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Of late, many a client has passed through the door with injuries stemming from incorrect training shoes. Conditions such as: Shin splints, plantar fasciitis, tendinopathies, stress fractures and overuse syndromes may be as a result of the this…

Shoes play and important role in our lives as we wear them most of the time is our daily activities. But how do I know what the right shoe is for my sport?

This is a quick go-to when having a look at which shoe is best suited for you.

Firstly you need to purchase a shoe that is in line with the activity you are performing.

Walking shoes: lightweight, with extra shock absorption in the heel and under the ball of the foot to decrease heel pain and burning/tenderness in the ball of the foot. Walking shoes are more rigid in the frontal area of the shoe for toe roll off.  If you feel that you need more even weight distribution, a smoother transition from heel-to-toe and less force over the foot, look for a shoe that has a slightly more rounded sole.

Running shoes: have good overall shock absorption, and heel control. Check your running style first, as a heel-striker requires different shoes to a fore-foot/mid-foot striker!

Aerobic conditioning shoes: lightweight with extra shock absorption in the ball of the foot to prevent foot fatigue.

Tennis and netball shoes: give upper support with quick transferring of weight and side to side movements and a flexible sole for quick changes of direction. When playing on soft surfaces look for a softer sole shoe, and vice versa with a hard surface.

Basketball shoes: have a stiff, thick sole for more stability whilst on court. The high top gives extra ankle support but won’t prevent the risk of ankle injuries.

Cross training shoes: a combination of many features and therefore help you participate in more than one sport, without having to purchase more than one pair of shoes. It will be flexible in the forefoot for running and have lateral control for aerobics and court activities. Obviously, because they are the “jack of all trades” when it comes to functionality, they are not particularly good at any one specific component. For exmple, a cross training shoe shouldnt be worn to run more than 10km. Rather get a dedicated running shoe for that purpose.

How to go about choosing the correct shoe.

-Like clothes- different brands fit differently, so don’t take it for granted that if in the one brand you are a size 7 you would be the same in the next brand.

-Measure both feet when they are at their largest- usually after exercise or at the end of the day. Remember one foot may be larger than the other.

-Use the same type of sock that you would usually use in your activity of preference.

-Comfort is key- the shoe should mimic the shape of your foot

-There is an old saying- “the shoe will become flexible/ loosen with time” this is partially true, however when purchasing a shoe, you should not keep this in the back of your mind. The shoe should be comfortable and fit correctly when purchasing it!

-The widest part of your foot should not feel cramped in the shoe, you should be able to wiggle/ move your toes freely

-The part where your toes are in the shoe (toe box) should have enough depth to prevent chafing, or calluses formation

-Stand and ensure that there is about half the width of your finger between the big toe and the second toe.

-Test the shoe, walk around in it, and ensure that it is comfortable with no chafing. Your heel should not slide forwards and backwards either.

Some extra tips

If you participate in a particular sport 3 or more times a week, then a sport-specific shoe is advised.

Shoes need to be replaced depending on how often they are used and age. It is recommended that after 300 hours of aerobic activity, or a maximum of 800km have been reached on the shoes, they have run their course and need to be replaced, much like the tyres on your vehicle. Rubber degrades with age, so a shoe that’s more than 5 years old, regardless of mileage/hours still needs replacing!

These are just a few pointers in helping you find the right fit for your foot. So the next time you head out to upgrade your footwear to what your feet deserve, stop and think before you just choose a brand and type of shoe because of its aesthetic appearance. Choose FUNCTION over FASHION!

Happy shoe shopping!

Amy@physiopro

Things are constantly evolving in the world of sports medicine. With a better understanding of how the human body works, comes an ever changing understanding of how best to treat it. One such notion which needs to be challenged is the age old acronym of R.I.C.E (Rest, Ice, Compress, Elevate) used for the management of acute injuries.

The “Rest” part of this strategy may in fact cause delayed healing and muscle atrophy. Several studies that have compared early PAIN-FREE movement to complete rest have shown decreased healing times and improved pain.

As I stated above, what is quite important is to start moving early on, but specifically without pain. Even some serious injuries/operations should allow for a degree of movement that is pain free.

Another area of uncertainty is the application of “ICE”. Whilst there is evidence that ice causes a numbing effect on tissue (by decreasing the speed and transmission of nerves), thereby reducing pain, the notion that icing decreases the inflammatory response and speeds up healing is being challenged.

Some studies are showing that the application of early ice (for 20 minutes in the acute stage of an injury) may in fact reduce the healing potential of tissue, and cause longer term negative effects on the healing collagen. So if your intention is to reduce pain, then ice may be appropriate, but if you think you are assisting the body healing process, think again…

What is now being suggested is a new acronym – M.E.A.T

MOVEMENT – as discussed earlier, must be pain-free

EXERCISE – the correct exercises done early on have been shown to reduce muscle wasting and improve outcomes

ANALGESICS – used to control acute pain, but be careful not to “mask” the pain so you can go back to activity too quickly. Again, avoid anti-inflammatories at first.

TREATMENT – from a Physiotherapist or other sports medicine practitioner. We can use other modalities to improve circulation and assist healing.

The Editor in Chief of The Physician and Sports Medicine Journal was quoted as saying,”Do you honestly believe that your body’s natural inflammatory response is a mistake?” I’ve said it in my article on anti-inflammatories, the first stage of healing is INFLAMMATION, but it seems we have all been hell-bent on trying to stop this.

It would appear that the more we learn about how to heal the human body, the more we realise it does a pretty good job, all on its own!

Ric@PhysioPRO

Shock wave therapy (also known as extracorporeal shock wave) is a cutting edge form of treatment in the world of sports medicine. Its a very similar technology to that used to “blast” kidney and gallstones, and does not involve electrical shocks (don’t panic, this isn’t the dark ages) but rather mechanical pulses, similar to sound waves.

Although the physiological mechanism of how exactly this mechanical pulse works is still not fully understood, the research shows us that the “waves” cause microtrauma and inflammation, stimulating the formation of new blood vessels and nerve cells, and speeding up healing of tissue. There is also a positive effect on reducing pain through a pain gate mechanism.

In other words, it improves blood supply and speeds up tissue regeneration!

So why is this so amazing you ask?

Well basically its taking something the body would normally do on its own, and speeds it up significantly, without the need for injections or surgery. Numerous medical research reports have shown that shockwave therapy can be 80-90% effective at completely and rapidly resolving injuries within 3-6 applications.

The most significant application in sports medicine is in the treatment of chronic tendon, muscle and joint conditions. So things like:

• Tennis elbow/ Golfers elbow
• Rotator cuff tendinopathy
• Frozen Shoulder
• Trochanteric Bursitis
• Hamstring tendinopathy
• Achilles tendinpathy
• Patella tendinopathy
• Plantar fasciitis
• Muscle knots and trigger points
• ITB friction syndrome
• Chronic ligament pain
• And even more conditions are healing in weeks instead of months…

It is particularly effective in breaking down the calcification of tendons, commonly seen in the shoulders, as can be seen in the x-rays below…

As technology and techniques improve, so will we find new uses for shock wave therapy. In fact, I chatted to a Doctor at one of the top SA rugby teams, who said they use shock wave to treat nearly all injuries on their players and are getting fantastic results.

Already studies show that in bone fractures that either wont heal quickly, or at all, the application of a single shock wave treatment was effective in causing fracture healing in 87% of patients.

It also has applications in the healing of diabetic foot ulcers, treating cardiac chest pain and erectile dysfunction…but don’t come to me for that!

So if you, or anyone you know has one of the above conditions, give us a call to see if Shock Wave Therapy might be the treatment for you…

Ric@PhysioPRO

How to safely increase your running distance

With summer just around the corner, most people have started getting ready for their beach body. You may have taken up any number of sports to achieve this, but certainly, the most common “seasonal sport” is running. Running is a relatively cheap, easily accessible sport, but if you are not careful with how you increase your distance it could turn into a costly exercise…

Most runners have heard of the 10% rule. This states that you should never increase your distance by more than 10% from the previous week. This “rule” has not been validated by science and a recent article published in the Journal of Sports and Orthopaedic Physical Therapy, revealed some interesting findings.

The study followed 874 novice runners for 1 year and gave each runner a GPS watch to track their distance. Based on their weekly running increase, they were placed into one of three groups: less than 10%, 10%-30% and more than 30%. In total 202 participants sustained an injury over the course of 1 year and what will surprise most is that the total number of injuries per group were not much different.

Yes, there was an increase in the number of distance related injuries in the group that increased by more than 30% compared to the group that increased by less than 10%. So injuries like patellofemoral pain (runners knee), iliotibial band syndrome, medial tibial stress syndrome (shin splints), gluteus medius injury, greater trochanteric bursitis, injury to the tensor fascia latae, and patellar tendinopathy (jumpers knee) were more common in the group that increased training distance by more than 30%.

A possible explanation for this is that when you increase your distance, your running speed decreases (especially if you get fatigued). If your speed decreases, you have to take more steps to complete a given distance and the increased number of steps equates to increased “wear and tear”.

However, this was not true for all injuries. Injuries like plantar fasciitis, Achilles tendinopathy, calf injuries, hamstring injuries, tibial stress fractures, and hip flexor strains were just as common in all 3 groups. These injuries may be linked to running pace rather than distance, and its only through more research that these answers will be revealed.

So, all that science can presently advise is that you progress your weekly distances by less than 30% per week over a 2-week period.

Train smartly!

Ric@PhysioPRO

Article by Rasmus et al, titled “Excessive Progression in Weekly Running Distance and Risk of Running-Related Injuries: An Association Which Varies According to Type of Injury” J Orthop Sports Phys Ther 2014;44(10):739-747. Epub 25 August 2014. doi:10.2519/jospt.2014.5164

Ankle injury is arguably the most common sport injury. I tend to see a lot of patients coming into the practice complaining of repetitively “twisting “ their ankles. They will frustratingly announce ”that’s my bad ankle…I’m always twisting it” upset that they can’t seem to shake off the injury.

Most of the time the reason for these continuous ankle problems,  is a history of inadequate rehabilitation, especially in the aspect of balance and proprioception. Proprioception being the sense of knowing where a body part is in space, which is commonly lost after spraining an ankle. So if this is not properly re-taught, the patient is more likely to re-injure that same ankle when they return to sport.

In the initial returning to sport phase ankle braces and strapping can be used to add additional support as well as aid in proprioception of the ankle.

Exercises such as standing on one leg and trying to balance, progressing to closing your eyes while standing on the injured leg as well as standing on an unstable surface such as a balance board will all help improve your proprioception and balance.

Once you are comfortable with these more basic exercises you can now progress to more sport specific balance exercise. Focusing on keeping your balance while performing movements’ specific to your sport, the exercises are limitless.

The problem being most patients, once the pain is gone, stop there and don’t continue with the full rehabilitation program. So if you want to prevent those recurring nagging ankle injuries remember balance is the key.

Andrew@PhysioPRO

The Achilles tendon is made up of the combined tendons of the gastrocnemius and soleus muscles (the two calf muscles). It is the thickest and strongest tendon in the body. But, that doesn’t make it immune to injury. Even the legendary Achilles – amongst the strongest and bravest Greek warriors – met his untimely demise following an injury to his Achilles tendon.

Injury to the Achilles tendon occurs when the load applied to the tendon exceeds the ability of the tendon to withstand that load. It is most common among males aged 30-50. These over-use Achilles tendon injuries may arise with increased training volume or intensity, change in training surface or footwear or decrease in recovery time between training session.

An athlete’s biomechanics might also predispose them to Achilles tendinopathies. These biomechanics include excessive pronation or supination of the foot (where the foot tends to fall inwards towards the arch or be pushed outwards), calf weakness and altered tibial or femoral mechanics etc.

Most of the time the athlete will notice a gradual development of symptoms, complaining of morning stiffness and pain, which diminishes with walking and application of heat. The two common sites of pain are the midportion of the Achilles tendon and the insertion of the Achilles tendon at the calcaneus.

One of the first things to look at when treating these problems is to identify and correct any predisposing factors i.e. training methods, footwear, orthotic and biomechanical correction.

Once these have been addressed the athlete should commence an eccentric training program, where they focus on controlling the negative motion of the repetition i.e.  where the muscle is working in a lengthened state. The Alfredson painful heel-drop protocol for Achilles tendinopathy has shown to be very successful in treating midtendon Achilles pain. It consists of two main exercises – the ‘gastrocnemuis drop’(knee fully extended) and the “soleus drop”(knee bent to 45 degrees). Both exercises start on a step with the calf in a raised position. From this position the patient slowly lowers the heel so that the foot is parallel to the ground. Patients should do 3 sets of 15 repetitions twice daily for 12 weeks everyday of the week.

Patients should not be put off by the fact that the pain may worsen at the start of the program as this is part of the normal recovery process. If a patient experiences no pain during the exercises, they are advised to increase the load until the exercises provoke some pain i.e. add a weighted backpack. If you are suffering from pain at the insertion of the Achilles tendon then you should do a similar exercise program but remove the step, just do it standing on the floor, as this has been shown to be more effective.

With the correct treatment approach and the guidance of your physiotherapist, Achilles tendinopathy can be successfully managed and overcome.

Andrew@PhysioPRO

This one is mainly for the ladies, but given some of today’s men’s shoes (think Nike Air Max), guys listen up…

Lets start off by saying: Women’s legs look great in high heels, and ladies do love their heels, but from a bio-mechanical point of view, they are the devil! Apart from nasty looking toes and blisters, they are actually causing serious damage to your back, hips, knees and ankles.

Do this quick test- take off your shoes and stand sideways on to a mirror. Now go up onto your toes whilst watching yourself in the mirror. What you will notice is that your body moves FORWARD (because your centre of gravity also moves forward). To stop yourself from falling forwards, your lower back has to arch BACKWARDS (thus moving your centre of gravity back again). Net result, you are putting a lot of extra strain on your lower back…

It does’nt stop there though…Now that you are on your toes, your Achilles Tendon (and Calf muscle) is in it’s SHORTENED position, so over time, you get a shortening of this tissue and less ankle movement. As a result, you will very likely over-pronate (to try get normal ankle motion during walking) and that sets up a whole host of other problems (e.g. shin splints, knee pain, ITB etc…).

In our previous three part series on running barefoot we discussed how you should be wearing  thin, flat and very mobile shoes and this also applies for your everyday shoes.

So if you have been wearing heels a long time (or even a slightly elevated heel in the case of guys shoes) and want to start helping yourself out a bit, start doing these stretches for tight calf muscles and ditch the heels.

Also, please do your kids a favour and don’t let them get into these bad habits. I strongly recommend letting your kids run barefoot around the house as often as possible.

You evolved over millions of years to have Achilles tendons that allowed your heel to rest on the ground…don’t mess with Evolution!

I’m sure you’ve heard of the term “tendonitis” before, and you probably know of someone who has (or had) “tendonitis” of the elbow I.e. Tennis or Golfers’ elbow. Technically they are wrong, and it could be hampering their recovery!!

In actual fact, tendonitis is a very short lived and infrequent tendon condition. What they most likely have is actually TENDINOSIS, or otherwise known as a tendinopathy.

So what’s the big difference you ask? Well, medical terms that end in “itis” usually indicate inflammation and swelling, however in these tendon conditions, no inflammatory cells are present. This then has a direct impact on the way in which we treat the condition. So if you or your friend has tendinosis, taking anti-inflammatory medication is actually having no effect, and you may as well be taking Smarties instead…

If its not inflammation, then what is it exactly?
Without getting too technical, the substance that makes up tendons (collagen) is in a big tangled mess instead of a nice, neat and tight parallel bundles of fibers. There is also increased fluid around the fibers and lots of small, poor quality blood vessels. This can occur in various tendons, but the most commonly affected are those of the elbow (Golfers’ and Tennis Elbow), knee (Jumper’s knee), hip and ankle (Achilles Tendinosis).

So if you shouldn’t take anti-inflammatories, what should you do?

Tendinosis is usually as a result of repeated OVERloading of the tendon and therefore the CAUSE of your problem needs to be addressed. It could be as simple as a lack of rotation at the shoulder that could be causing your tennis elbow, or over-pronation at your ankle causing Achilles tendinopathy. Your physio should evaluate all likely factors and address these to prevent re-occurrence of your injury.

Where previously we were concerned not to inflame the tendon, treatment now focuses on actually CAUSING an inflammatory reaction, thus increasing blood supply and stimulating healing. Although painful, eccentric loading exercises are the “gold standard” of treatment to improve these conditions.

Nitric oxide donor patches and Shock wave therapy have some evidence to suggest they work, and a relatively new technique known as PRP (platelet rich plasma) injections (a topic we will discuss in future posts) are showing positive short term results at reducing pain and improving function.

I would highly recommend wearing a counterforce brace or getting strapped, as this will reducing the mechanical load on the tendon and alleviate pain.

One last thing you need to know. Tendon injuries usually take a long time to heal, especially if you’ve had it for months, so be prepared for some rehab and don’t wait till your pain is excruciating before you seek medical advice.

Ric@PhysioPRO

The most annoying of all injuries is probably knocking your little toe into a piece of furniture or door frame… However the most common everyday injury is the Ankle sprain…

The ankle joint, which connects the foot with the lower leg, is often injured in an unnatural twisting motion that occurs when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint. Ankle sprains are common sports injuries but can also happen during everyday activities such as walking or even getting out of bed.

The ankle joint is complex and comprises of several bones, many ligaments and tendons.

Ligaments are injured when a greater than normal stretching force is applied to them. This happens most commonly when the foot is turned inward or “inverted”. Outward or “eversion” sprains are less common, but usually more severe. Both results in tissue injury and inflammation. Blood vessels become “leaky” and allow fluid to ooze into the soft tissue surrounding the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases, all causing signs of inflammation: swelling, pain, tenderness, redness and warmth…

Urgent medical attention should be sought if signs appear more serious than this, for e.g., pain is excessive, despite the use of medications, elevation, and ice; the person cannot walk at all or cannot walk more than a few steps without severe pain, and/or the foot or ankle is excessively swollen. Fractures can also occur during severe sprains, and your physiotherapist can advise you when an x-ray is necessary.

Less severe sprains can be handled by self care at home by aiming to reduce and prevent inflammation…Remember PRICE: protect, rest, ice, compression and elevation (see Acute Injury Management blog).

Simple ankle sprains usually resolve between 6-8 weeks, however people often experience residual pain and stiffness in the ankle without proper rehabilitation. The chance of re-spraining the same ankle is said to be close to 80% due to a lack of, or improper rehabilitation.  To avoid this and gain complete recovery, seek expert care and rehabilitation of the ankle from a physiotherapist.

Physiotherapy treatment options for ankle sprains

Depending on the results of your ankle evaluation and examination and your specific needs and goals, your physiotherapist will create a comprehensive treatment plan specifically made for you. Physiotherapy treatments may include a combination of the following

• Patient education
  • About the condition
  • Precautions and injury prevention
  • Work or activity modification
  • Home treatments for symptoms
  • Home exercise program
• Recommend bracing or immobilization
• Recommend walking device (e.g. cane, crutches)
• Kinesiology Taping, Sports taping/Bandaging
• Ice / Heat application
• Electrotherapy & Ultrasound (US)
• Joint mobilization
• Graded Physiotherapy exercises including Balance, Proprioception and Gait re-education
• Formulate a work or sport-specific ankle rehabilitation program

The physiotherapy treatments for ankle sprain listed above will not be provided to you in one visit. Your physiotherapist is your best source for which interventions are best for you, based on your specific problems, overall level of fitness and your goals.

So if you have sprained your ankle already, or would just like to prevent this injury from occurring, pop in to your nearest PhysioPRO today.

Mitesh@PhysioPRO