Osteoarthritis – The End Of The Road?

It is not unusual to see people who have been informed that they have changes in a joint related to osteoarthritis. Two cases I have come across recently were handled completely differently.

The first was informed that, yes there were signs of osteoarthritis but don’t worry you don’t need to stop running. The second was similarly told that there were signs of arthritis but that was about it. No other advice was given or suggestions made.

Not surprisingly their point of view about the pain they were suffering was a bit different Continue reading “Osteoarthritis – The End Of The Road?”

Practising what you preach – graded exposure and progressive overload in rehab

I injured myself in mid November last year. Nothing serious just a mild grade 1 tear in vastus lateralis, one of your quads, when doing some heavy squats. I took it easy for a couple of weeks and gradually worked back into things. I then tore it again in the first week in January! To say I was not happy would be an understatement.

 

man squatting

What went wrong?

Continue reading “Practising what you preach – graded exposure and progressive overload in rehab”

Ankle mobility, are you missing some?

Are you missing ankle mobility? Having sufficient range of movement in your ankle is important. If you want to run fast or jump high having good ankle range of movement in dorsiflexion is essential.

This is not just in the sporting environment but simply to walk well we need good ankle mobility. The movement that important is the ability to pull your toes towards you. A lack of dorsiflexion is linked with increased injury risk with achilles tendinopathy and patella tendinopathy having been shown to be impacted by a lack of ankle mobility in dorsiflexion. Continue reading “Ankle mobility, are you missing some?”

Knee pain and running: where it is tells you what it is

What are the most common causes of knee pain in runners?

There are 3 conditions that are likely to cause knee pain in runners; patella tendinopathy, ITB syndrome and patellafemoral pain. How do you know which one you have?
Whilst they all cause knee pain where the pain is lets you know which one it is that is that you are suffering from.

 

 

 

  1. Illiotibial Band Syndrome

ITB syndrome is a complaint that runners will often talk about but describe a pain in a different area. The true site of pain from illiotibial band syndrome is on the outside of the knee. The pain will be felt at and above the condyle of the femur. One of the common held thoughts is that it is caused by your ITB being tight but the problem here is it is supposed to be. The ITB is part ligament part tendon so should be pretty stiff so that it can do it’s job properly.

The pain that is felt when people talk about having tight ITB’s is generally more to do with tight quads.  The pain coming from the illiotibial band syndrome isn’t from the ITB itslef but from tissue underlying it. Another name for it is ITB friction syndrome because of how it rubs the underlying tissue.

When dealing with ITB syndrome we want to first calm things down. Playing with running frequency, duration or intensity are all useful to find the combination that helps. Increasing your stride frequency can also help. Increasing your stride frequency to between 160-180 spm reduces both the time spent in the air and the force you hit the ground with. Both of these reduce the chances of being in the zone that causes the irritation that creates the pain in ITB

In this post I expand more on illiotibial band syndrome

2. Patellofemoral Pain

Patellafemoral pain or PFP is where the pain exists on the front of  the knee  and can be along the edges or under neath the knee cap, patella. the pain will often present itself when sitting for long periods or on ascending hills/stairs. PFP is a particularly frustrating problem as the there hasn’t been any one biomechanical or physiological factor that accounts for it. PFP is more of a general overload of the tissue surrounding the knee rather than a specific biomechanical fault. This overload can be from one sudden incident such as a fall or repeated micro-trauma for an extended period.

 

For runners the problem is often more one of repeated micro trauma. In this situation the tissue becomes reactive because it never really gets a chance to recover from the previous bout of exercise. This is where load management becomes important. When looking to increase mileage or other variables it is better to make small regular increases rather than larger ones. Perhaps starting at 10% per week and gradually reducing this to 5%, then even 2.5%. In doing this you are allowing time for the tissues to adapt and get stronger and more robust by not exceeding the ability to adapt.

3. Patellar Tendinopathy

Patellar tendinopathy differs from PFP in that the location, whilst still on the front of the knee, is much more specific in location.  Sufferers of PFP will feel  pain below the knee cap in the patellar tendon itself. This is good news as having an exact location makes it much easier to treat.

The great thing about tendinopathy injuries is that we can treat them following some basic guidelines.

  1. Reduce pain.
  2. Build Strength.
  3. Increase power
  4. Improve movement

This doesn’t mean that you have to stop running but rather alter the fequency, intensity or distance. It might be that you run less frequently and keep the distances the same or that more frequently but shorter runs each time. Each individual will react differently to the demands of exercise which is why various strategies often need to be tried before finding the one that suits you. To reduce the pain and fit in with the clients schedule it may be that it is a case of running every 48 hours but in a run/walk manner.  Sufficient training stimulus must be maintained and by performing the run walk we never exceed tissue tolerance.

When building strength the progression will go from static, isometric, work to slow movements to faster movements. The isometric movements also help in reducing the pain as well as building strength and flow into pure strength development. The heavy strength work allows for sufficient demand to force adaptation in the tendon. The power development work sets you up for transitioning into more running specific work that finishes off the rehab.

All 3 examples of knee pain should follow a graded approach to the rehab process. The final phase of the rehab process should incorporate drills that better reflect the demands of running. This is the case in all of the 3 of the problems above where the ultimate focus needs to be on returning you to running better than before.

 

 

 

Lower limb injury assessment

The first step in any injury assessment is what previous injuries do you have. The biggest predictor of future injury lies in your injury history. As a result looking into your injury history will play an important roll in deciding on what needs to be done. If you have previously injured your ankle, knee or hip these are areas we need to investigate in the injury assessment. We do this becasue of the scale of the impact they have on the way you move. Two of the more important things that we are looking out for in the clinic are asymmetries and pain.When we are assessing movement we are looking to see both how good it is and does it cause pain. Continue reading “Lower limb injury assessment”

How to manage runners knee

Runners’ Knee is a common complaint with runners. 10% of runner’s will experience some sort of knee pain in any given year. Given it’s so common what causes it and what can you do about it?

Generally most injuries runner pick up are of a “repetitive strain” nature and runner’s knee is no exception. Given the nature of running, this isn’t really that big a surprise. There aren’t really many demands in terms of changing direction or speed. It is very much about simply putting one foot in front of the other. Continue reading “How to manage runners knee”

5 races you could do if you didn’t have knee pain

Knee pain is a familiar problem for runners and accounts for about 20% of running injuries. The big problem with it is often in tackling hills where it can be fine as you go up but the pain really increases as you descend and as a result you are always looking for flat courses while you deal with it. Here are 5 courses from across Scotland that really do require your knees to be in pain free before you tackle them.

The Whangie Wizz

The Whangie Wizz has to be in the list for it’s name alone but it would be a great introduction to hill racing if you hadn’t done any before.

Glentress trail runs

Famous for it’s mountain biking trails Glentress also hosts 3 trail races over 10k, 21k and 42k. I had two clients do the half marathon event this year on what was a dry day but pretty grim conditions under foot as it had been raining heavily that week.

The Fort William Marathon

With a route that is anything but flat, this multi-terrain route will give you plenty of challenges and some amazing views.

Edinburgh 7 Hills

I would suggest infinitely more interesting than the Edinburgh Marathon itself, in my opinion. The Seven Hills of Edinburgh doesn’t have a specific route beyond you have to cover all of Edinburgh’s 7 hills starting on Calton Hill before you finishing back on Calton Hill. The course is just over 14 miles and has 2,200ft of ascent/descent and takes you around the city from Edinburgh Castle, Corstrophine Hill, Craiglochkhart Hill, Braid Hill, Blackford Hill and Arthur’s Seat. It takes the top finishers around 100 minutes and has to be one of the most interesting city races about.

The Harris Half Marathon

I’ve been to Harris, though not to do the race, and it is stunning regardless of the weather and we got everything except snow when we were there. Whilst not as hilly as you might think there are enough descents that you would definitely want your knees to be in good shape before tackling it.