The Opti-OK clinical trial is looking at the frequency of physiotherapy appointments for people with knee osteoarthritis (kneeOA). You will get free physiotherapy treatment, which may be six treatment sessions over three or six weeks, or a single exercise treatment session.  You will also be asked to attend testing sessions at the University of Otago Research Centre at Southland Hospital.
There will be four of these over a six-month period when we will gather health and economic data. All sessions will take 45–60 minutes.
For more information go to: otago.ac.nz/kneeOA

Or to register for the study contact:         
The School of Physiotherapy and mention the Opti-OK trial
Tel: 0800 687 489 (0800 OU PHTY)
Email: kneeOA@otago.ac.nz

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”

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 (1^st 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”

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 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”

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”

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”

To start with let’s get our nerd groove on and break down one of the most important parts of our running stride (foot contacting the ground) into the fundamentals of physics (specifically Sir Isaac Newton’s 3^rd Law of Physics)  – which is, for every action (force) there is an equal and opposite reaction (force). When your foot hits the ground, the amount of force it hits with is equaled by the ground resisting, thus if you run with a slower cadence you are more likely to over stride which leads to a greater contact force between your foot and the ground! 

The picture above shows this, with a slower cadence you’re more likely to hit the ground on your heel out in front of your body with force (red arrow) acting like a break on your momentum and thus leading to increasing ground reaction forces. The increase in the force has been shown to increase leg pain in runners! So we know why cadence is important for reducing force but what is ideal? And is there a magic number we should aim for..?

As mentioned above, cadence is the number of times your feet hit the ground every minute. The ideal number in the literature that is bandied about is 180 steps per minute. As mentioned in my September 2017 post (The running Conundrum – Part II) that would mean then each foot would hit the ground 90 times in 1 minute. If we extrapolate this out into a 30 minute run, at optimal cadence your feet hit the ground 5400 times!

When thinking about it this way, the amount of force your body is exposed to is considerable, so anything that can be done to reduce this is advantageous. Most of us in the general population have a cadence of between 155-160 beats per min which is too slow. The guideline is generally to aim for between 170-190 steps per minute with 180 being the flagship.

The increase in cadence:

1. Reduces ground reaction forces and vertical loading rates
2. Reduces vertical oscillation – how high you spring with each step (to a point!)
3. Reduces stride length
4. Promotes more midfoot contact at foot strike causing a lower peak force of contact

So, with the knowledge of what is a good guide, is it as simple as increasing cadence? Yes and No! Whilst changing your cadence is very important (in my opinion, one of the most important things to consider!) it should be done gradually and under the watchful eye of someone who knows running form and technique. Changing things too fast or by too much can result in increased risks of injury! If you are interested in your running style and cadence and would like some advice then I would be more than happy to assist as I can 🙂 .

Until next time,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”

1. What is the best shoe for me to be wearing?
2. I have been fitted for this shoe so it must be right…Right?

Well the answer to that is…

When looking at running shoes and how appropriate they are for your body you need to ask yourself a few key questions:

1. Do I have (or have I had) and injury to my foot, ankle, knee, hip or back?
2. How old am I?
3. What are my previous footwear habits?
4. What is my running experience?
5. Do I care about my performance or am I happy with where I am at?
6. Am I currently at the start, middle or end oy my training for the season?
7. Do I like the feel of my shoes?
8. Do I like the colour? (the latter not being that important but to be honest it is a little 🙂 )

I can appreciate that this is a lot to think about when choosing a shoe! But, if I put it to you this way, if you were to run with what is considered the optimal cadence (number of times your feet hit the ground in 1 minute) then each foot would hit the ground 90 times in 1 minute. Over a 20 minute run each foot would hit the ground 1800 times! That’s a lot of repetitions! When thinking of it this way, suddenly choosing the most appropriate shoe is definitely something to think about! Upwards of 70% of running injuries occur in the lower limb and some studies report up to 50% of these occur at the knee (van Gent et.al, 2007). This is why putting time and knowledge into correctly choosing your running shoes are paramount.

This is also one of the reasons why when looking at changing a running shoe the transition to doing so should be very gradual and controlled. The best way that I could think to try and make this as user friendly as possible is to show you the wee flow chart below.

It is extremely important to stress that when looking at changing (or moving to a more minimal) running shoes that this is done in consultation with a health professional and the process is done gradually, because if done to fast the mechanical load will be too high and injury will ensue. The rule of thumb is for every 10 percent change in minimalism this should be done over a 1-2 month period.

So what is the take home message…if you run in traditional shoes and have no injuries and do not want to increase your performance and efficiency – stay in your normal shoes. If you have an injury or want to improve your technique, efficiency and performance then you will need to consider what is between you and the trail and get a professional to guide/assist your decision making 🙂

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”

Over the past few years there has been discussion, research, marketing and objection towards reducing the supportive nature of shoes and getting back to basics – “The Minimalist Movement or The Barefoot Running Movement”. If you are involved in the running community, enjoy reading fitness blogs or magazines and/or have a healthy obsession/fetish with running shoes then you may have heard about this. However a large part of the community hasn’t. So together we will delve further into the black hole that is “running shoes” and hopefully come out the other side refreshed with a newfound knowledge (or strengthening existing knowledge) you can use for yourself, family and friends. It is important to note that I have no vested interests in any shoe company and unfortunately 🙂 get no gratuities from any shoe brand.

In the beginning there was terminology…broadly there are two main terms/groups that most people talk about with running shoes, those being “minimalist” in nature and by virtue of opposing forces…you guessed it maximalist shoes. The way I like to think of the running shoe “groups” is more of a continuum by which there are varying degrees of minimalism – this is called the “Minimalist Index”.

You might be asking: Well Joel, how do I tell what is what? And what is best for me or my child? Great Questions! As with all my blogs my goal is to promote thought and understanding and I will hopefully answer those questions in the coming series.

The “Minimalist Index” was created by a group of Researches to allow a standardized measurement of minimalism within a running shoe. The research consisted of 42 experts from 11 countries and agreement was met on the classification (Esculier, et.al 2015). The index is characterized by 5 main measures of a shoe:

Simply put, the lower the stack height, lighter the weight, lower the heel-toe drop, less motion control (pronation control) technologies and the more flexible the shoe is, the higher the “Minimalist Index”. Now more questions are likely to be popping into your head … like what is the best? What should I be wearing? I have been fitted for my shoes so they are the best right? I could imagine you’re sitting at home (or work) thinking about the next awesome run and now wondering are my shoes the most appropriate and efficient I could be wearing..? All great questions!

If the shoe fits do I wear it? Well…it depends! This is what we will start to discuss next time 🙂

Until then,

Keep Safe and Happy Running 

Joel

Physiotherapist & Exercise Scientist

Certified Professional with “The Running Clinic”