Blog

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

Now before you start panicking, NO, we are not going to be doing the stretch you see above, but we are going to show you a REALLY important stretch…

Most people are aware of the importance of stretching, and we have covered the topic on the benefits of stretching in an older post that you can read here, but what I would like to focus on today is the importance of stretching your HIP FLEXORS. As a Physiotherapist, I consider this muscle group to possibly be the most important muscle group to stretch, as it not only affects athletic ability but also your posture, and subsequently, chronic pain.

First for some anatomy. Your hip flexors are comprised of 3 distinct muscles namely: Iliacus, Psoas Major and Rectus Femoris (bet you probably never heard of them?).

Iliacus and Psoas Major (often grouped together and called Iliopsoas) are pure hip flexors (bringing your knee to your chest), whilst Rectus Femoris is a hip flexor and knee extensor (as it crosses both the hip and knee joint).

If you have a look at the first picture above (left), you will notice that the Psoas muscle is attached to the lower part of your spine. Thus, if it is tight, it actually pulls your spine down and exaggerates the curve of your lower back (anterior pelvic tilt). Together with the other two muscles being tight, this can account for “hyperlordosis” and lead to lower back problems and pain.

So why do they get so tight? Surely if you are not exercising these muscle, there is no reason for them to become overly tight?

There are two main causes for this. Firstly, we sit way too much, and secondly, we all like to have a six-pack, so if we do get a few minutes to exercise, we tend to do sit ups…

Now I’ve said it before, “Humans were just not designed to sit all day long!”, so for the majority of people that sit most of their day, these hip flexor muscles are in their shortened position for hours on end, and as a result, they become shortened and tight. Then when you do finally stand up, they are “fixed” in this position.

The second point was on sit ups and most other stomach exercises. Most people don’t realize this, but if you do a standard sit up (i.e. lying on your back, knees bent and then curling your back to bring your chest to your knees), your hip flexors are doing about 70% of the work…. Whether you bring your chest to your knees, or your knees to your chest, its the same movement– HIP FLEXION! (on a side note, thats the reason a lot of people get lower back pain when doing sit ups-tight hip flexors).

So here come the Rescue Remedy:

Its called many different names, but we like to call it the PROPOSAL STRETCH- for obvious reasons

I teach 2 different ways of doing this, either as you see above (more effective as you are bending the knee as well, so you are also stretching Rectus Femoris), or by placing your back leg on a chair (below). If you are doing it right, you should feel the stretch in the front of your hip, and possibly also slightly on the front of your thigh. People that do a lot of squatting movements (Crossfit, gym, skiing etc), or lunges (squash, tennis etc) would benefit immensely from this stretch, as It could limit your ability to get into those positions.

Hold this for 30 seconds and repeat for 3 sets,  at least 2-3 times a day (more if you are sitting all day long).

Happy Stretching

Ric@PhysioPRO

The hamstring muscle is in fact a group of three muscles –  the semimembranosus and semitendinosus medially (more inward) and the biceps femoris laterally (more outward) which is divided into a long and short head. ( see picture)

A substantial force is usually required to develop an acute muscle strain in the hamstrings. This is so much the case that individuals can typically recall precisely when their injury took place. A few risk factors are listed below:

• Age – the older athlete has an increased risk of acute hamstring strains.
• Previous injury – a prior history of acute hamstring strain increases the risk of future injury
• Hamstring:Quadriceps strength ratio – the weakness or strength of the hamstrings and quadriceps n relation to each other are seen as a risk factor.
• Poor lower limb proprioception( knowing where your limb is in space)

There are 2 distinctly different types of acute hamstring strains. The more common of the two, Type 1 hamstring strains usually occur during high speed running when the hamstrings is working eccentrically and involve the long head of biceps femoris most commonly at the upper muscle-tendon junction. These types of strains seem worse in the early stages of the injury with a marked acute decline in function but respond well to treatment and typically require a shorter rehabilitation period than the type 2 hamstring strains.

Type 2 hamstring strains occur during movements leading to extensive lengthening of the hamstrings into hip flexion such as high kicking or sagittal ( front) splits and are typically located close to the ischial tuberosity (high up the leg, in the bum region) and involve the uppermost free tendon of semimembranosus. These types of injuries can have less dramatic acute limitation but their rehabilitation period is often longer than that of type I strains.

The most common cause of posterior thigh pain is hamstring muscle strains but that does not rule out referred pain into this area from other structures such as the lumbar spine, the sacroiliac joint and trigger points in the gluteus minimus and meduis, as well as the piriformis muscles.

Management of the acute hamstring strain starts off in the acute phase by following the RICE (rest, ice, compression, elevation) principles in the first 48 hours as well as commencing with early pain-free muscle contractions. Subsequently recovery moves onto moving onto stretching, neural mobilisation, soft tissue treatments, strengthening and assigning a running program and/or individualised sport-specific training.

Acute hamstring strains are common injuries in most popular sports and have a very high recurrence rate of injury. Therefore having a good prevention program is essential. It has been suggested that a balance/proprioception program, regular soft tissue therapy and eccentric hamstring exercises may help prevent hamstring injuries.

Some of the best eccentric exercises for prevention of hamstring strains are Nordic Drops and Askling’s gliding exercises  and it’s important to see your physiotherapist for assistance in this regard.  But, be aware that in those new to eccentric muscle training, it can result in muscle damage and delayed onset muscle soreness. Therefore, any eccentric strengthening program should factor in adequate time for recovery.

Andrew@PhysioPRO

A Total Hip Replacement  – or THR as we like to call it in this business – is a surgical procedure in which diseased cartilage and bone, located at the head of the femur and acetabular cap, are replaced with artificial materials (a prosthesis).

More often than not, this is an elective procedure. Therefore, many older patients come to me for advice on whether or not to go for a THR. What I always tell them is that as with any surgical procedure there are potential risks, so it should not be entered into lightly and should be seen as a last resort. In my opinion, the biggest factor is how the operation will affect quality of life. If one’s current hip condition is impairing function to a significant extent – such that quality of life is severely diminished – then a THR would be of great benefit.

Who needs a THR?

• Patients with severe Osteoarthritis
• Patients who have tumours  in the hip that have destroyed the hip joint rendering it dysfunctional
• In cases of avascular necrosis (hip joint is destroyed due to lack of blood supply) can develop due to fractures, drug and alcohol abuse and other diseases.
• Patients with intense chronic pain persists despite the use of anti-inflammatories for more than 6 months, adversely affecting sleep, ability to work and movement.

A THR is not recommended for patients with:

• A current hip infection
• Paralysis of quadriceps
• Severe blood disease
• Nerve disease affecting the hip
• Severe mental dysfunction
• Morbid obesity i.e. weighing more than 140kg

If possible, once one has decided to have the operation, it would be of great benefit to  start pre-operative strengthening exercises to assist with rehabilitation post-surgery.

To prevent post operative risks, rehabilitation starts immediately after the operation. This includes circulatory and isometric exercises. On Day 1 post-surgery patients are usually sitting up, out of bed and working on strengthening the quadriceps. By Day 2 patients are walking with an assistive device (normally a walker). Physiotherapy is critical in the coming months to regain strength and functional activity.

For the first 3 months post-surgery it’s prohibited to lie on one’s side or cross one’s legs as the hip could dislocate in these positions. After 6 months normal daily activities should continue comfortably.

Always remember to inform your health care professionals that you have had a THR and avoid strenuous activities, running, contact sports etc as this will decrease the life span of your THR. Swimming is a very good way to strengthen and increase the mobility of your hip without causing too much strain on and friction at the joint.

Andrew Savvides

PhysioPRO

Many patients come into my practice with various complaints of knee, hip and sometimes ankle pain. They give me a rather strange look when I ask to test their bum muscle strength (more specifically a muscle called Gluteus Medius).  Invariably, most end up shocked at how weak this muscle is when it only takes one of my fingers to push down their whole leg…

So why is the strength of this muscle SOOO important? Well, of late, researchers have found that this muscle is possibly one of the most important muscles when it comes to pelvic, hip, knee and ankle stability. It controls rotational as well as vertical movement of the pelvis and lower limbs, and as such has a massive influence on how ones leg moves and functions during activities.

For example, a common knee condition known as ITBFS (Ilio Tibial Band Friction Syndrome) was once believed to be the result of the ITB being tight and thus “rubbing” on the femoral condyle, leading to inflammation and pain. We now know that a major cause is in fact due to the femur (upper leg bone) ROTATING inwards and the ITB remaining almost STATIONARY. This means that to fix the cause of the problem, the femoral ROTATION needs to be addressed. This is where the Gluteus Medius (GM) comes in, as it controls rotational stability.

ITBFS is not the only problem that can be attributed to a weak GM. Other common injuries include:

• Trochanteric bursitis
• Medial knee ligament sprain
• ACL (Anterior Cruciate Ligament) Sprains/tears
• Patellofemoral Pain Syndrome
• Achilles tendinopathy
• Lower Back Pain and the list goes on…

Due to its influence on biomechanics, it can also have an effect higher up the Kinetic “chain”, and as such, a shoulder or elbow problem could in fact be stemming from a weak GM!

It’s worth mentioning that this muscle appears to be weaker in female athletes, and accounts for the higher incidence rates of ACL tears in this population. The USA is implementing preventative programs in order to reduce the rate of a possible career ending injury. A complete program can be downloaded from www.smsmf.org/pep-program.

A very basic exercise to start training the GM is called “the clamshell” exercise (see images below). Try to complete three sets of fifteen repetitions. When done correctly, you should feel a deep burn on the side of your bum.

If you are suffering from any of the above mentioned injuries or you would just like to prevent them, come in to your nearest PhysioPRO branch where you will be assessed for GM weakness, and then given the appropriate training program depending on your needs.

Till next time, TIGHT BUMS…quite literally

Ric@PhysioPRO