Archive for February, 2010

Allow me to update you on who I am. I’m Wendy Bowen and I have a background in Kinesiology and 13 years of clinical experience as a physiotherapist.  I hadn’t run more than a mile until the age of 22. I struggled for years with running. Even five kilometres was a challenge due to a chronic Iliotibial Band problem.

What I discovered through my physiotherapy postgraduate studies and from what I had learned about my own issue was that the pelvis is the centre of your universe if you want to run without the pain of tissue damage or injury.   

WHEN WE RUN

we are standing only on one leg at any given time. We transfer the load from the ground up through the pelvis. The pelvis is made up of the sacrum (triangle bone) and two innominants (pelvic bones). It’s held together through very tough ligaments at the front and the back (stronger at the back). It takes a lot of force to damage these ligaments (child birth, car accidents etc.). Very few people actually have hypermobility from ligament damage.

The pelvis is also controlled by muscles (dynamic system). There are a few key inner core muscles (transverses abdominus, pelvic floor muscles, multifidus at the back and the diaphragm) that all need to work in perfect timing to offer good stability. 

WHAT ELSE?

Other muscles attached to the pelvis (quadriceps or thigh muscles, hip muscle or gluteal muscles, hamstrings, hip adductors or inner thigh muscles) are the movers. Think of these longer muscles as springs. If there is more tension on the spring at the front of the thigh it will pull the pelvis forward and vice versa with the tension at the back of the leg (hamstrings). We can also see this tension from the muscle that runs from the pelvis up to the mid back region.

Many people are told that they have one leg that is shorter and get the leg tugged on (manipulation of the pelvis). This only corrects the problem temporarily until the next time you run. If you run with an apparent leg length discrepancy, what may happen is that you run more on the outside of your foot to have it hit the ground (more supination) but in order to get the foot in the position to push-off, you’ll need pronation, which will come from the mid foot. This pronation may contribute to plantar fasciitis or Achilles tendonitis (two other big running injuries). 

Muscle shortening (springs too tight) also contributes to muscle weakness. A common weakness is the muscles at the side of the pelvis (gluteus medius). These attach to the ITB, along with the outer (lateral) quadriceps, gluteus maximus and Tensor Fascia Lata (TFL). There is often an over dominance of the TFL over the posterior gluteus medius. This creates the abnormal pull on the ITB.

THE ANSWER!

If you’ve tried stretching or yoga and still find you have muscle imbalances, what has worked well for me (to the point where I have been able to run a half marathon distance without any ITB symptoms) has been to use Intramuscular Stimulation (IMS) to release my chronically tight muscles around my pelvis and lower back. It also worked on finding and retraining my inner core muscles while continuing to strengthen my outer core.

I continue to use core shorts as I’m still not able to continually recruit my inner core over long distance runs. 

I’m currently the only person in the Cowichan Valley trained in IMS, but as of April 1 Heidi Bovey, who is also working at Start Line Physiotherapy, will also be trained.

IF YOU’RE MOTIVATED:

1. www.istop.org

  We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook site by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

HERE’S WHAT’S HAPPENING

Our tissues are made up of different types of fibers. Elastin is the stretchy type of fiber that is found in high amounts in skin and muscle. Collagen is the tougher fiber that is abundant in ligaments. Tendons have a mixture of both (in between muscles and ligaments).

ELASTIN VS COLLAGEN

When you stress a tissue, there is a certain amount of give, depending on the amount of elastin vs. collagen. The stress creates a strain and the tissue needs time to recover after each stress (collagen tissues need longer as they are not as elastic).  If you apply several small amounts of stress over a short period of time, you have what is called repetitive strain syndrome.

The little stresses build up on top of each other until your tissue reaches its breaking point. If you apply a small amount of stress over a prolonged period of time (like what happens when you have to sit on a long flight and don’t get to change position very often) you again build up the strain on the tissue (and start to squirm around because of the discomfort).

These little muscle aches are telling you this: (“GET MOVING” or “TAKE A BREAK”). This is the hurt, but not the harm. The harm comes when you don’t listen and keep stressing the tissue until it breaks (tears). RECOVERY is an essential part of all activities. This is called taking a break, or changing the stress on your tissues. A physician once put it like this: 

The difference between working out to make your tissues stronger and injury, is that working out is controlled injury. You are only stressing the tissue enough, and then providing it with recovery, so that the body knows it needs to make the tissue stronger. When you overstress the tissue, whether it is gradually, repetitively or with a fast trauma, you get injury.

OUR BODIES ARE VERY SMART!

They know that when we stress the tissues, that it needs to strengthen them. This is called Wolfe’s Law.

What to do to train, work, or play without injury? 

1.  Start small and gradually build mileage, resistance, repetitions.

2.  With mileage (running, swimming, biking etc.) keep track of your weekly mileage and build no more than 10 per cent/week.  Every fourth week should be a recovery week.

3. If you miss a week, don’t increase the 10 per cent the following week, only repeat what you did the week prior.

4. If you miss more than a couple of weeks, start over.

 Having a preventative screening assessment performed by a physiotherapist is also a beneficial way to minimize the risk of injury. This assessment would help determine areas of specific muscle tightness or weakness which will allow you to develop a program to address any issue before the injury occurs.

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook site by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

LET’S FIND OUT 

You’ve  just come into the physiotherapy clinic with a script stating that you have Achilles tendonitis. You know it must be this because it hurts at the back of the heel area (maybe a little bit above the heel).  It really hurts after a run and sometimes even into the next day if your run is more than a certain distance. It often feels a bit tight and sore at the start of your run, but it seems to get better as the run progresses. And boy is it sore when you press on the area or it touches something. 

This is the story that you tell the physiotherapist. You may be asked a few more questions regarding how far you typically run or how long you have been running. 

As a physiotherapist I could ultrasound the sore area over several visits or give you some eccentric exercises and teach you some stretching. But what I really want to know as a therapist is why? Why is it just happening on one side of your body? What is happening at your pelvis?; your foot?; and even into your back that might be contributing to this problem.   

A COMMON PATTERN 

I’ve  noticed with Achilles tendon pathologies is that there is often one hip (pelvic bone) that is higher when the person is standing. There is more muscle tension in the muscles running up one side of the spine that may be pulling the pelvis up. The foot then has to supinate (roll outwards) to achieve heel strike. The outer calf muscle (gastrocnemeus) often has a ropy band in it (indicative of a shortened muscle).  This can also create a loss of movement/mobility at the calcaneus (heel) joints. Other times the heel joints are stiff because of past ankle sprains (even up to 20 years prior) where there was no treatment administered. 

TREATMENT 

How I might treat this is by releasing the tight ropy muscle bands (using my preferred method – IMS or intramuscular stimulation). Go to www.istop.org for more informaiton on IMS. Then I would use my manual therapy skills to restore joint mobility where needed (this may include the ankle and foot as well as the sacroiliac joint or SIJ). Friction massage to the tendon can be helpful if there is a bump. Clinically, what I have noticed is that if the tenderness seems to get less as the area is rubbed, it is likely a tenodonopathy (no inflammation but rather a change in the quality of the tendon collagen).  Eccentric exercises have been reported in the literature to be effective in the treatment of tendon problems.  These are when exercising the muscle you lengthen it rather than shortening it. Proper stretching (watching the heel position as many people turn the heel in at the back when stretching) of the calf muscles can also be beneficial. 

IF YOU’RE MOTIVATED 

Check out:  

1.www.istop.org 

2. If you are a physiotherapist, there are a couple of upcoming video/teleconferences on the use of electrophysical agents and the Achilles tendon issues.  Go to the PABC website for more information at: http://www.bcphysio.org/app/index.cfm?fuseaction=pabc.ubc 

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook site by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.