Self care to stay niggle free and keep moving through lockdown.
It frustrates the life out of all of us when you pick up a niggle. Should I run? Shouldn’t I run? Most of you are potentially ‘ticking over’ with your training right now & hoping that some of the events you have planned will happen this year. What you do not want is a niggle that just will not seem to go away that curtails you, either from your training or increasing your training when the time comes.
Are any of these injuries familiar to any of you?.............. Plantar fasciitis, Achilles tendinopathy, Shin splints (which is old terminology…. now diagnosed as Medial Tibial Stress Syndrome (MTSS)), I.T. Band Syndrome, Knee pain, persistent calf tension or strains?
These are injuries that I see in clinic daily and are all issues that are mainly stress/overload related type problems that can be minimised by looking after key areas of the body. Many athletes get niggles and then get in touch because they have rested for a few weeks, only for the problem to re-occur as soon as they return to activity. A key point to remember is that in many instances, where the pain exists is not necessarily where the problem is located. If there is restriction/weakness/dysfunction within another key area of the body that contributes to the occurrence of these injuries, if that is not identified and addressed, you could rest for a year and the problem could potentially return as soon as you return to activity, if that key dysfunction is not sorted out.
When Steve asked if I would put a piece together for the newsletter, I could have written a book on the ‘why you should’ and ‘why you should not’ of sports injuries, but I have tried to isolate a few key muscle groups to keep you from overloading yourselves and try keep you niggle free for the types of training that you all do.
HIP MUSCLES (Gluteus Medius)
Some of the OTCF athletes that visit me will know all about these and are probably sick of hearing me going on about them. There is a particularly good reason for that. In my opinion they are the most important muscles in running for injury prevention!!
Why? Dysfunction of this muscle group occurs so often and can then result in overloading the Achilles tendon, the calf complex, medial ankle and associated tendons, plantar fascia, medial shin…. all of these on the opposing leg to where the gluteus medius (GMed) is not functioning. On the same leg as the misfiring GMed it can contribute to I.T. band problems and other lateral knee pain. It is also a key muscle in pelvic and lower back function and resultant occurrences of back pain. For you triathletes, incidents of back pain can affect your training for all 3 disciplines.
Evidence – Running Assessment
Attached are screenshots from a client video running analysis. Image 1 (far left) shows right foot strike, and the yellow line identifies the pelvic position. On the right-side foot strike, the clients’ Gluteus Medius is functioning correctly as the pelvis is stable, meaning that the pelvis is level or slightly elevated on the opposite side. Compare with image 2 (adjacent), left foot strike, the green line shows the pelvis is dropping down on the right side, identifying that the left side Gluteus medius is not supporting the pelvis.
The change in pelvic angle during stance phase of the left leg then changes the angle of the opposite (right) leg as it swings through to take the next stride. The foot position is therefore pushed too far across towards the middle of the body as it hits the ground (see image adjacent. The red line represents centre line of the body. Foot strike should be to the right of the line, under the line of the right hip). This is classified as cross over gait. Body weight transfer on to the right foot is therefore putting greater stress through the medial arch of the foot and medial lower leg. This one functional fault can result in so many of the injuries that are listed.
Try standing on your right leg with the foot underneath the hip joint, where it should be.
Do a single leg squat and assess what you feel through the lower leg and the foot. Now move the right foot under the centre of the body and single leg squat again. Notice any difference? The knee wants to rotate inwards and you may feel greater load bearing through the big toe and more of a stress through the lower medial shin. You can now see how this dysfunction can overstress the structures mentioned when distance running.
Exercise Rehabilitation for the Gluteus Medius
There are many different options for functional exercise rehabilitation for targeting this muscle group. To identify some simple ones:
Hip Hitch
Standing on a step with the opposite leg hanging off the step. Slowly allow the hanging leg to drop below the level of the step, tilting the pelvis. Then recruit the gluteus medius muscles of the standing leg to pull the hanging leg and the pelvis back up. Repeat 3 sets of 10 reps.
Clamshells
Side lying – best performed with back & pelvis against the wall to prevent any compensatory movement of the pelvis. Knees & hips bent with knees & ankles together. Keeping ankles together, raise top knee to rotate hip, up to 30-to-45- degree angle only and return to starting position. 3 sets of 10 reps for each leg. Over time, difficulty & resistance can be increased by tying a resistance band around the knees.
A key element to many muscle issues where you are trying to strengthen them is to also work on the opposing muscle group, as part of this process. The way some of the main opposing muscle groups work in the body is that if one of them gets noticeably short and tight, it will overpower the opposing muscle group and ‘switch it off’. The gluteus medius muscles are known as abductors. The opposing muscle group therefore are the adductors (running up the inside of the thigh). The key to getting everything to function correctly therefore is to relax the tight muscle group FIRST! You can strengthen the abductors as much as
you like, but if you have tight adductors, they will continually overpower and switch the abductors off, hence being stuck with the issues we have discussed.
Adductor Stretch
The adductor muscles should be stretched for a minimum of 45 seconds, which should be enough to release them and allow the abductor muscles to activate. I have discussed that muscle group in a bit more detail, as it is such a key muscle group for the reasons stated.
Other key muscles and body regions to focus your attention on are as follows:
Lower Back and Pelvic Region
Imbalances can develop in the pelvic area and restrict the movement of key joints within the pelvis and lower spine. This can create over stressing of muscles and ligaments and restrict the correct movement of joints, leading to back pain. Being in a time trial position on your bike and having restrictions in the lumbar and pelvic regions for half ironman or ironman distance will not be comfortable and could also restrict power through the pedals. Lower spine restriction can also result in nerve irritation, resulting in lower leg muscle weakness, affecting performance, and increasing the risk of a stress related injury. Many of us are working from home more now, possibly on chairs that are not suitable. Like the example of the adductors/abductors, stretching the hip flexors (shortened when seated for long periods) will prevent them from overpowering the glutes (gluteus maximus).
Both muscle groups are big contributors to pelvic and spinal imbalances and back pain. Stretch the hip flexors FIRST, then include glute activation/strength work, such as bridge exercises. General lower back mobility exercises and nerve release exercises are great regimes to include. Look after the back and pelvic/hip areas and in most cases, the legs will take care of themselves.
Gluteus Maximus/Hamstrings
The glutes are already identified as a key muscle group for function of the lower back and pelvis, but along with the hamstrings, they are the two powerful muscle groups that are key for propulsion during the running and cycling disciplines. The quadriceps (front of the thigh) are the opposing muscle group to the hamstrings and are naturally 60% more powerful, so again, stretch the quads regularly so they do not overpower the hamstrings. Stretch the quads and hip flexors, before strengthening glutes and hamstrings.
Lats (Latissimus Dorsi)
The lats are connected to the top of the pelvis and run along the spine, inserting into your shoulder. The back part of your arm pit is the insertion of your lats into the shoulder joint. Again, many of us are home working more, potentially hunched over laptops. This can shorten key muscle groups in your chest (pectorals) and creates the dominance over muscles in your upper back and the lats. The lats, along with the glutes, play a major part in correct function of the lower back and pelvis. For you triathletes and your swimming discipline, they also play a big part in the pull phase of your swim stroke. Over dominance of your pectorals will affect this and can also contribute to shoulder pain by pulling the head of your upper arm bone (humerus) too far forwards. So again, stretch the pectorals and anterior shoulder muscles regularly and do that FIRST, before lats and upper back strength work.
Calf Muscles
Ever had tight calf muscles? In many cases, calf tightness is due to them not being strong enough to cope with the loads you are putting through them when running or overloading them by excess mileage increases. A simple test is to do a single leg calf raise and see how many continuous reps you can achieve. The reps should be slow and controlled and not aided by compensating with leverage from other parts of the body. The numbers vary depending on age, however on average, you should be able to do 25 continuous reps comfortably to indicate that your calf muscles are strong enough to tolerate the loads of running. If you cannot achieve that, work on it. It is amazing how many runners cannot. Another key point when strengthening the calf complex, as well as with stretching them, is that most people neglect the key muscles. The calf consists of the gastrocnemius muscle, which is the main belly of the calf that you can visibly see. Underneath the gastrocnemius is the soleus muscle. The fibres from both muscles insert into your Achilles Tendon. The soleus muscle is less powerful than the gastrocnemius, but it bears over 80% of the load (between 3 and 8 times your bodyweight) during running. The soleus has a greater number of slow twitch fibres however, making it more suitable for endurance loading. During stretching and strength (e.g., calf raises) work, sets should be carried out with the knee BENT as well as straight. This is because the gastrocnemius connects above the knee joint, the soleus below it. The bent knee isolates the soleus for targeted work, therefore.
Other Important Keys to Managing Injury Risk:
Foam rollers are OK for general release of muscle tension after hard training sessions. TIP – DO NOT FOAM ROLL YOUR I.T. BAND!!
Studies have shown that you must apply almost 1000kg of load through and I.T. band to get it to change length by only 1%. You will cause yourself much pain, but not achieve anything. Getting a good regular sports massage will also help with recovery, release of tension and injury prevention.
Proper Running Footwear – Get yourself to a reputable running specialist, such as Metres to Miles, to get accurately assessed for your running footwear. If the Mizuno Wave Rider 24 was the ideal shoe for you, it does not mean the Wave Rider 25 will be!!
Changes to the design of the shoe may not make it suitable for you. Always get re-assessed. Your gait can change over time too.
Professional Bike Fitting – Especially for the triathletes amongst you doing Half and Full Ironman. Poorly positioned shoe cleats, saddle position and saddle height can reduce Watts, stress the lower back and the knees. Poor handlebar position can result in shoulder and neck pain. Athlete and machine should work in harmony to reduce injury risk and increase performance. It is particularly important that during any bike fit, that the rider is assessed, prior to being fitted on your bike. It is pointless if you need to be in an aggressive aero position on your time trial bike, for your bike to be set up for that position if the rider has a restricted lower back and short hamstrings. You will not be comfortable in that position for long! I have seen too many riders who will pay £1250 for a new disc wheel but will not pay £100 for a professional bike fit. Refer to my website (address below) for further information on this.
Swim Technique – Use the expertise available to you at OTCF to work on your swim technique. Poor technique can stress the body, such as with muscles and tendons around the shoulder joints (i.e., rotator cuff injuries).
Who am I?
I have been working as a Sports Therapist for 15 years; assessing, treating and rehabilitating many runners, cyclists, swimmers and triathletes during that time, or providing them with a general sports massage pre- and post- event or purely for monthly maintenance. I was a keen runner before having to stop running for health-related reasons, so have always had a passion for running and treating running related problems. I am now a keen cyclist and have also developed a good knowledge of cycle related sports injuries and am qualified to carry out bike fitting as part of my services. I became a member of Off That Couch Fitness in early 2020. I mostly train alone on my bike but joined OTCF purely to have some company for weekend social group rides with like-minded people. Cannot beat a group café stop for coffee and cake! I joined OTCF just before lockdown 1, so the group rides have not worked out too well so far!! Loved riding some of the Zwift sessions so far though. If you have any niggling injuries that require assessing, or if you would like a consultation to assess for any key weaknesses that need addressing. Please do get in touch. I am happy to help.
Andrew Coulson Adv. Dip. ST. MSTO. MCNHC.
Sports Therapist
Tel: 07709 985457