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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

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

Back in 2011 I wrote an article called “How your BUM controls your BODY”.  In the article I explained why the gluteus muscles are such an important muscle to train because it directly affected your ankles, knees and hips. If you haven’t already read it, then I suggest you go read it by clicking here.

In about 90% of lower leg injuries, I find that these gluteus muscle needs strengthening, so its crucial if you have any of those conditions mentioned in the previous article. In the article I only showed one exercise to do that targeted that gluteus muscle. Today I want to give you some more so you can really work it.

Advanced Clam

The starting position for this exercise is much the same as for the original Clam shell exercise (lying on your side,knees bent and  heels touching). Place your forearm on the floor and then “push” your bottom knee into the floor, forcing your body to lift up off the floor-similar to a side plank.  Now move the top knee up and down, but keep the heels touching.

The difference here is that you are training BOTH bum muscles at the same time. The bottom leg’s bum muscle is having to hold you up whilst keeping static (isometric) whilst the top leg’s bum muscle is moving the top leg (concentric). Trust me, it’s a real killer and you should feel the burn in your bum, right behind your hip. Once you can do 3 sets of 15 reps, then try adding an elastic band around your knees. An added advantage of this exercise is that is also trains your core at the same time!

This one looks easy but don’t be fooled… Stand with one leg over the edge of a step. Now keeping both knees LOCKED OUT STRAIGHT, lower your one leg by dropping your pelvis down on that side (keep those knees straight!). Now lift that leg as high up as you can and repeat. You want to concentrate on slowly lowering the leg (eccentric movement), and you should feel a burn in the gluteus muscle of the leg that you are standing on. Again, do 3sets of 10-15, but the slower you go the better.

So there you have it, two more exercises to add to your prevention program! And to all my CrossFit Athletes, this WILL help with your squat form! Tight buns

Ric@PhysioPRO

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!

Having had an unusual number of patients at my practice with this condition, I decided to tell you a little more on Plantar Fasciitis…

Plantar Fasciitis (PF) is a painful and often prolonged injury. The source of the pain is a thick “band” under the foot, connecting the heel bone (calcaneus) to the toes, which becomes inflamed. It is usually associated with morning pain (first few steps) felt under the heel. Pain is usually also present following sitting or standing too long, climbing stairs or after exercise.

Some of the risk factors include very high or very flat foot arches, wearing shoes that are not supportive of the arch, sudden increase in weight and unaccustomed exercises. Having tight Achilles tendons and calf muscles have also been shown to increase the risk of this injury, hence ladies that wear high heels a lot are prone to developing it.

So I had to ask my self why the sudden increase in this condition lately? Well it turns out most of my patients started feeling pain from the change of winter to summer. They went from supportive boots or closed shoes to wearing flip-flops with absolutely no arch support, almost overnight. This lead to stretching and irritation of the band, and hence the start of PF.

Treatment modalities that have proven effective are:

• Soft tissue release and stretching of the calf complex (see stretches as per “A real pain in the calves“)
• Stretching the plantar fascia (by rolling a golf ball under the arch)
• Icing under the foot to relieve pain
• Strapping to support the arch
• Using a gel heel cup to alleviate pressure

I have found that dry needling the plantar fascia reduces pain, and I also recommend that most of my patients avoid wearing flat, unsupportive shoes. A good trick to stretch the band and relieve pain at the same time is to freeze a bottle of water and then use this cold, hard bottle by rolling it quite hard underneath the arch.

Im not quite sure why, but doctors still send patients with PF for x-rays to look for something called a “heel spur”? Having this spur is not a diagnostic feature (i.e. you could have the spur and NOT have PF) and surgery to remove this bone formation is rarely necessary.

As mentioned, the condition can sometimes take up to a year to heal, so don’t prolong your pain, come see your physiotherapist.

Ric@PhysioPRO

So in the last two articles, Mitesh discussed the relative advantages and disadvantages of barefoot running. It still comes down to personal preferences and some people are quite rightly saying, “But people have run marathons in running shoes for years and are ok, so why should I change?” Well, although this may be the case DURING their running careers, many of those long distance athletes are only NOW starting to suffer from knee, hip and ankle degenerative changes at a later age. Are their running shoes to blame or the distances they ran? No one can really say for sure, but since the evidence does show that running with shoes does increase the forces generated at the knee and hip during running, we can deduce that this contributes to their injuries.

But how does one start barefoot running? Do you suddenly ditch the expensive running shoes and take to the road?

The answer is NO, unless you want bad blisters and pain…!!

In his book entitled Barefoot running step-by-step, (it’s a worthwhile read if you want to take barefoot running more seriously, as is Born to Run-Christopher McDougall) “Barefoot” Ken Bob suggests the following program in order to ease into running without shoes.

The above is for injured or novice barefoot runners and he also gives a different table for non-injured veteran runners. Also, expect some small blisters and callous formation as this is part of “hardening” the foot.

Some important points to note when getting started:

• SLOWLY! Go slow at first and get used to it. If you do too much to quick you will most likely develop injuries.
• Walk around barefoot at home or in the garden as often as possible.
• Run “quietly”. Imagine you are running through a room of sleeping lions! If your foot hits the ground with a thud, then you are not absorbing shock correctly. To do this:
  • Shorten your stride (take smaller steps) to avoid hitting your heel against the ground. You should rather be landing on the ball or mid-foot section of the foot.
  • Make sure your knee doesn’t straighten out all the way when you swing it forward.
  • Avoid bouncing up and down. Keep a smooth, “light” feeling to the run.

People tend to start barefoot running on soft ground, but this is not ideal, as you are unaware of the impact you are actually placing on the foot. Rather start on a hard surface and you will quickly realise if you are going too fast/hard.

One last thing on minimalistic shoes (like Vibram’s 5 finger), yes they are good for protection and to get used to less cushioning, but they don’t give the same level of feedback as your naked skin which is the important part. If going barefoot is a 10/10, then minimalistic shoes are 3/10 and normal running shoes 1/10. That’s according to the hard-core bare footers!

My suggestion is to “supplement” your regular running with some barefoot/minimalistic running in between. Use it to strengthen the small foot muscles and alter your running biomechanics so that you place less impact on your joints. It’s quite addictive though and actually feels great having the dirt between your toes again…just like when you were a kid.

Ric@PhysioPRO

One of the theories of man being adapted for barefoot running is that evolution once saw us as being persistence hunters. Man has a highly evolved thermoregulation and breathing system, whereas animals must pant to take in air to cool their organ systems. So, we were able to ‘run down’ our prey for several hours, resulting in the animal simply collapsing from sheer exhaustion and overheating (Persistence hunting)…Food for thought…

Although we appear adapted to running bare, there are definitely some Disadvantages of Barefoot (minimalistic) Running. Here we mention these cons…

If you have no problems and no pain, do you really need to change anything? … Why fix what isn’t broken?…
Glass, nails, rocks, thorns and other bits and pieces can injure our feet. Shoes save our feet and also offers protection from blistering (on hot surfaces) and frostbite (on cold surfaces).

Switching to a minimal shoe or starting to go shoeless will usually result in blisters for the first few weeks until calluses are formed.

For most of us modern athletes, going minimalist will be a shock to our feet and our running system of muscles and joints will be overwhelmed. This could lead to injuries such as Achilles tendinitis, calf strain or medial knee pain when the typical heel lift is removed from the shoes.

The sole of the foot (plantar surface) is usually soft and tender. Going without a generously soled shoe may initially cause plantar pain, and raise the risk of plantar fasciitis (inflammation within the sole of the foot).

And…let’s face it: It looks a little strange, so people will notice, and they may stare 🙂