running injuries

Is Cycling Good For A Runner?

A new patient from last week prompted this post. He is a 43 year old presenting with persistent calf pain during running. ⠀⠀⠀⠀⠀⠀⠀

He's been a competitive cyclist most of his life. Now, as a father of three young ones he is attempting to make the transition from cycling to running. As his time is limited, he wanted a sport that maximizes his 'bang for buck'. ⠀⠀
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He was frustrated because he generally felt very fit and never had any trouble with injuries as a cyclist.
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On assessment, his calves and hamstrings were weak, hip flexors very tight, and gluteal muscle function poor. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
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Long story short, his strong lung capacity from cycling allowed him to push his body well past what it was prepared for and into the danger zone of overload and injury. ⠀
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Tim Gabbett - "It's not the load that breaks the individual down. It's the load they are not prepared for."
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A really common scenario & and probably explains why triathletes find themselves injured so often. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀

A research study (Rendos et al 2013) confirmed that cyclists develop muscle imbalances (particularly tight hip flexors) that can increase the risk of lower extremity injuries. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀
Key Points:
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1. Cycling, while beneficial for cardio health can contribute to muscle balances that can set you up for an injury.
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2. The human body is adaptable to change, but needs plenty of TIME to adapt. The fascia, muscles and tendons can take months/years to build capacity, while the cardio system responds much quicker. ⠀
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3. Running is a high load activity & has the potential to cause long-term problems if you take on too much too soon. ⠀⠀⠀⠀⠀⠀⠀

4. An individualized Movement Assessment and corrective program will help maintain your body and keep it moving optimally. ⠀
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The Resilient Runner Workshop takes the latest evidence-based research and practical strategies to optimize your movement foundation so that you not only avoid injury, but enhance your running performance. 

Saturday June 2nd. 12pm - 3pm.
2 spots left. More details via this link

How To Return To Running (Without Doing Another Injury)

The research is pretty clear that the biggest risk factor for an injury is a past injury.


Pain and injury can trigger off protective mechanisms that can sometimes be tricky to identify and overcome.


For many runners returning from an injury, a common theme is to run within yourself, intuitively trying to protect the body from further injury.

Blog Post continues HERE

Tendinopathy Update

The past weekend I attended Peter Malliaras's course, 'Mastering Lower Limb Tendinopathies'.

Peter is an Associate Professor at Monash University and has spent many years researching and working with people with tendon problems. 

In recent years there has been a lot of significant new research in the world of tendon rehab.

If you've ever had an issue with an ongoing tendon problem, you can understand how frustrating the long term pain and dysfunction can be. 

There is much conflicting advice and out dated treatment approaches that can contribute to the poor outcomes many people face with tendon injuries. 

Thankfully, Peter has put all of the latest based evidence into a comprehensible format and in this blog post I'd like to share just a little summary.

This blog would be particularly helpful if you suffer from ongoing pain in the:

  • Achilles tendon
  • Hamstring
  • Patella tendon
  • Hip pain/bursitis
  • Plantar fascia

What is a tendon?

Tendons connect the muscle to bone.  They are made up primarily of collagen fibres.

In the lower limb, role of tendon is to absorb and release energy

Tendons are like springs that absorb stretching forces and then release energy when we move.

 

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What causes tendon problems?

Tendons are very sensitive to changes in load. 

Essentially, tendons become injured when we over-load them too soon, or when demand exceeds capacity.

This can be from:

  • too much volume
  • too much intensity
  • change in footwear or surface

For example a runner may start to include sprinting or hill work too soon or increase mileage suddenly leading up to a big race.

High training load is not a risk for injuries, it's how you get there that is the important factor (i.e. avoiding acute spikes in training loads).

                   Tendons become damaged when demand exceeds their capacity

                   Tendons become damaged when demand exceeds their capacity

What is the difference between Tendinitis and Tendinopathy?

Tendinitis refers to the inflammation in the early stages of an injury. 

This is opposed to tendinopathy that refers to the process of degeneration that tendon goes through in response to chronic overload.

Recent research suggests a lot of what we previously thought of as tendon inflammation was actually related to tendinopathy.


Who is likely to suffer from a tendon problem?

Patella tendon (front of knee)

Usually occurs in younger people involved in jumping sports such as volleyball, basketball and football.  There is some evidence to suggest pathological tendon changes can begin in early adolescence if there excess load on the maturing collagen in the tendon.

Achilles tendon (back of heel)

Affects people across the lifespan, in particular long distance runners, sprinters, football and soccer players.  Often there is pain and stiffness that is worse on waking and when running. 

Gluteal tendon (side of hip)

Common in young females that are doing a lot of running or playing sport.  Also older women, especially around menopause or after post a hip injury / surgery.  Pain is often worse at night time, standing and walking.  There is some research showing a reduction in oestrogen can pre-dispose to tendinopathy. 

Hamstring tendon (back of hip)

Fast walkers, footballers, runners and people who do a lot of yoga are susceptible to hamstring tendinopathy.  They often experience pain on sitting, walking and bending forwards. 

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What are the key risk factors for developing tendinopathy?

One of the biggest risk factors for a tendon injury is a past injury (2-19x greater risk of injury).

According to the research, people with tendon problems are not getting the rehabilitation and re-building of capacity they need.

Often patients self-discharge when their pain has gone away

It is imperative for the treating clinician to educate the patient that rehabilitation is a two step process:

1.  Reducing pain and then

2.  Re-building capacity in the tissues to match the demands placed on them

Other systemic conditions that can increase the risk of developing tendon pain include:

  • Type 2 Diabetes ( 3 x risk)
  • High cholesterol
  • High blood pressure
  • Menopause
  • Obesity
  • Inflammatory arthropathies

Some other factors that put you at a higher risk of ongoing tendon pain:

  • unrealistic beliefs about likely healing time and optimal load management strategies
  • inaccurate beliefs pain e.g. avoiding movement due to fear or rupturing a tendon
  • too much passive treatment
  • reduced variability of movement / exercise

How is a diagnosis made? 

Tendon issues are diagnosed with a combination of history and physical testing

If you have a localised pain that gets worse with movement and you can recall a sudden change in loading, there is a good chance you have a tendon problem.

Do I need a scan? 

Ultrasound scans can be useful to confirm the diagnosis and rule out certain other conditions. 

(See below for more info on scans)

Recovery and Management :

1.  Education ... (And Addressing Beliefs About Pain)

The long term goal is to create greater capacity in the tissues and this is your job, under the guidance of the physiotherapist looking after you.  

Manual therapy and dry needling does have a role to play in the short term to decrease pain and normalise muscle tone.

Credit: Jill Cook

Credit: Jill Cook

Pain and Pathology

You may have a scary sounding ultrasound report, with words such as 'severely degenerative'.

The bad news first.  Your scans will most probably always look terrible. 

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Structurally over time, there will be no change, despite what you do in terms of treatment.

The good news:

Many high quality research studies have shown that there is no correlation between pain and structural changes on scans. 

Your tendon will always be degenerated.

However, the thing we do have control over is the mechanical adaptation in the tissues around the tendon, as well as optimising biomechanics and sharing the load around the body.

The goal of treatment is to build the capacity in the tissues surrounding the tendon so that it meets the demand and creates a buffer zone of relaxation.

Some very important things to remember:

"Pathology is common in people without pain, so it cannot be the cause of pain.

Worse pathology does not mean it will be harder for you to get better.

Tendon pathology often does not change, even when the pain resolves" - Peter Malliaras
 

Recovery Time Line

It's important to understand the nature of recovery is often a case of 2 steps forward and 1 step back pattern. 

It's normal for your pain levels to fluctuate.

If you can accept this, while continuing with your rehab, you will have a much greater chance of success.

Credit: Adam Meakins

Credit: Adam Meakins

2.  Reduce the load temporarily while reducing pain and inflammation

Pain can be brought under control by managing load and using ice and NSAID's. 

You may need to take a short break from any aggravating activities.

If you can't take anti-inflammatories you may need to look at your diet for areas to address inflammation.

How can isometrics help decrease pain?

Isometric refers to a static contraction of a muscle without any movement. 

For example the diagram below shows an isometric contraction of the calf/achilles:

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Benefits of isometric contractions in tendon healing (Malliaras et al 2013):

  • Isometrics can decrease pain without adding excess load to the tendon.  
  • time under tension can be maximized to allow greater tendon strain, which is a likely stimulus for tendon adaptation
  • there is minimal soreness after doing isometrics, making them an ideal exercise 'during season'
  • loading can be performed in a range that is not painful and tendon compression can be minimized

The positive research around isometrics is in it's early stages and mainly focuses around the patella tendon.

3. Assess current load capacity and tolerance then begin re-loading the tendon.

Your Physiotherapist will take you through a comprehensive load capacity assessment and then develop a re-loading strategy.

This most important factor is that we progress the load over time to bring out positive adaptation and improved load tolerance. 

You will most likely meet with your Physio once per week in the short term to closely monitor and progress the load at a suitable rate.

 

4.  Clean up biomechanical issues and kinetic chain deficits

Biomechanical issues that may need addressing:

  • poor running technique
  • over-pronation
  • landing mechanics
  • postural issues

Kinetic chain deficits that may need addressing:

  • weak glutes
  • weak calves
  • weak quads
  • weak hamstrings, adductors
  • weak core
  • excessively tight muscles and joint restrictions

We will address these factors in the clinic.  By optimising your movement efficiency, you will increase the likelihood of successfully returning to doing what you love and staying pain-free.

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5.  Progress the load and build capacity to greater than demand and gradually ease back into sport / exercise

This is where you get to really to push the boundaries of building capacity and gradually resume training and getting back to what you love. 

It's important at this stage to think not only about training but also proper recovery to allow the tissues to optimally adapt. 

You will want to optimise things like sleep, food / protein intake and foam rolling to keep your muscles tuned up.

This stage may weeks / months to fine tune and this is where we will monitor you loads to ensure a successful return.

 

In Summary - 5 Take Home Messages:

1.  There Is Hope

Despite your ugly looking scan and long-term pain, there is good evidence to suggest you can make a good recovery and get back to doing what you enjoy.

2.  It Takes Time

Tendons are resilient and adapt.  But you need to give them time. 

The time-frame on average to achieve this is a minimum of 12 weeks (but continual small improvements can still occur up to 5 years later).

3.  Get Assessed By A Physiotherapist

There is a significant degree of complexity involved in a tendon problem and a Physiotherapist, after a comprehensive assessment will be able to guide you towards a positive outcome. 

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4.  Only Exercise Can Increase Load Tolerance

"Your tissue capacity will only be as good as the load you put on it" - Professor Jill Cook

The end game is to build your resilience and capacity to create a 'buffer' zone of relaxation. 

5.  Think Quality Of Movement Before Quantity

Movement capacity develops step by step

Small mindful movement of the muscle-tendon complex can improve efficiency and help ensure that your tendon issue becomes a thing of the past.

This is where Pilates can be very useful. 

Pilates provides the perfect environment for sharpening the mind-muscle connection and also introduces elements of movement variability that help improve resilience.

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Bonus Tips:

  • PRP injections are a waste of time
  • Steroid injections can have short term benefit but 12 months later can end up worse due to weakening of the tendon.
  • Fast walking can cause hamstring issues
  • For a tendon problem, generally it's best to avoid stretching
  • Hip bursitis is treated with same strategies as gluteal tendinopathy
  • Extracorporal Shockwave therapy is worth trying (more info about this click visit our friends at Adelaide Podiatry)

 

Thanks for reading this summary and if you have any questions or comments, please feel free to email dan@kinfolkwellness.com.au

If you have a tendon issue you would like to have assessed, I'd be honoured to help guide you.  

You can make a booking using our easy online system here.

10 Alternatives to Running When You're Injured

 

Sometimes injuries are a blessing in disguise.  They force you to re-examine your training style and open you up to other possibilities in the way you go about doing things. 

Unfortunately running injuries are common and being forced into a lay off for a few weeks/months can be quite daunting.  Being told you can't run can be a serious blow to a runner's sense of self.  You suddenly realise how addicted you are to the physical and emotional payoffs that running brings. 

Most runners tell me that there is nothing else quite like the endorphin buzz that running gives you.

Why runners are vulnerable to injury

One of the downfalls of running is that it's very repetitive and demanding on certain parts of the body that are vulnerable to overload.  Common areas include: knees, hips, ITB's, achilles, calf muscles and hamstring issues. 

Most runners generally have very good pain thresholds.  This comes as a blessing AND a curse.  Niggles that are ignored over a long period of time tend do have a tendency to develop into something more serious. 

If you are in pain, there is a good chance your Physio will recommend taking a short break from training to allow your tissues to recover and heal properly.

 

To help you get through your injury, try the following exercises, which are designed to:

1.  Maintain your cardio-vascular fitness

2.  Encourage blood flow and oxygen to assist the healing process

3.  Re-build your foundation so that you come back better and stronger that before

DISCLAIMER** Of course check with your physio to get the green light before trying any of these exercises**

Nutritious Movement

If you compare exercise to eating, running is like eating dessert and your foundation exercises (below) are like your main course. 

It's not healthy to only be eating dessert - running should be a part of wide base of 'nutritious movement'. 

This approach will sustain you and help you find longevity in your running career. 

1.  Swimming

We all know the benefits of getting in the water: the non-weight bearing movement of your body that helps decompresses the joints and allows you a full body workout without the stress of gravity wearing on your body. 

Try and build up to some intervals, for example 10 x 100m.  This will really help optimise your breathing and cardio-respiratory performance.

Even if you don't like swimming, just being in the water will be beneficial, assisting recovery.  Standing in the cold water at the beach in the middle of winter is refreshing and surprisingly therapeutic. 

 

2.  Kettlebell Strength Workout

A solid kettlebell workout is the closest thing I've come to experiencing the high that matches up with a good run.  Everyone should own a kettlebell or two.  If you have never tried, find a good personal trainer and get them to show you the basics over a few sessions.  Try swings, squats, lunges and other variations to get your body moving and re-build your capacity

 

3.  Pilates

Research tells us the biggest risk factor for an injury is a previous injury.  Pain and injury leads to compensatory movement patterning that helps us get through the short term but isn't an ideal long term solution.  Pilates help you to learn the principles of dynamic core alignment, so you will create a solid foundation that naturally leads to optimal performance in sport and life. 

Term 3 Pilates kicks of July 26th - Reserve your place here

 

4.  Stair workout

Stronger glutes = better running and lower risk of re-injury.  Stairs will also send your heart rate sky rocketing, boosting your VO2 max.

 

 

5.  Hiking

Hiking some trails in the great outdoors has a few benefits for runners:

  • build better balance on uneven terrain
  • breathe some fresh air
  • learn how to 'slow down' and enjoy the scenery
  • get to know your running friends better - talking is easier when you're not struggling to breathe!

 

6.  Boxing

Stressed?  Angry?  Let your fists do the talking.  Boxing will challenge your cardio-vascular system like nothing else.  Working with a trainer will quickly fine tune your power and precision and bring an intensity to your workout that may rival your running training.

7.  HIIT (High Intensity Interval Training)

Try something like the 7 minute workout or ask your local personal trainer to design you a program.  Add a challenge by using a foam roller or Swiss Ball to your workout.  Try a combination of burpees, squats, step-ups and mountain climbers for starters.

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8.  Yoga

Reset your fundamental movement patterning, connect with your breathing and jump start your healing process by activating the para-sympathetic nervous system.  Most runners could benefit from finding a little bit more flexibility.  Restorative / yin yoga is particularly recommended for runners to keep their bodies balanced.

9.  Stand-Up Paddle-boarding

Stand-up paddle boarding is an ideal way to strengthen your core (obliques in particular that are important for runners) and also gives your quads a nice burn.  Also will improve your balance (especially if you find some fun waves to have a go at!).

10.  Elliptical / Cross Trainer

Minimal weight-bearing, using the elliptical machine is an nice way to get your blood and oxygen flowing.  It's also an easy way to keep an eye on your heart rate and push some challenging intervals sessions...crank up the resistance!

 

11.  Bonus Tip: Avoid Cycling

Despite it's popularity, I DON'T advise cycling as a good alternative to running as cycling strongly activates the hip flexors, and can mess up your muscle balance around your hip, knee and lower back. 

I would advise your to either choose cycling or running as your main form of exercise.  If you are triathlete, there are some specific exercises you can do to help reduce the negative effects of cycling.  You can email directly dan@kinfolkwellness.com.au and I will give you the details.

Over to you...

What form of exercise have you found most beneficial when you can't run? 

I'd love to hear your thoughts below.