Biomechanics of running….

Good paper here on the Biomechanics of Running.

Running is VERY different to walking and injuries for both need to be addressed differently.  it is critical to be assessed correctly.

The practitioner needs to look at you thoroughly and understand chain reaction biomechanics.

It could be how your back leg or hip is not extending as to why you have opposite foot pain…..  As always… get it looked at …properly…

Nutrition tips for marathon runners

RUNNING THE MARATHON? 

Here are some vital nutrition tips:

1.   STAY HYDRATED

It’s really important to be hydrated for the marathon. The trick is in the preparation. You don’t want to be making lots of toilet trips during the race! Drink plenty the week before and in the morning 700ml will do, avoiding any for the hour before the race.

Make sure you have water throughout the run, but don’t feel the need to drink constantly. The most recent research suggests it’s best to drink when you are thirsty. This helps avoid over-hydrating and can also reduce gut discomfort and improve performance on the day. Coconut water is also a great natural alternative to the energy drinks in replacing lost hydration, sugars and electrolytes during the race.

2.    FAT THEN CARB LOADING GIVES MORE ENERGY

Research has shown that a diet (short term) high in fat before you embark on the more traditional pre-race carb loading offers great benefits for increased energy. 10 days of fat loading are enough to increase the muscles fat burning capacity, while the three day carbohydrate load ensures muscles have plenty of glycogen available for energy.

In the fat loading days, start 2 weeks before the race and aim for 65% of your total calorie intake from foods containing healthy fats. These could be avocados, cheese, eggs, salmon, whole milk, Greek yoghurt, nuts, olives and olive oil. In the carb loading days, start 3 days before your race and aim to get 70% of your total calories from carbohydrates.

3.    DRINK BEETROOT JUICE

Beetroot juice is packed with dietary nitrates, which dilate blood vessels, increasing blood flow to muscles during exercise. Studies have shown that drinking 500ml of beetroot juice 2-3 hours before running can enhance performance. Try it on a couple of training runs before your marathon day and see if the red juice helps.

REMEMBER YOUR NUTRITION IS FUEL
Getting it right can really make the difference not only in performance, but your enjoyment of the day. Good luck and fuel smart.

Written by Stephanie Gammell M.Ost FAFS
Functional Osteopath at Back to Back – The Earlsfield Osteopath

SHIN PAIN IN RUNNERS EXPLAINED

Lower limb injuries in runners are all too common and unfortunately hard to predict.  With the ‘Virgin Money London Marathon’ not too far off, we wanted to share some Back to Back thoughts on shin pain. 

Lower leg pain can come on for unseasoned runners or those that change their training routine too quickly without laying suitable foundations.  This could be switching to lots of hill running or adding in more speed work.

One or more of THREE pathological processes are often involved in shin pain.

Shin Splints or Medial Tibial Stress Syndrome/Inflammatory shin pain

This is normally pain on the front or inside of your tibia/shin bone.  It can wax and wane, but normally decreases as you warm up.  The runner can often complete their training but it can recur after exercise and be painful the following morning.  If left untreated, it can become worse.

It is generally agreed that if you have shin splints, you should stop running or alter your training depending on its severity. Reduction of the inflammatory response is key and it may be helped by rest, stretching, ice and soft tissue work.

Medical Acupuncture in the right places appears to be pretty effective. Off load your shins with alternative training methods or running in a pool.  When you return to running, do it gently and follow the 10% rule. Don’t increase your speed or distance by more than 10% per week.

Bone Stress Response
Pain in the shinbone may be due to a stress response/stress fracture of your tibia.  This without doubt is more serious than ’shin splints’ and needs to be ruled out if pain persists.  This sort of pain can be increasing or pretty constant.  It is often worse on impact or after use.  There may be some night pain.  Pain is normally more localised or acute than ‘shin splints’.

Compartment Syndrome
The muscles in your lower leg are separated into compartments.  Causes are not fully known, but as your muscles swell during activity, they create increased pressure in these ‘closed compartments’.  Signs and symptoms are directly related to use and intensity.  It increases with exercise and decreases with rest. Soreness can be minimal and diffuse. There may be muscle weakness and sensory symptoms into the foot and toes.

Seeking help is important if you have pain, especially if it does not go away.  Making sure you see an appropriate practitioner with suitable qualifications to enable a correct diagnosis or referral is important.

Sports Massage… the low down

Here is a great write up by Bhavesh Joshi about the benefits of Sports Massage.  It does make a difference and people do report that they feel and notice the difference.  With those of you that are training for an event such as the London Marathon or triathlons in the near future, make sure that you try a regular sports massage to keep your muscles less tight and feeling better!

Bhavesh says…..

Research shows that there is moderate data supporting the use of massage to facilitate recovery from repetitive muscular contractions, as well as being effective in alleviating DOMS (delayed onset muscle soreness – that achey feeling you get after tough exercise) by approximately 30%.

True Proprioception and Function

Proprioception could be looked at as one of the inner ‘controllers’ of our body!

You get great proprioceptive training for free if you do authentic Functional Exercise. Proprioceptors provide us with information about movement and the position of our head, limbs and body in time and space. Their aim is to protect our body from damage by using ‘stretch reflexes’ and these can restrict or limit our movement at times of need. Some of these sit in joints, some in our muscles and some in skin and fascia. In combination, proprioceptors give our body a supreme and enhanced awareness of our ‘whereabouts’.

You do need to proprioceptively train the body towards the function it so requires. Doing a ‘plank’ for example will not train your abdominals proprioceptively to protect you in upright function with lumbar spine extension and rotation. Squatting will not proprioceptively train your legs to run and that ‘static squat hold’ at 90 degrees that many are given, will certainly not protect your hips, knees and ankles while you ski.

Training proprioceptors effectively requires movement and often (although not always) it needs ground force reaction too! Increased effectiveness is achieved by using different tweaks or additions to our movement such as adaptations in speed, depth, height and angulation and this may involve using your head, limbs and body, all in 3 planes of motion. An INTEGRATED chain reaction is needed, nothing is ISOLATED.
Whatever sport or exercise you want to do, to become and stay good at it, your conditioning and rehabilitative training needs to look and smell like the sport you want to do!

If you need any help with Functional Training or need an injury treated, call us at Back to Back on 020 8605 2323

Get Wise for CrossFit – and keep safe!

The first affiliated CrossFit (CF) gym was opened in Santa Cruz in 1995 and was founded and developed by the coach Greg Glassman.  Over his years of watching the fitness industry, his idea was to create versatile athletes (gymnastics and weightlifting) through primal movements and intense training.  It has since gained worldwide momentum and a huge following.

The typical workout or WOD may involve intense drills of weightlifting (squats, deadlifting and carrying odd objects or kettlebells etc) box jumps, burpees, sprinting and using gymnastic rings to name a few.  Most activities are all well and good and with a structured and progressive integration into your lifestyle and using the basic premise of not walking before your can crawl and not running before you walk.  This puts in place not just the neurological inputs that are needed to perform and function, but embeds some firm foundations of the chain reaction needed for movement and structural control.

I see and treat a fair amount of injuries sustained through CrossFit and whilst injury is often seen to be part of any intense exercise, I do feel some of these could be avoided.

CrossFit is massively intense and with that comes excitement and vigor and over time, a body that develops in power, coordination and agility.  But I feel that with this excitement and vigor often comes lack of care for ones self and the idea that if your push yourself harder, you get faster results.

Let me use the example of running again.  If we have a basic level of fitness, most of us assume we should be able to run.  Running is composed of lots of hops and leaps.  When treating/rehabbing athletes, I am often asked “am I ready to run yet?”…… and I ask them “can you repeatedly hop and leap?” and then depending on their answer we watch and see…… and we see if they can or if they fail.  That gives us the answer and often, they cannot hop and leap!  So surely, they should not run!

My point of this is much more about creating the foundations much deeper than you think you need.  To enable Mo Farah’s fabulous achievements at the 2012 Olympic Games, he would have run around those tracks hundreds if not thousands of times and known that if he gets a PB, it will probably be within a certain amount of time.

So doing 25 squats with 100kgs if you have only ever twice before would be foolish.  Doing 25 squats with 100kgs should ok if you are regularly doing 25 times 90kgs.

To enable good technique with power moves such as deadlifts and squats you don’t just need good technique, you really need good functional mechanics such as sufficient ankle, knee and hip movement and these need to be able to load the weight correctly.  If they cannot do this, somewhere else will take the hit….and this hit maybe your lower back, shoulder or neck!

Over the next few months I will be working with Tom and Harri Bold from CrossFit Bold and other coaches from Athletic Alliance to develop some easy strategies to enhance movement and control, which we will be sharing with all the members.  All with the idea injury avoidance!  But in the meantime, please be careful of your form and technique and keep your ego in check and don’t find yourself where you are trying to push your body to a place where it has not been before too quickly.

Ignore the figures but, think of it like an iceberg – 70% underneath and 30% on top…..

Could your groin injury be coming from your hip?

Groin pain can be a difficult problem for patients as well as their clinicians. Part of the problem is that the location of the pain is often a poor indicator of the where the pathology actually lies. Additionally, when the pain becomes chronic, multiple pathologies can be generated, adding a further layer of complexity.

It is very important to make a clear diagnosis, and we should seek to look beyond merely labelling the problem as a ‘groin sprain’. There many causes of pain in the groin, but approximately 50% of groin pain can be attributed to pain generated by the hip joint; a surprise, perhaps, for younger patients. As in any medical condition, the patient’s history will give us many clues. It is extremely important to rule out sinister ‘red flags’, such as night pain, severe pain on loading the leg, weight loss or systemic symptoms, and we need to be mindful of conditions which may occur in certain age groups, such as slipped epiphysis in teenagers.

Common causes of groin pain besides the hip, include those generated by the lumbar spine, pubic overload (osteitis pubis), iliopsoas and adductor tendon pathologies and stress responses in the femoral neck in runners. Abdominal wall hernias may cause pain which is a little higher in the groin, and less commonly, younger patients can experience the rectus femoris pulling away from its attachment at the anterior inferior iliac spine. Testicular tumours and avascular necrosis can present insidiously and we need to be on the lookout for them.

A big proportion of patients who present with groin pain as a result of hip pathology, have an underling condition known as ‘femoral acetabular impingement syndrome’, or FAI. This is essentially a problem resulting from a tear in the acetabular labrum, usually caused by repetitive trauma due to a ‘bump’ or ‘CAM’ on the head neck junction of the femur, which may be genetic.

This can cause groin pain which is worse with exercise, sitting or standing, and the pain can be brought on by putting the patient in the ‘impingement position’ of hip flexion + internal rotation + adduction. In the long term, we believe that the tear in labrum causes changes in the acetabular articular cartilage next to it, and over many years, this may lead to osteoarthritis in the hip.

FAI can affect people of all ages, and is often missed in 30-40 year olds. Taking a careful history, and carrying out a thorough examination can help identify the likely cause. Imaging, such as MRI arthrogram of the hip, can help confirm the underlying diagnosis (as X-Ray cannot rule out FAI), but it should be remembered that imaging needs to be interpreted in light of the history and examination findings. FAI may require treatment with hip arthroscopy surgery, but in some cases injection therapy and robust physiotherapy or osteopathy may be enough to get a person back to full activity.

Sports Physicians and Osteopaths are ideally placed to identify the underlying cause of unexplained groin pain, and are skilled in directing the rehabilitation necessary to resolve the problems.

If you have any problems at all and would like in to see James Dodd or one of the team at Back to Back, please call 020 8605 2323.