Obliques for Runners, Endurance Racers and Tri-athletes

Running should NEVER be just about the legs.  They’re fairly important components I grant you that, but all too frequently we are overlooking the muscles that help stabilise the pelvis and generate an elastic force condusive to controlled, effective and energy saving forward propulsion.  Let’s be honest here, hand-on-heart, who just slings on their shoes and heads out for a run or a ride…..and that’s ignoring the warm-up too??!!

As mentioned previously, I will leave the technical industry jargon and associated mumbo-jumbo to those who wish to shower themselves in intellectual glory.  This post is intended to be inclusive, realistic and should hopefully resonate with your own experiences.

We’re talking about the Obliques, or your tummy muscles.  Their main purposes are concerned with flexion (forwards bending) of the spine, rotation of your trunk and stabilization of the pelvis.  Put simply, what happens when you run is that your upper body rotates or twists in the opposite way to whichever leg is about to hit the ground next (left foot forward, right shoulder/arm/fist forward etc), your pelvis wants to lean left and right and your torso actually tries to lean back to balance out the forward lean of your pelvis.  If all of these movements were allowed to happen unchecked and without stability and “core” training, you’ll be asking for trouble through injury.

I like pictures so here goes:

Trans Abs (often called your Core) which deal mainly with trunk rotation.

Internal Obliques which flex your spine and rotate you to the same side.

External Obliques which make you bend to the side, flex your spine forward and rotate your trunk in the opposite direction.

Rectus Abdominis which mainly gives you spine flexion with some opposite and same sided trunk rotation (and if trained hard enough will likely be shown to you by people who do “selfies” or something like that on Twitter…..they usually pout as well which is an odd thing to do).

Ok.  I hope you now know what’s what and thank you to my Anatomy in Motion app for the images.

It can be successfully argued that poor conditioning to these muscles can lead to injuries such as Runner’s Knee, CMP (damage under your knee-cap normally by a mal-tracking of the patella itself), Piriformis Syndrome that can be misnamed as Sciatica merely because the pain in is your buttock, IT Band Syndrome, Adductor (groin) strains, Sacro-Illiac (base of your spine) joint aches, collapsed arches of your foot, shin splints, Achilles Tendinopathy…….it goes on and on; it’s a big list unfortunately.

So, why do we have a comparatively weak “Core” then?  We use our core constantly as predominantly we move forwards!  Not really rocket science there, but the vast majority of people are only walking and hence the muscles become used to walking; we also sit, ALOT.  Sitting, as everyone does with most doing this this for more than 8 hours a day (I challenge you to say I’m wrong) is possibly the worst thing we could do to our body.  What happens is that your tummy muscles start to switch off and add in to this equation the probability of working at a desk, the possibilities of back pain (causing you to do less), the effects of being pregnant etc and all-in-all, we turn ourselves into puddings with a seriously compromised ability to hold ourselves up.  Ridiculous isn’t it!?  When we try and take exercise, people usually start with a jog, the core is under-used, lazy, in a weakened state and therefore unable to provide the stability required for the “platform” that is the pelvis; if you hadn’t guessed already, the legs attach to the pelvis, so if the pelvis is unsteady, our legs have no chance.

Enough of the doom and gloom, what to do about it?  To keep this blog from going on too long, you absolutely must look up these exercises and I strongly urge you to get cracking with them.  If I may, a word of warning for everyone: Please PLEASE check that you are doing the exercises correctly as you could get injured and defeat the whole object of this.  I’ve seen too many “bad backs” to not wish that on anyone, so it’s always worth it!

Russian Twists (with weights when you progress), Side Plank Twists, Side Plank Dips, Plank Twists (Hip focus), Bent Leg Obliques, “Windscreen Wipers” (I kid you not), Straight Leg Obliques, Crunches but please be careful of doing SIT-UP’s.  “Sit-up’s” are mainly a flexion of the hip and use the hip flexors – if they go tight, you could get a bad back so DON’T get involved in any of these “30 day sit-up challenges” that seem to be doing the rounds.

So, hope this helps you and best get cracking straight away!  If you’re a beginner and you want to try to minimise the risk of injury or if you’ve fallen in to the category of being a casual runner “but that’s all you do”, or even if you’re a more experienced and serious runner and for that matter, a triathlete who is “strong on the bike” and just hopes for the best on the run part (I’ve done that), then give these exercises a go and I promise you that you’ll notice a difference.

I can point you in the direction of some excellent Personal Trainers or group classes if you would like to go down that route.  All comments welcome as ever.

Shin Splints – The common mis-nomer, signs, symptoms and treatment explained.

“Ah Shin Splints, that’s unfortunate”………everyone says, sort of scratching their heads whilst recommending NSAID’s (anti-inflammatories).  Unfortunately I hear this far too often and all a runner (or non-runner) is left with is an extremely unwelcome condition to the lower leg(s) that feels incredibly tender, sore, irritating, debilitating and taxing to the wallet in trying to buy your way out of it – add to this that SS can sometimes be troublesome to treat and no one is smiling; let’s start with a big deep breath.

Technically, “Shin Splints” (SS) is a bit of a mis-nomer and is not an accurate diagnosis of the problems in the lower leg.  It’s fine to receive this diagnosis, but in order to treat correctly, there are many signs and symptoms to take into consideration before forming a treatment plan.  At the last count, SS can potentially be one or several of 31 diagnosed issues to do with the lower leg, including micro stress-fractures and so to treat a generalistic condition in a “hit and hope” type of fashion is irresponsible and downright unprofessional.  Rather than quote learned text in this post, I’m going to use my experience and welcome it then being challenged and analysed further.

Let’s see what we’re looking at:

shin_splints_09

Ok, no hairy legs there, but we’ve had a good look so what are the causes?

Most injuries occur when we increase frequency, load and intensity.  To a novice runner, most of these three causes will apply; to a more experienced runner we could assume that the body should be used to running per se, however, as it can happen to anyone, therefore in every single situation it’s a case of sit back and gather the facts.  “What”, “How”, “Why”, “When”, “Which”, “Where”, questions should draw out what’s going on.  Throw into this mix an individuals own bio-mechanics, what they do for a living (on your feet, sitting at a desk, wearing heels, steel-toe boots, flat leather shoes and so on) and most importantly the current condition of the soft tissues in the lower legs, then we’ve got a lot to go at.

You’ll normally experience one or more of the following symptoms somewhere in the lower leg – Ache, Throb, Tightening, Hot sensation, Tenderness, Compression, Knifing somewhere in the middle 2/3rds of the shin, either at the front (A), the sides (M & L) or sort of behind (P) and to a more M aspect, like you want to get your thumb in behind your tibia (look at the pic above to check).  It’s really important to differentiate these sensations from anything to do with the Achilles in the first instance.

So, we know you’re feeling a lot of discomfort but what to do now?  An understanding and thorough Therapist will want to gather every single fact possible, so bear with them and be honest!  The absolute worst thing you could do is put on a brave-face and under-state what you’re feeling – they’re there to help you and you’re paying for it!!  Firstly, take lots of everyday as well as training shoes with you, for they will speak volumes about what’s going on.  If you wear Orthoses prescribed by a Podiatrist, take those too (try and remember when they were last checked if applicable).  A Therapist should then put you through your paces (literally) and start to build a picture about exactly what you can and can’t do from a very specific muscular movement point-of-view.  Once both you and the Therapist feel satisfied and you’ve pointed out where it hurts, they will want to investigate (palpate) themselves – they will try not to make you scream out, so if this is likely, try and scream quietly…

Treatment time!!!!  Let’s be honest, it’s horrible in the beginning, but if I know my runner’s from my non-runner’s, you’re probably one short run from feeling you need crutches before you’ve finally given in to the thought of getting yourself treated….hmmmm.  SS conditions normally predispose to having a hot sensation in the shins and then tightness with swelling (especially if almost exactly on the tibia itself – this may be spongey meaning it’s possibly sub-periostal which is NOT good).

My initial thoughts are just STOP what you’re doing and apply Ice to the affected areas in short (5-7 mins) bursts and as frequently as possible (every 2 hrs approx).  I’d advise against NSAID’s as you’re not getting rid of the problem – it’s swollen for a reason so respect that, but the sooner the soft tissues are restored to full working order, then the swelling will miraculously disappear.  It’s not rocket science.

Many would say to stretch to cure, but stretch where?  Just because the discomfort feels like it’s in the calves, how do you know stretching is the right thing to do?  For example, are the calves actually stretched within an inch of their lives, hence they’re pretty inelastic? Are you running too quickly or too slowly?  Are you getting enough elastic response to complement the exercise you’re undertaking?  Does going from wearing everyday footwear to minimal or high anti-pronation footwear help or hinder you?  Which muscles do I stretch then?

Do you need Orthoses (orthotics) from a Podiatrist?  Has someone in a shop merely said you need a certain type of shoe because you have high or low arches?  Do you tend to “muscle” along or are you a “flyer”?  Do you run like a chicken or a duck? (joking).

What I do know for treatment, is that if you want to get better and it’s clear you need treatment from one or several of the above modialities, then a Massage Therapist will help restore balance and conditioning to the soft tissues in your legs so that you can then be set forth onto the right recovery path.  Once you feel happy that your legs have settled and they aren’t killing you when you’ve only got half a mile down the road, then making informed and intelligent decisions about prevention and  cure will be much easier.  Then it’s strengthening time to ward against the cause from returning.  I’ve regularly prescribed exercise ranging from pool-work (it’s damn hard I tell you), to weights, to core work and general proprioceptive exercises.  Mixing things up for a while (biking, rowing, gym) can definitely help and just take some pressure off the legs whilst they become stronger.

So, the outcome?  You’ll be doing what you want soon enough.  Don’t delay.  Why wait until you’re injured?  SS can be agony, believe me.  Go and see a Therapist; you’ll thank yourself, you’ll become fitter, you’ll achieve your goals, you’ll change from a duck into a swan (admittedly I’m still waiting).

I hope this helps you – just pick up the phone if you’re not sure and any Therapist will gladly help you.  Remember though, challenge the Therapist (metaphorically not literally), and I’m sure they will do a good job for you so long as you listen to the rehab plan and then stick to it.  Enjoy your running…

Proximal Hamstring Tendinopathy “A right pain in the backside”.

To the vast majority of the population, the image of a hamstring tear will be a Sprinter pulling up in a race looking like they’ve been shot. To me, a common hamstring condition is an endurance athlete, runner, cyclist or triathlete, saying to me that they’ve got “a pain right in my ar*e” and “I’m struggling to increase my speeds as I know it’s going to go”.

It’s really important to run a full diagnostic with the evidence presented and pinpoint the cause, but invariably, the description given will lead you right to the spot, basically proximal hamstring and often right at the Ischial Tuberosity (your seat bone).

To understand what’s where, there are 3 hamstring muscles of the posterior thigh: Semitendinosus (ST), Semimembranosus (SM) and Biceps Femoris (BF) with it’s long and short heads. Proximally, while the short head of BF attaches to the femur, all the other hamstring muscles share a common point of origin on the ischial tuberosity (seat bones) of the pelvis, all covered by the gluteal muscles.  Distally, ST and SM both attach to the medial tibia while BF attaches distally close to the fibular head, lateral to the knee.

However, the hamstrings, being a two-joint muscle group (crossing hip and knee), when we run there are other considerations to take into account, especially during stance phase. During this phase the foot is anchored to the ground by our body weight creating what’s called a “closed chain environment”. As the hamstrings contract with Glute Max to create hip extension propelling us forwards, they also create an extension moment at the knee… rather than just knee flexion.

The Injury Itself!

The common origin point of the hamstring muscles at the ischial tuberosity of the pelvis is basically the site of injury when diagnosing Proximal Hamstring Tendinopathy. The injury is classified as a tendinopathy rather than a tendonitis, as it has a more degenerative nature rather than being an inflammatory condition.

Sufferers will complain of pain local to the ischial tuberosity when running, especially when accelerating and sustained faster paced running as mentioned before. The pain will most likely be an intense ache in nature, rather than sharp or stabbing. Due to the anatomical proximity to the common hamstring origin, the sciatic nerve can sometimes be affected (Therapist will check Glute Med and Piriformis), which can cause referred pain into the posterior thigh. Once aggravated, sitting on solid surfaces can also be uncomfortable, as can direct palpation and pressing onto the ischial tuberosity manually.

Differential diagnoses for similar symptoms can include piriformis syndrome, pelvic stress fractures and low back injuries. Thus, a proper assessment from a musculoskeletal physiotherapist or similar sports injury professional is important. Often an MRI scan will be used to support diagnosis once and for all, but this can be avoided with accurate diagnosis – depends entirely on the choice of the individual!

Treatment and Rehab:

Soft Tissue Treatment, Manual Therapy & Stretching:

Hands-on treatments providing soft tissue mobilisations to break up scar tissue and adhesions can be useful, as can transverse frictions to the affected tendon. Care should however be taken not to apply direct pressure to the ischial tuberosity itself. This sort of soft tissue work is complementary to a gradual introduction to regular hamstring stretching.

If upon assessment, pelvic malalignment (anterior innominate rotation in particular) is identified, manual manipulation to restore alignment of the pelvic bones is often useful in restoring proper hamstring function. The question of course must always be asked – where does the imbalance come from that caused the pelvic malalignment…?

Specific Hamstring Strengthening:

It is suggested that the progression of targeted hamstring exercises should go as follows:
Double leg, non-weight-baring isometric exercises:

Bridge Holds

Single leg isometric (closed chain) and isotonic (open chain) exercises:

Single Leg Bridge Holds
Single Leg Hamstring Catch

Eccentric hamstring loading exercises:

Swiss Ball Hamsring Curls
Single Leg Swiss Ball Hamstring Curls

It goes without saying that these progressions depend on the pain free completion of each stage.

(“Finally, you might say”) Core Strength & Pelvic Posture Correction!

Hands-on treatments, stretching and progressive strengthening are all important parts of the any good rehabilitation plan for Proximal Hamstring Tendinopathy. However, in my experience, I find the following core strengthening element to be the key to a successful outcome.

In my experience of working with triathletes/athletes/runners who suffer from proximal hamstring tendinopathy, or recurrent hamstring strains, almost all were displaying poor ability to control their pelvic position throughout the performance of functional movements for their sport.

In virtually all cases, it seems that the recurring theme is that they fall into an anterior pelvic tilt/innominate rotation during exercise; this will put the hamstring in a position where they are chronically held under tension, or put a different way, the soft tissue is now technically inelastic and unable to contract and extend from a neutral (and stable) position.

Re-educating proper pelvic position throughout movement, and working to correct imbalances which predispose an athlete to poor pelvic posture should be treated with equal importance, because if not, increased precedence over elements of the rehab programme such as eccentric hamstring strengthening protocols are potentially exacerbating the problem. It’s absolutely vital to check for quad flexibility or a dominance (unwilling to release), and tight hip flexors.

It’s very simple to prescribe a raft of general exercises that will help build stability, but equally as important, you have to treat and deal with the individual in front of you so that the balance between anterior and posterior muscle groups must be achieved first so that all you are strengthening on a “stable” platform rather than over-exerting already (technically) weakened muscles.

Get in touch with if you want to talk further and we’d also like to hear about the topics that interest you that you’d like us to put on the website!

Train well and look forward to seeing you soon (preferrably uninjured!)

Hip Flexors, signs, symptoms and treatment by All Sports Therapy.

The triathlon season is now fully underway and it’s become apparent already that many Triathletes who have come to see me are seeking explanation for unexplained pains in the groin/buttock and lower back regions that just won’t go away.  The latest occasions were last weekend (14th Apr 2013) at the Epic Events Clitheroe Sprint Triathlon when several people mentioned that they had a lumbar back ache that “just seemed to ache more the harder I pushed and PULLED on the pedals”; the conditions were cold and wet, but on further investigation of training schedules and lifestyle analysis, we were looking at several cases of Illiopsoas syndrome (hip flexors), with some also indicating Piriformis Syndrome – both conditions are easily treatable, but an accurate diagnosis is a must when an athlete indicates discomforts in these areas.

The IlioPsoas muscle(s) lie in front of the hip joint and both sit quite deeply, below the surface of the skin. Their main job is to flex the hip (bringing the leg out in front of the body), so technically the upstroke of the pedal/knee lift on the run. The IlioPsoas attaches to the thigh bone via the IlioPsoas tendon and therefore run “deeply” through the core of the body.  Technically, the term Illiopsoas “Syndrome” is the name given to the condition in which a person has IlioPsoas bursitis (irritation and inflammation of the IlioPsoas bursa) and/or IlioPsoas Tendonitis (irritation and inflammation of the IlioPsoas tendon). The condition occurs primarily in gymnasts, dancers and athletes (endurance/track etc) and is caused by repetitive hip flexion, but a shortening or decrease in the elasticity of the muscles themselves is normally the root cause, but presenting itself as bursitis/tendonitis.

Tell-tale signs of this condition can be groinal tightness, sometimes a “clicking” in the inner hip region, a lumbar ache (especially on thebike/run) and put even more simply, the feeling that you want to “stand” on the bike and “arch your back” – how many of you have got out of the car after driving back from a race and felt like you can’t straighten up?  Whenever you become aware of any of these signs, don’t ignore them but go and seek advice and help and you’ll be surprised how quickly an experienced Therapist can help you – ignore the signs and you’re placing huge stresses on your spine that can most definitely lead to long-term chronic issues that may see you “off games” for a considerable time – be warned that your spinal health is definitely NOT something to be put in jeopardy for the sake of “pushing through”.

Treatment after accurate diagnosis will involve massage to relieve and correct soft tissue imbalances, the right combination of stretching techniques both pre/post exercise and a re-focus on preparation for exercise (warming up!) combined with an analysis of your lifestyle (active or desk-bound/driving long distances etc).  A further prescription of CORE strength exercises will also help to alleviate any excessive anterior tilting of the pelvis, strengthen the glutes and deliver a more stable platform (pelvis) during your training and competing.

Now is the vital period to pay attention to your body as the intensities are increasing, so don’t “overuse” your body to the extent where it can’t respond!  You’ll thank yourself if you go and get a good “MoT” soon – stay injury free, train well and I look forward to seeing you out on the courses!

“To Stretch or not to Stretch” from Sports Therapy North West

Posted: October 30, 2012 by marclaithwaite in FlexibilityInjury TreatmentsUncategorized

Don’t worry, I’m not about to tell you that you should stretch before and after every session and attempt to make you feel guilty.. I’ll take it for granted that you probably don’t stretch enough and I’ll add myself to that category. This article is focused more upon the type of stretching you should complete and understand the theory which supports it.

Static V Dynamic

Static stretching involves you holding a position for a specific count to stretch the muscle, dynamic stretching involves some kind of continuous movement to gain the stretch. As a simple example, touching your toes and holding the position for a count of 10 seconds would be a static stretch for your hamstrings. Standing tall and swinging your leg backwards and forwards in a ‘high kick’ manner without stopping would be a dynamic stretch. Both types of stretching have different benefits and both are useful in their own way.

Tight muscles or damaged muscles?

It’s really important to understand what causes tight muscles following a hard training session. Your muscles are surrounded by a sheath of connective tissue and the fibres within the connective tissue can become short and tight, released by stretching relatively easily. If you feel ‘tight’ or ‘stiff’ and stretching removes the problem immediately, then its likely that the connective tissues were the problem. If your muscles feel tender and despite stretching the ‘tenderness’ doesn’t go away, then this is more likely to be muscle fibre damage caused by training, as opposed to connective tissue tightness. The day after a marathon, the pain in your legs will not go away, however much you stretch and that’s because you have severe muscle damage. Whatever the cause of your discomfort, I can safely say it has nothing to do with ‘lactic acid’ in the muscles, this is a myth which has existed for many years. The day following any hard exercise, there is no remaining lactic acid causing discomfort.

Why do my legs hurt the day after a long run?

One of the key things is muscle fibre damage which leads to bleeding and inflammation. Running road marathons creates a huge amount of damage, but due to the DOMS effect (delayed onset of muscle soreness), you don’t actually feel it until the morning after, or worse still, the morning after that! Stretching will not help to resolve this and in many cases you should not stretched when your muscles are severely damaged. Running downhill is known to make this problem worse as the braking effect exaggerates muscle fibre damage.

There are several ways of reducing the damage caused by impact and the main ones are simply running more mileage and running downhill more frequently. Aside from the obvious options, cushioned shoes and better run technique to avoid excessive impact can also help. The final option is to try compression clothing during exercise which can help to prevent muscle damage.

Why do my legs hurt after a faster training session?

Your muscles have built in sensors called ‘stretch receptors’ which monitor the amount of stretch and the speed of the stretch, this information is fed back to your brain. I’m sure at some point when walking along the street you’ve stepped on an uneven surface and ‘turned your ankle’. If you were lucky enough, within a fraction of a second, you managed to make the muscles on the outside of your lower leg contract and pull the foot back into alignment, saving a torn ligament. This is usually followed by you hobbling for a few metres whilst asking the question ‘is it twisted? is it twisted?’ followed by relief as you continue to run and the pain subsides. You survived.. this time!

What happened during that scenario is your stretch receptors on the outside of your lower leg realised that the muscles were being stretched too far and too quickly. In response to this, they trigger a muscle contraction to try and prevent the twisted ankle. There was no conscious thought process, you didn’t make the decision, it just happened automatically within a fraction of a second and saved you a few weeks off training!

What does this mean for faster training sessions?

If you are a slower runner who spends a lot of time travelling at a slow pace, with slow movements, the stretch receptors can lead to problems when you attempt to run fast. If you run 100m as fast as possible, each time you stride out, your hamstrings are stretched beyond their normal range and at a speed which they are not used to. The stretch receptors unnerved by this change in length and fast speed make the hamstring contract as a protection mechanism, this is an attempt to reduce both the stretch and speed of stretch. In such situations, your muscles is trying to lengthen, whilst also trying to shorten at the same time! Pulling in both directions leads to muscle fibre damage and in some cases the tug of war is so powerful that the hamstring may tear!

Avoiding the stretch receptor reaction..

The purpose of dynamic stretching is to accustom the muscles to stretching quickly, without triggering the stretch receptor response. The example hamstring stretch mentioned earlier in this article is a simple example of how this can be achieved. Following a warm up period, stand tall and begin by swinging your leg gently backwards and forwards gently. Gradually increase the height of the swing and the speed of the swing over a period of 30 seconds, never stretching to the point of discomfort. This action allows the stretch receptors to become accustomed to changes in both length and speed of working muscles. Another simple way to progressively and dynamically stretch the running muscles is to complete acceleration strides. Start jogging and over a 50 distance build to 75% of maximum speed, complete twice. Progress to 85%, complete twice and finish by building to 95%, complete twice. Total = 6x50m with 30 seconds between each. The key is starting slow and gradually building, too fast will trigger the stretch receptor response!

Ice and Achilles Tendonitis

I’m a believer in the healing power of ice in the treatment of Tendonitis wherever it may appear in the body.  I recently persuaded a very active person with Grade 4 AT to stop exercising for a planned 12 week period – they were struggling to walk further than a few miles, put their foot down when getting out of bed and going down the stairs one foot after the other…not good.  The purpose of the experiment was to see if the planned treatment period could be reduced by a continued and systemmatic application of Ice Therapy combined with a full postural and bio-mechanical analysis to assess muscular imbalances.

The problem with Tendonitis as a condition, is that it needs an experienced Therapist to correctly diagnose the grade and type.  If you get any element wrong, the rehab will be less effective and the plan for recovery will be normally have to be extended – what’s worse, is that the patient will be eager to return to action but without the correct controls in place, the condition will have a greater probability of returning.

The symptoms of Tendonitis can often be confused, especially where a joint is surrounded by a greater mass of soft tissues (compare the shoulder to the ankle for example).  The differential diagnostic process needs to be incredibly thorough to determine the function, lack of function, active and passive mobility and strengths.  I’ve come across a significant number of mis-diagnoses between Bursitis and Tendonitis for example, where muscular imbalances have not been assessed fully and hence the wrong treatments have been administered.  It’s not complicated in itself, but sometimes Therapists are too eager to seek the easy option rather than consider the wider implications of sports specific bio-mechanics and each person as an individual.

Getting back to the point, my true belief is that the Ice Therapy makes a condition respond more quickly due to the stimulation of blood flow in response to the cooling effect – I also believe it is vital to treat each case individually as it is very easy to apply ice for too long and negate what you’re trying to do.  The person in question above is now 2 weeks back into running mode, 2 weeks ahead of schedule!  As a casual runner and multi-sport participant, the focus is on a very gradual build-up back to a certain fitness level (8 week benchmarks laid down), a change in their running style (a whole new blog subject) and work to restore a better muscular balance to cope with the exercise variety.

Any questions, please send them in – this is my first blog so I’ll go with the flow and try and keep things relevant and specific!

Cheers and stay injury free with good physical maintenance…