Plantar Fasciitis is one of the more common ailments we see in clinic and Susie Burness is here to outline some of the reasons for it followed by best treatment plans.
What is Plantar Fasciitis?
Plantar fasciiopathy, as it is technically known, is characterised by pain focused under the heel, classically at the inner part, or as it is anatomically known the medial tubercle of the calcaneus. This is the insertion or attachment point of the plantar fascia. The Plantar fascia ligament is a fibrous tissue along the bottom foot that connects your calcaneus (heel bone) to your metatarsals (toes).
It is responsible for supporting our arch and helps to propel us in walking.
Classic symptoms include:
Start up pain – pain on starting to walk following prolonged periods immobility (i.e. sitting)
Morning pain – worst pain experienced first thing in the morning when taking first few steps.
It can occur both in the sedentary person and the athlete and is generally thought to be caused by ‘overload’. Overload to the plantar fascia can occur due to a sudden increase in frequency, intensity or time of training per week, or a change in terrain.
The prevalence in the general population is estimated between 3.6-7%. It is most common between the ages of 40-60.
What risk factors are there?
reduced medial arches or flat feet
increased BMI – if you are carrying more weight than is optimal for your frame.
reduced control around the hip and core, which can lead to increased loading at the foot
increased pronation (rolling in with your foot when walking)
A spike in loading through the foot i.e. suddenly doing a lot more than normal for you
How do we best treat it?
It is a notoriously difficult thing to treat and there has been a significant lack of research over the last few years. Developments more recently mean that we are progressively treating it with loading based exercises as we would treat an overuse tendon problem such as with an achilles tendinopathy. Flexibility and load modification are also key components to the management.
Physiotherapists would also look to insure we treat any biomechanical factors that maybe contributing from the knee, hip or lower back. These may include reduced gluteal and calf strength and reduced control of muscles such as the tibialis posterior that controls the arch of the foot.
Gel heel inserts or medial arch supports can also be a helpful tool to help offload and support the foot to help things settle. Our biomechanist, Michael Thompson, would assess walking and running styles to see if there would be suitable orthotic adjuncts that may help the foot as well.
Strengthening your calf which is made up your gastrocnemius and soleus, is key to the treatment of plantar fasciiopathy whilst ensuring you regularly update your trainers and keep on top of stretching and foam rolling your calf muscles. If doing large amounts of walking or running you also need to ensure you keep up strength and conditioning work to maintain strong core, gluts and lower leg muscles.
Click here for a link to our YouTube Channel for form rolling ideas.
If you feel as though you are being affected by plantar fasciiopathy, it is important to get a correct diagnosis and then treatment plan. Please contact Bristol Physio to get an appointment with one of our expert physiotherapists or Michael Thompson.
Spring Marathon Training – Tips for Training and Injury Prevention
By Susie Burness
It’s the New Year when many often increase their training on a drive to kick start their fitness, and may have signed up to an event to help with the process. Both London and Brighton Marathon are looming closer with Brighton 7 weeks away and London 9 weeks away.
“How do we do train for these, reaping the maximal benefits whilst minimising the risk of injury?”
The following article seeks to look at a few top tips to train well.
Training error accounts for 60-70% of running injuries (with some articles reporting a figure of up to 80%).
Our musculoskeletal system made up of muscles, bones and tendons can tolerate a certain amount of load without any issue. However, when we suddenly demand more of it than it is ready for, that’s when pain or injury can occur.
Training Load is made up of the volume (amount), frequency and intensity of our training.
I have often seen people in Clinic who, on having signed up for running events have jumped from one run once every few weeks to 3-5 runs a week. Even though those runs themselves individually may not be perceived as difficult or challenging, the overall load on the body has significantly increased.
Gradual increase is important whilst allowing the body time to adapt to the new demands we are placing on it and therefore minimising the risk of injury.
Training error can commonly include things like:
A rapid increase in mileage or overall volume (the amount of training you do per week)
Not enough rest time
Bunching of training (i.e. all sessions completed over the weekend due to a busy working week)
An inappropriate mix of high versus low intensity sessions (too much high intensity).
High intensity sessions would include things like sprint sessions or intervals.
A big change in the terrain or gradient that you normally train on
A few things may be useful to keep in mind as you increase your training heading towards your goal.
Only increase your mileage by 10% each time (particularly when thinking about your ‘long’ run)
Step up, step back
On increasing the mileage of your runs, keep at this distance for several weeks before increasing it again
80:20 ratio of low vs high intensity
Low intensity, steadier state work should make up the bigger proportion of your running training versus sprint or interval based work for pace.
One goal each run
Try not to focus on too many things at once, i.e. don’t run long runs too quickly
Plan training to allow rest after longer or harder sessions
I.e. plan your rest day after your speed session
Gradually increase the number of runs per week, allowing your body time to acclimatise.
Take into account other exercise you may also be doing in the week, your body will need to recover from this too. Plan your training and plan your rest days.
How else can we decrease risk of injury?
Many of the below may be things we reach for or think about once we already have a problem. However, as the saying goes, “prevention is better than cure.” Fitting several short foam rolling sessions in a week or periodically treating yourself to a sports massage will improve your performance as well as avoiding the niggles that build up.
Foam rolling is a great tool to aid recovery. A low cost roller is simple and effective and can be used to release muscle groups all over the body.
More information on this can be found in the foam rolling article on the Bristol Physio Blog. Videos of rolling methods for different muscle groups are also available on our YouTube page.
Though foam rolling is a good tool, sometimes we require the expertise of a Sports Masseuse. They can affectively assess and treat more specifically tight muscles groups in a way that we can’t with a foam roller.
My colleague and Sport Masseuse Anna recently published an article that can be found on the Bristol Physio Blog.
Strength & Conditioning
Running places a lot of load on your body. To put this into some perspective statistically, a 80kg runner who averages 500 foot contacts per mile will tolerate 100,000 kg of load per mile. (This takes into account the effect of ground reaction force) That’s a lot of load!
Therefore, being strong and having good muscular endurance is important. Especially if we’re asking our legs to tolerate the demands of 3-5 hours of running during a marathon.
Good gluteal, core and lower limb strength can contribute to improved biomechanics and load tolerance when running.
Strong core and gluteal muscles help to stabilise your pelvis and minimise valgus forces at the knee (when your knee drops in), which is a common contributor to ITB syndrome and patellofemoral pain.
The calf complex (made up of your gastrocnemius and soleus) plays an important part in both propulsion and shock absorption. A strong calf can both improve your speed and minimise the forces translated up your leg.
Mo Farah can squat 1.5 times his body weight. He uses regular strength and conditioning sessions to not only minimise the risk of injury, but to improve his running performance.
Incorporating some simple exercises like squats and lunges can be excellent for maintaining this.
A good pair of trainers
Running shoes are designed to last for a certain mileage and how long they last will depend on your weekly running volume. Digging that pair from the depths of the cupboard that have been around since the early 2000’s may not be ideal for pounding the streets multiple times a week in the run up to a marathon.
The general rule is to find a pair of trainers that you feel comfortable in though some people may benefit from more support in their trainers than others.
The best way to find a shoe that works for you is to go to a running shop where they can assess this.
Our friends at Motican advise you on what kind of shoe would work for you. They do running assessments in house and have a great range of running trainers to suit all needs.
I hope this gives you some useful tips for marathon season. However, if you’re having pain or discomfort that isn’t settling despite adhering to the above, we’d advise you pop in to see one of our Physio’ s for an expert assessment. Happy running.
Our resident Sports Massage Therapist, Anna Wright, answers your questions and more!
Why do we require massage and what benefits will you get from a Sports Massage?
Professional athletes have regular sports massage as they strive to improve their performance. This is for a number of reasons:
To reduce risk of injury by breaking down adhesions
To maintain flexibility
To flush out waste products of heavy exercise
To decrease localised swelling if an injury has occurred
Massage will help in reducing scar tissue and speed up recovery time. The physical & brutal collisions in sport mean injuries are inevitable. If we think specifically about rugby; all the tackling, rucking and scrumming, hitting the ground and smashing into one another lead players to become injured. Injury can also happen in other activities that involve running and jumping and lifting and carrying, and overuse injuries are all common in all physical activities.
Muscular and soft tissue injuries are most common.
When an injury occurs, players want to regain their strength and flexibility as soon as possible.
The repairing of damaged muscle tissue results in scarring. Scar tissue is fibrous and bulky tissue, which is so tough that it can be as hard as bone. If this area around the injured site continues has reduced flexibility it may affect the player’s function as that area will demonstrate limited range. The muscles and tissues will not be able to glide next to each other as smoothly as they should, as the scar tissue will cause them to fuse together.
What does this mean for our active person?
The result of scarring may mean a loss of Power, Strength, Flexibility and a risk of further injury in the same area.
Without treatment, the tissue in the injured site may never be as strong. Untreated scar tissue can be a common cause of re-injury, often weeks after it is thought that total recovery was achieved.
Deep tissue massage techniques will break down these tough fibrous tissues, and if achieved in a timely manner after the injury, it can stop these cells binding and causing adhesions. Certain techniques are used to break down fibrous tissue into smaller particles and remove the unwanted waste products through the lymphatic system. This system is a vital mechanism of clearing the body of toxins and waste products.
Can massage increase general circulation?
Massage helps pump blood and lymph around the body. If the fluid is pumped in an upward direction towards the heart, the force of this movement creates a suction space behind it that is immediately filled with fresh oxygenated, nutrient rich blood. This oxygenated blood is full of the ingredients that we need for growth and recovery.
Massage can reduce delayed onset muscle soreness (DOMS) and prevent injury.
After a tough match or training session when the muscles have been worked hard, a pain message is sent to your brain telling you that your muscles are sore and painful. This is due to the byproduct heavy exercise called lactic acid. Massage soon after exercising can help to remove this acid and other waste products.
A massage therapist can help to identify where more attention is needed in an individual’s training program.
Massage therapists are trained to recognise tightness in certain muscles, therefore advise can be given on stretching those areas. They can also identify micro-trauma from over-training (training above the bodies capacity to cope with load) and in this case, recovery strategies can be discussed. Overall these skills will help to avoid future injuries.
Often when we are experiencing pain due to ‘tight muscles’ it is due to weakness and over working of those muscles. Function will be affected in a bid to avoid further pain but this may result in further injury to another part of the body. Massage will help stimulate muscles and then exercises can be given to build strength where needed to allow the body to work better as one unit.
Massage can instantly make someone feel relaxed and improve sleep.
The feeling of relaxation reduces stress and anxiety. By releasing tension in the soft tissues then balance can be reinstated to the body, this can improve many conditions such as high blood pressure, migraines, stress, and anxiety, and it can also improve sleep. More sleep means better recovery as when we sleep growth hormones are released allowing the body to fix itself.
Should you feel any of the advice above will be relevant to you, please contact Bristol Physio and we will arrange an appointment with Anna so you can help your overall recovery.
School sport update from September to December 2016
Bristol Physio is extremely proud to be associated with a number of local schools where we’re managing their sports injuries at the weekend, primarily on the rugby field. This requires all our staff to be trained in Sports Trauma Management as well as their other physiotherapy qualifications. Our role involves the treatment of minor niggles, strains and sprains using physiotherapy techniques and to provide medical support for more serious injuries.
All our staff are fully trained on concussion management. In under 19s, concussion management is very precise and is taken very seriously. At Bristol Physio we have designed our own Concussion Protocol based on the latest findings from the Sports Concussion Consensus (2012) and the RFU Guidelines. This is the most up-to-date researched based findings on how to deal with concussion in sport and is the basis that all governing bodies around the world are using for their concussion management. Should you wish to see a copy of this protocol please email email@example.com.
We are pleased to announce that all our schools have achieved great results this term.
Bristol Grammar School.
The 1st XV Rugby Team managed a great season this year with significant wins over many local rivals. The highlight of the season probably remains their tour of New Zealand in the summer, however extremely close results against Colston’s and Clifton College should highlight the improvement in their performance this term. They unfortunately lost to Blundell’s in the Natwest Trophy having beaten Sherbourne in the previous rounds.
Queen Elizabeth’s Hospital
For the first season ever, Bristol Physio were helping QEH teams at Failand. The rugby was hotly contested and whilst the 1st XV may have had a developing side, there were some great results throughout the school. The U15s were flying the flag for the school with impressive over KES Bath and Beechen Cliff School.
Prior Park College
In the second season at Prior, we were very impressed with an emerging 1st XV that clearly had made great strides forward. The team consists of a number of Lower 6th players, who showed great potential coming into the 7s series; wins over Kings College, Taunton and Kings School Bruton were some of the highlights of the term.
Looking forward, all three schools will now enter into the 7’s season. All age groups will be participating in tournaments throughout the South West culminating with the Rosslyn Park 7s at the end of March.
Bristol Physio will continue to provide our services throughout next term to all hockey, football, netball and rugby teams at all three locations.
Please remember that all students, parents and staff from the schools are eligible for discounted treatment and services at Bristol Physio. Just click here to contact us.
Foam rolling is a method of self myofascial release using a cylindrical foam roller. It is an inexpensive and convenient adjunct to help with the maintenance of mobility and healthy muscle tissue. Foam rollers themselves can vary in size and texture but all do a similar job, though you can be more specific with some of the more textured rollers. They can be found in most gyms but are a useful and compact piece of equipment to have in your home.
What are the benefits?
A foam roller uses similar principles to that of massage through physical manipulation of the tissue to help release knots and reduce muscular tension. However, instead of a therapist applying the pressure, you use your own body weight to affect the area of the muscle you are rolling. You can alter your position on the roller to target specific areas of the muscle whilst rolling back and forth.
By doing this there is an increase in blood flow and lymph to the muscles which increases the supply of oxygen and nutrients. This increased blood flow brings with it many benefits:
Increased muscle flexibility
Improved joint mobility
Decreased recovery time
Decreased risk of injuries
Foam rolling cannot completely replace the skill and accuracy of a massage therapist but can help to reduce the amount of time (and money!) you may need to spend seeing one.
Decreasing Recovery Time
For those frequent gym attendees you may be acquainted with that delayed stiff and achy feeling in your muscles that builds up a day or two post workout. It tends to occur after a particularly hard session or, more commonly after integrating a new exercise into your regime. This is known as DOMS (Delayed Onset of Muscle Soreness). It not only limits our ability to exercise but can interfere with daily tasks. (I’ve definitely struggled up and down the stairs after a hard session).
The soreness felt is secondary to micro-tears in the muscle fibers followed by an inflammatory response and chemical reaction. It can cause discomfort and stiffness for up to a week unless treated with massage therapy or a foam roller. The increased blood flow provided through rolling, can help remove waste products from the tissues, helping your muscles to move more easily again and therefore can decrease your recovery time.
When our muscles become more pliable we in turn increase our flexibility which can help with decreasing our risk of injury.
Many of us spend long hours in the day sitting in front of screens, (or we may be on our feet for work, but get home to wind down by slumping for several hours on the sofa). It’s very easy to lose your postural awareness and before you know it you’ve slouched over your screen for hours at a time.
Over time these repeated positions can cause respective lengthening and shortening of certain muscle groups resulting in a deviation of our posture from our optimal mechanical position.
For example, in slouching at our desks with our chins poking forwards and our shoulders and upper back rounded, the pecs muscles in our chests tighten and the rhomboids and trapezius in our upper back lengthen. Long periods of sitting also tend to tighten our hip flexors and hamstrings.
Using a foam roller to lengthen the shortened muscle groups can help to oppose these daily dysfunctional positions and therefore improve our posture.
How does it work?
The exact process behind foam rolling is still up for debate, but it is evidenced by its affects.
By releasing “knots” or “trigger points”
Knots or trigger points are hyper-irritable points in the muscle or fascia surrounding it. You can palpate them as nodules in tight bands of muscle. Trigger points are characterised by a referral pattern where by pain can be felt (but not always) at a point further away. For example, some headaches can be caused by tight muscles in the neck due to referral from these muscles.
Trigger points are differentiated from muscle spasm as they only occur in a small part of the muscle, whereas muscle spasm will involve tightness in the whole muscle.
They can occur as a result of injury, excessive or unusual exercise or following persistent overload of the muscle i.e. those used to maintain posture due to poor sitting or working habits. Repetitive tasks at work or home can also be a cause.
These trigger points can be released using the foam roller to pressure them. In smaller areas such as the neck, more benefit may be gained by using a massage ball.
By manipulating the fascia
Fascia is a continuous network of connective tissue that envelopes and separates our muscles, bones and organs in one long connected structure. In order for fascia to function correctly it needs to be able to glide smoothly over the tissues that it surrounds. Through excessive postural or mechanical stress the fascia can get stuck and adhere to itself or other tissues.
When foam rolling, we also affect the fascia and can release these adhesions, allowing it to glide freely again.
When and how to use it?
How and for how long?
If using for general maintenance each muscle (or muscle group – i.e. the quadriceps) should be rolled for up to 2 minutes. So the total time for rolling will depend on muscles you are focusing on for the session.
For example, for runners, the calf, quadriceps and hamstrings are key muscle groups to roll. Office workers may find they benefit from rolling their spinal muscles and hip flexors as these muscles are frequently affected by hours of sitting.
Gently rolling back and forth to increase circulation prior to focusing in on more specifically tight sections will warm the muscle up first. As a general rule for long muscles – i.e. quadriceps, hamstrings or calf it’s good to start at one end and roll upwards towards your body.
It’s important to ensure you focus more on the tight and tender spots in the muscles you are rolling. Roll more slowly and hold at these points until the pain dissipates for maximal benefit. This will help your treatment to be more specific. Ensure you breathe normally and try to relax the muscle you are working on as much as you can.
Listen to how your body feels – you will gain nothing from pressing too firmly and can even cause more pain and tightness if you’re too firm or if you spend too long on a painful point. If you have a specific injury, don’t roll it directly, instead try to influence the muscles around that may be tight. You can offload particularly tight or tender areas by putting more weight through your supporting arms or legs. You may also find placing a towel over the roll will make it more comfortable in the first instance.
Rolling can be beneficial both pre and post training. Prior, it increases the circulation to the muscles, helping the body to warm up and prepare for physical activity and post it can help to remove the waste products of exercise aiding recovery.
In the same way as you may have a post event massage – it should be done gently as its primary focus is not muscle release but its main aim is relaxation and recovery.
Fitting a quick 10 minutes after work whilst you wind down in front of the TV may also be useful to release tension from the day and aid your sleep.
In terms of rolling for the specific release of muscles, time this on days you are not training heavily, it may be worth fitting 5-10 minutes several times a week to release tightness and help optimise your recovery.
If you feel as though even with a large amount of foam rolling you are unable to change your tightness or soreness then it would be best to contact us and see one of our experienced therapists to get a definitive diagnosis on the problem. Occasionally you may not find any change with the rolling therefore the need for a proper diagnosis for the cause of the pain should be explored.
We are delighted to welcome Susie Burness to our practice following a move from London back to her native Bristol.
Susie graduated with a BSc(Hons) from Manchester Metropolitan University in 2010 and began work in London where she gained valuable experience in the NHS. This included rotations in stroke and neurosurgery, community rehabilitation, cardiorespiratory, and orthopaedics before specialising in musculoskeletal physiotherapy. Susie gained most of her experience at The Royal London which is one of London’s major trauma centres.
Here she worked across a variety of specialities including sports injuries, rheumatology, chronic pain, post-operative orthopaedics and complex poly-trauma’s, this also included hydrotherapy.
Once specialised, she also worked at Guys’ and St Thomas’s where she had the opportunity to assist in teaching undergraduate physiotherapists. Susie has also gained a post-graduate qualification in acupuncture and has completed further courses including lower limb tendinopathy, the sporting shoulder and running repairs.
A keen exercise promoter, Susie has experience rowing at national level, as well as participation in triathlon and half marathons and she brings knowledge of these sports to treatment of her patients. She has a passion in facilitating patients to return to function whether it be day-to-day tasks or sporting participation.
She uses a combination of treatments to facilitate this, including manual therapies, exercise, education and self-management. She has more recently been working in Private Practice in London, but has just relocated to Bristol to be closer to fresh air and family. When not at work, Susie enjoys baking, running, cycling and yoga, and planning her next travel adventure.
Shin splints, or Medial Tibial Stress Syndrome (MTSS) to use the more medical term, is a common injury amongst runners.
Like so many of the running injuries we see in clinic every day, shin splints is classed as an ‘overuse injury’. It does appear in other sports, but is certainly much more prevalent in runners.
In typical cases of shin splints, pain is usually felt two-thirds of the way down the shin bone (Tibia), just off the inside edge of the bone.
In the early stages of the condition, pain is usually felt at the beginning of a run and then normally subsides during the training session itself. Commonly, symptoms also tend to reduce a few minutes after a given run session has finished.
As the injury gets worse the pain can be felt when walking and at rest.
It is often painful when direct pressure is applied to the inside border of the tibia. Occasionally some swelling can be present.
So what exactly is going-on to cause the pain of shin splints?
THE SOFT TISSUES OF THE TIBIA
One group of suspects in this case, are the soft tissues of the tibia. The muscles of the calf and the smaller muscles of the ankle have their attachments along the tibia. Specifically, the tibialis posterior, flexor digitorum longus and soleus muscles, have been implicated as possible sources of injury.
The theory being, that tightness, weakness, or excessive movement at the ankle of foot causes traction or tugging at the site of their origin on the tibia, leading to an irritation of the lining of the bone (periosteum).
There is another soft tissue that does attach to the lower medial border of the tibia, in the location of the symptoms. That structure is the deep crural fascia (fascia is a thin sheath of fibrous tissue enclosing muscles and organs).
This structure has deep insertions to the medial tibial border, finishing at the medial malleolus (inside ankle bone). It’s highly likely that the above mentioned muscles will be continuous with this fascia. Therefore, the deep crural fascia could tug on the periosteum, in the location of symptoms, and create the traction mechanism of injury detailed above.
DECREASED CALF STRENGTH
Some studies have suggested that smaller calf size, and decreased calf strength, could be connected with shin splints. The theory being, that it is the bone tissue of the tibia itself that is the source of pain.
Bigger, stronger calf muscles encourage the tibia to become stronger, and therefore, able to take greater loading. Additionally, stronger calf muscles would be able to absorb impact forces directly, again taking the load off the tibia.
TIBIAL BOWING / BENDING
This alternative explanation, again implicates the tibia itself. With this hypothesis suggesting that the problem arises via micro-trauma to the bone, due to repeated bending or bowing of the tibia.
It is well known in engineering, that when you load a long, narrow structure (like the tibia) axially, e.g. place a force through the centre of the object, lengthwise, it will result in bending moments at the structure’s lowest cross-sectional area (the narrowest part). The narrowest part of the tibia is the distal third where symptoms of shin splints are commonly felt.
It is generally suggested by biomechanists, that the tibia bends in the sagittal plane (forwards and backwards plane of movement) when running, placing most force at the distal anterior section of the tibia. But this of course depends on form; dictating where and how you strike the ground as you run.
Think of this a bit like a pole vaulter’s pole…
As they approach the jump, they plant the pole ahead of themselves (similar to an over-stride when running). Subsequently, we you see this big, anterior bowing of the pole. Great for pole vaulting but not so good for shins!
If we factor in three potentially important elements, we see that this anterior bowing force, in many runners, will be shifted medially, to where the symptoms of shin splints are reported.
As the foot loads, pronation occurs, (we all do it to varying degrees) which will shift the ground reaction force more towards the medial shin, and cause more of a side-bending force in the tibia.
Pronation is usually coupled with medial rotation of the tibia, which also places more stress medially.
When we run, we tend to land more towards the midline than directly in line with our hip. This is because it’s easier to get our centre of mass over our base of support. The consequences of this, are that our tibias will absorb the ground reaction force at an angle, and therefore a side-bending force, will again, be applied to the medial tibia, at the part of the tibia with the least cross sectional area e.g. where most people with shin splints have their symptoms.
Additionally, the muscular contractions of our plantar flexors, namely soleus, can also cause a tibial bending moment. If you imagine the attachment site of soleus, at the top of the tibia, and its insertion at the calcaeneus (pictured left).
As we go through mid-stance, and the soleus begins to contract to slow the acceleration of the tibia, the origin and insertion sites will be pulled towards each other, again causing an anterior bending in the sagittal plane.
It is important to note at this point, that bone stress is not a problem, if it’s applied at a gradual rate. Bone is an organic and dynamic structure. Like all living structures in the human body, it responds to stress by remodelling itself, to ensure it can cope with the demands being placed on it.
The problem comes, when the accumulated stress of training exceeds the body’s ability to remodel the area. This gives us an insight into why this condition is more prevalent in novice runners, or less fit runners, because their bones have not adapted over time to the stress of repetitive, high impact exercise.
It also gives us another layer of evidence to illustrate that when it comes to injury prevention it is important to obey the law of adaptation, and accumulate the stress slowly, giving your body’s tissues the chance to adapt and get stronger.
Prevention is always the best medicine when it comes to running injuries. Shin splints are similar to most running injuries, in that the most effective way to prevent them is to respect the laws of adaptation. This means, firstly, listening to your body.
If you are feeling pain when running, it’s because your brain has decided, that a particular area of your body needs protecting. Usually, but not always, this is because too much stress, or load, is being accumulated in the painful area, and you are not leaving enough time in between stresses to allow the tissues to adapt.
So the key to injury prevention is gradual, patient loading.
Another key factor is ensuring that you have strong pelvis stabilisers (Core muscles and glutes), good flexibility and up to date trainers.
The goal of running re-education is to assess an individuals running style, and see if, through subtle changes to their biomechanics, you can shift the load from the painful area, whilst not jeopardising their performance or creating an environment for another injury elsewhere in the body.
So in the case of shin splints, we are trying to reduce the anterior and medial tibial load.
Here’s some of the running cues that I like to try with this condition. It’s important to note that there is huge variability in what works for different patients.
Word of warning with these: If the cue is going to work for you, you should feel marked relief, and ideally no pain at all, within 30s – 1min of adopting the cue.
If you’re not getting any relief by then, try not to run through it.
If none of the below cues are working for you, then it may be time to book in with one of the Bristol Physio team for some advice.
1. INCREASE CADENCE
One of my most used running re-education cues across the board. The best way to do this is with the aid of a digital metronome (there are many phone Apps available).
The theory behind increasing your cadence is to decrease an over stride, get you landing closer to your centre of mass and with a straight tibia, as opposed to your tibia flicking out ahead of the knee.
As mentioned earlier this article, think of it a bit like a pole vaulters pole. As they approach the jump, they plant the pole ahead of themselves so you see this big, anterior bowing of the pole, great for pole vaulting but not so good for tibas!
If you can imagine the pole vaulter placing the pole down vertically, and not ahead of themselves, you will see a poor pole vault, but also less anterior bowing of the pole, that’s what we are looking for – less anterior bowing = less force through the painful area.
2. INCREASE STEP WIDTH
Trying to move the load from the medial shin, to achieve less side bending/tibial bowing. I try to bring about this change using a variety of cues. Generally, asking people to have some daylight between their legs or imagine running on either side of a yellow parking line, gets the right changes.
3. STIFFEN THE ANKLE
The idea here is to decrease the amount of dorsiflexion (toes travelling towards your shin) the ankle goes through. Lessening dorsiflexion means less tibial bowing from the action of soleus, as it tries to decelerate the tibia as it moves into end of range dorsiflexion.
Stiffening the ankle also helps to pretension the muscles, so they can work reactively and elastically. Good for speed but also takes the load of the bone itself.
4. CHANGE THE DIRECTION OF THE GROUND REACTION FORCE
Again, we are trying to decrease the anterior tibia bowing. If we go back to our rubbish pole vaulter, as we discussed, if he places the pole out in front of him with forward and downwards force it will create anterior bowing.
However, if he plants the pole down with a backward and downwards force, it will not bow anteriorly, but posteriorly. Bad for a pole vaulter, but good in our tibial context! i.e the force will go more through the back of the tibia.
Any change in the direction of the ground reaction force, to a more backwards and downwards force, will decrease the load in the anterior tibia and may be enough for us to keep running without pain. To cue this, think of pushing your leg back and down in a backwards tick type direction, using your glutes to perform the movement. Often I’ll say paw back on the ground like a raging bull! And think of kicking your leg back and out behind. [See Mo Farah running above: look at his kick back and the degree of hip extension. This will automatically make him land on his mid-fore foot].
As mentioned earlier, weak calves have been implemented in shin splints. So seems like a good idea to strengthen these muscles as a way to create a stronger, thicker tibia, but also being able to take more load themselves. But remember to maintain your flexibility when strengthening by stretching post work out.
ORTHOTICS / TAPING
Often a medial arch support works well to offload the medial tibia. Taping (and sometimes orthotics) can be great tools to offload an injured or sensitised area which physio’s will use to assist you in your rehabilitation.
CHANGING THE SURFACE YOU RUN ON
Bit of a weird one this, intuitively you would think that running on softer ground, such as an athletics track, sand or grass, would be easier on the legs, but the literature suggests that when we run on softer ground our leg actually stiffens more to compensate for the softness, and the reverse is true when running on hard ground i.e. less stiff legs.
This has led many to suggest that it may be better for runners with shin splints to run on harder ground. I remember when I had my shin splints, I found it better running on softer ground, but might be worth bearing in mind if you find the pain is worse on softer ground.
Cross-training can be effective at this point, to maintain strength and fitness. Remember you only need to offload the painful area, not your whole body. I will often suggest aqua-jogging which will allow you to work on technique and keep your running specific movement patterns with very little stress on injury.
Title: Full or Part Time Physiotherapist
Department: Bristol Physio
Summary: To provide expert physiotherapy services within a vibrant and forward thinking physiotherapy practice in Bristol.
Assessment and treatment of musculoskeletal dysfunctions for a wide range of clientele
Assessment and treatment of insurance clients
Be able to offer evening and weekend work for clients
Be an active member of the Bristol Physio Team helping with in-service training
What we offer:
Multi site clinic locations
Monthly in-service training
Appraisal system with supported learning
Key Job Qualifications:
At least 5 years post graduate experience
CSP and HCPC registered
Excellent communication and relationship building skills
Proficient computer skills in Word, database software and use of the internet
Ever wondered about affordable office furniture that can help reduce pain?
At Bristol Physio we have teamed up with Gazelle Office Furniture do give some information on office furniture that can help you when sitting in front of the computer.
There are 30,600,000 hours lost from work due to musculo-skeletal pain (back and neck pain) each year!
The Department for Work and Pensions describe this as leading to a third of all sickness issues. If the average office worker sat at their desk for 8 hours a day, 5 days a week, they would on average be sitting in the same position for approximately 1,800 hours a year.
Oh….and then they go home and sit in front of the TV for another 2-3 hours….
Bristol Physio has teamed up with Gazelle Office Furniture who have a number of high level products at affordable prices that we at Bristol Physio believe can help individuals that get pain whilst at work.
The KX2 Task Chair has all the features of a top quality chair including a lumber support pump and independent tilting backrest and seat. We feel the folding arms are a great addition allowing people to get closer to the desk and not have to reach for the keyboard.
Manual and Mechanical Adjustable Desks
Sitting for hours on end can lead to a number of problems. One of the main bits of advice that is given to people is to change position regularly throughout the day. Using a height adjustable desk means you could be sitting one moment, then standing the next. By stanidng, the postural muscles have to work differently and you use more calories.
Gazelle Office Furniture provide both manual and mechanical desks. At Bristol Physio we suggest that individuals should sit for an hour and then spend an hour standing. Obviously it is worth having the desk adjusted for you so you are not over reaching or looking down too far.
We all sit in front of our computers for too long!
We have as many at 30.6 million hours lost due to some joint, bone or muscle problem therefore it affects all of us in some way.
We have put together a small list of stretches and strengthening exercises to try and help neck and back pain. Click on Office Exercises and a PDF version of the exercises can be printed off and the whole office can gain benefits from these. Also Jason Heddington has put together further advice on poor sitting posture whilst at work.
N.B. these exercises should not cause pain and if they do then consult one of the physiotherapists at Bristol Physio.
If chairs and desks are an issue at work, have a read of this advice, in conjunction with Gazelle Office Furniture, regarding the best furniture for your office.
Do you have an office job? Do you sit at your desk for up to 8 hours a day?
Do you suffer from back and neck pain?
Our backs were not designed to spend long periods of time sitting at desks – a common feature of many work environments.
Taking time off work with a bad back is common, but for many businesses such employee absence is a real problem. A government report this year into sickness absence in the labour market highlighted that more days were lost to back, neck and muscle pain than any other cause.
Musculoskeletal (MSK) disorders accounted for 30.6m working days off in 2013 and, according to the Department for Work and Pensions, were the cause of a third of long-term sickness absences between October 2010 and September 2013.
What problems can I get from sitting in a poor posture all day?
Spending six to eight hours a day in front of a computer can lead to shoulder, arm, hand and neck problems, as well as issues with balance and coordination.
If you slump in your chair you can develop tight muscles around your neck and upper chest, weak muscles in your back, tight muscles around your hips and knees. Also sitting for long periods will decondition your muscles, tendons and ligaments making you prone to injury. A physiotherapist can do much to help these issues – but this must be in conjunction with ensuring the workstation is set up correctly and that regular breaks away from computer are taken. Otherwise, the issues may keep recurring.
What can I do to help prevent these problems occurring?
The good news is that postural issues can be corrected, and even, in most instances reversed.
When in a working environment that requires a lot of desk and computer work, make sure your workstation equipment is ergonomically sound. Check that your desk, keyboard and computer screen is at the correct height and position.
Ensure you have a comfortable chair that puts you in an ergonomically friendly positions making sure your knees, hips and elbows are at the correct angle. Your physiotherapist will be able to assess this and advice you on correct positioning.
Finally, make sure you take regular breaks to stand up, walk around and stretch at least every 30 minutes, keeping yourself well hydrated with water.
What can help further…
We at Bristol Physio have teamed up with the guys at Gazelle Office Furniture Ltd. Based in Bristol, this national company offer office solutions to poor workstation positioning. Fully ergonomic chairs, manual and machine operated standing or sitting desks are among their wide range of furniture ideas. At Bristol Physio we have two KX2 Task chairs and if we had the space we would opt for the standing desks. Do pop into their store in Lawrence Hill, Bristol or come into our Clifton branch to see the furniture in the flesh.
We also offer Work Station Assessments. One of our trained physiotherapists would visit you in your office environment, ask a number of questions not only about your work station but also lifestyle and take an assessment of the work space.We can advise on aids for your environment and give solutions to help you get the best position for you at the desk, as everyone is unique therefore a ‘one size fits all’ approach is neither appropriate or able to achieve in an office environment.
To see the April 2016 Newsletter with articles on Surfing Warm Ups, a new partnership with Gazelle Office Furniture, updates on our supported clubs and teams and many other things click on the link below:
With Spring in sight, It’s time to get back in the water! People from all over the country will be contemplating returning to ‘The Green Room’, however, how do you know that you are in good shape? Lucy Johnson our expert surfer will tell you how…
Surfers across the UK will be crawling out of winter hibernation or fresh off planes from exotic locations. The waters here are still Baltic so this article will be about focussing on a decent warm up you can do at the beach before jumping in and also signs of hypothermia.
Should you be concerned about a dodgy shoulder, either book in to see any of the expert physiotherapists, or click here to see an article by Tony Gill on Shoulder Injuries.
A Dynamic warm up is great for improving functional range of motion, mobility and coordination pre surf which is essential. It gets the blood flowing to the skeletal muscles and gets the body ready for producing greater amounts of force for paddling, pop-ups and manoeuvres.
The video below shows Dynamic stretches you can do on the beach to get you ready for your session:
90% of heat loss occurs through the skin and 10% through the lungs. In Theory, Hypothermia begins when your body temperature goes below 35°C.
There are four levels of hypothermia: mild, moderate, severe and profound.
Signs of moderate Hypothermia suggest that you need to urgently get out of the water, get warm and tell someone you’re struggling:
– Tiredness/drowsiness. This can be subtle at first and gets more and more severe. Don’t just put it down to the surf and outdoor exercise.
– Delayed thoughts/ dazed consciousness.
– Slurred speech.
– Extreme dizziness
– Pale face and purple extremities.
– Bad surfing! You start to lose your fine motor control e.g. in the hands and feet.
– Pauses between shivering. A good test is if you can stop yourself shivering you only have mild hypothermia. Pauses between shivers means things are getting more serious.
– Irrational behaviour. If someone is acting unusual be suspicious!
Severe hypothermia can cause paradoxical undressing, in which a person removes their clothing as they feel very hot but this will lose more body heat. Heart rate, respiratory rate and blood pressure all decrease, and there’s a risk of the heart stopping, it is possible to lose consciousness. With Profound Hypothermia vital organs will begin to shut down as the body tries to protect essential function i.e blood supply to the heart and brain.
So don’t forget that extra neoprene and if in doubt get out.
If the surf is flat or you want to work on things at the gym that will help your body prepare for the rough and tumble, see the following videos.
“New Year, New Goals, New Kit and clothing you want to try out on the bike…But oh look its winter out there, damn. Oh well I’ll go tomorrow!!”
Lets be honest no-one really likes getting on the bike for a 3-4 hour training ride when all around you the rain is coming in horizontally and the trees are blowing over at 90 degrees. Kind of takes the fun and beauty out of cycling.
Now lets face facts, its not all about the bike after all, there are other activities we as cyclists can and should engage in to benefit us as the cycling season approaches. Strength and conditioning work is as equally important as getting the miles under your belt. As cyclists we work in a linear motion often for hours on end, day after day, week after week. lots of repetitive movements in one plane. Trouble is, we are made of bones, joints, ligaments, tendons, muscles; and not forgetting our nervous system, all of which helps us through 3 dimensions in our everyday function and activity. It is therefore important that we make ourselves fit for purpose in a 3 dimensional way.
Ah yes the old ‘core strength’. A group of muscles including Rectus Abdominus, Transverse Abdominus, Mulitifidus, Internal and External obliques, Erector Spinals, Gluts to name a few.
So what I hear you say??
Well it’s these muscles that need to be strong and fit for purpose to help avoid predisposition to injury and support ourselves whilst we hold our linear static postures for 3-4 hour plus rides. Its these muscles that when strong, fit and efficient help our pedaling become more efficient, help our handling and control of the bike improve and make the sport we all love become much more enjoyable!
Ideas to help train the core:
Firstly keep it simple! The harder and more complicated you make your training regime the more likely the chance of bad form, bad training and potential risk of injury. Aim for 2 sets of 12 to 15 reps initially, 3 times a week, aiming to progress onto 3 sets, then sets with load (weights). Its also important to stop exercising when your form has gone, or indeed if you feel pain. It is all about quality not quantity after all.
Some simple exercises to consider in your core sessions: Plank
At Bristol Physio we believe there is huge scope to increase general fitness prior to any surgery that will then increase your ability to increase stamina and speed up recovery after you get out of hospital.
For anyone that saw our Tweet on January 25th, we highlighted an excellent blog describing the evidence behind doing ‘Prehab’ before surgery. It has been found that patients about to have bowel operations are more likely to have a speeder recovery if they are able to perform some prehab prior to surgery.
In the musculoskeletal world (joints and muscles), we would always encourage patients to perform a course of prehab prior to any elective surgery. Operations to replace knees and hips, surgery for shoulder injuries and back surgery would all benefit from specialist strengthening prior to ‘going under the knife’.
The principles of prehabilitation are to strengthen and improve the current ability of the patient within the confines of the limbs or body part that requires the surgery in order to gain general fitness or muscle mass. MacMillan Cancer Support also highlight a trend in some hospitals that perform versions of prehab
known as Enhanced Recovery Programmes, just to speed up getting back to normal life after surgery.
Benefits can include quicker tissue healing rates, fast return to normal walking or daily activities, reduced blood pressure and improved health overall. If you happen to need crutches after the operation, some upper body strengthening will greatly improve your speed in getting around and reduce the ache on the limbs supporting the body.
Feel free to discuss with any of our therapists at Bristol Physio if you are keen for more information or a prehabilitation programme to help you prior to your surgery. If coming into see us if tricky, have a look on our Exercise page to see our YouTube Channel for exercise ideas.
Teamwork, never say die attitude, pushing the limits are all phrases that could be said to be used too often. With the GB Women’s Basketball squad, they are extremely apt. After 4 back-to-back games at the EuroBasket 2015 in Hungary, the players continued to push themselves to the limits. We had managed to surpass expectations to reach Hungary and now the end of the competition was in sight. We played our best basketball in the last game against Croatia and only lost by 6 in the final quarter. An admirable achievement for all involved.
The squad did not achieve their own high targets. External factors disrupted the lead into the tournament with illness and injury but this seemed to galvanise the squad. Pre-tournament trips to France and Spain were great learning opportunities and it is worth noting that we beat the eventual European Champions Serbia while in France. A number of younger players were given their first caps throughout the campaign and I even was initiated into GB Basketball.
GB Women’s Basketball staff
With my assistant, Nick McCarthy
From a physiotherapy perspective I worked hard and I hope had a positive impact on the players and the campaign. We finished EuroBasket with no soft tissue injuries and the monitoring systems that were implemented were robust and hopefully prevented further disruption from injuries. Overall the staff and players felt the campaign was one of the best structured camps in years and a lot of that is down to the Sports Science and Medical team helping to design a robust programme.
I thoroughly enjoyed the experience and I would like to thank all the players, staff and management for a great rewarding experience. GB Basketball will continue to thrive if we have positive experiences and continue to give younger players the exposure to the top level of the sport. Watch out for the BBL and WBL this season!