. Blood stealing – sounds horrible but put simply it is blood getting transferred away from your working muscle (i.e. leg muscles during running or cycling) and diverted to your breathing muscle as they are fatiguing (9)

So what can be done?

Breathing Pattern Retraining

This is a technique used by Physiotherapists to correct breathing pattern disorders and poor abnormal respiratory mechanics (10-12) and may benefit athletes by correcting resting breathing pattern disorders or poor mechanics. Correcting poor mechanics that arise from exercise and altering respiratory centres sensitivity to the build-up of the by-products of exercise (13,14).

I hope this helps you realise that getting breathless with exercise is normal and is generally a sign of fitness, and as you increase your training load then your fitness should also improve. However, if you are training hard and wanting to maximise your performance, then looking at your breathing pattern during your chosen sport may be the edge you require 🙂 .

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”