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Injuries

Are you Imbalanced? Part One: Lower Extremity

Tuesday, August 7th, 2012

Per request of a comment I received from the last post, I tried to tackle the topic of identifying imbalances on the body. We all aren’t physical therapists and athletic trainers, so sometimes knowing the basics can help you recognize when you are at risk for an injury, or how you can make an easy fix for a nagging problem. My thought process was to break it up into upper extremity and lower extremity and identify “hot spots” or common areas that lead to multiple problems for endurance athletes. I will start from the ground up literally, with part one being Lower Extremity.

 

Area: Achillles

Common Injury: Plantar fasciitis, Achilles tendinitis, bursitis, calf cramps

Am I imbalanced?: Checking for calf (gastrocnemius and soleus muscles) tightness is difficult. A quick test to try and see is to simply extend your leg in front of you, (so you need to be sitting or laying down.) Try and bring your foot to your body, if you can see a reflection of your foot, even better. If the angle of your foot to your shin (tibia) is over 90 degrees, you are not in the “normal” flexibility range.

The first stretch is a basic stretch. First obtain a towel and wrap around your toes. Pull the towel and your toes towards your body. Hold for 30 seconds and repeat 3 times.

Pull with a towel towards your toes

 

The next stretch is probably one we all have learned from elementary school, but if you can look in a mirror, see how good your flexibility is. The key is to keep your heel in contact with the floor at all times.

 

Keep heel in contact with the ground, lean into the counter

This next stretch helps to stretch the other part of your calf, the soleus muscle. The soleus lies directly underneath your gastrocnemius. Keeping your heel in constant contact with the ground and the bending your knee slightly, you will feel a different stretch.

Strength test: This is a test that as an athletic trainer I will use on someone if they present any symptoms of weakness. It’s quite simple, if you can’t perform this, you’ve got some work ahead of you or you have a nerve issue. Simple see if you can do 25 calf raises with a straight knee in a row without any issue. Next, bend at the knees slightly to test the solues muscle. (Assume the same position as the stretch above, only doing calf raises).

 

Area: VMO (Vastus Medialis Oblique)

Common injury: Patellar tendinitis, patellar tracking issues, ITBFS, general knee pain, condromalacia patella, etc

Am I imbalanced?: To start, the vastus medialus oblique is one of the three major quadriceps muscles. It is seen most predominantly on athletes right on the inside part of the knee. I used my own leg as an example, and it’s not the greatest, but I will use Marit and Therese to really show a good example.

When you flex your quad you should have a “tennis ball” shape appear by your knee. If you touch right by your knee and only feel some squishy skin, you’re in trouble. This muscle supports the patella in all its motions, so if the VMO is weak, the patella likes to run all over like a loose train cabin. A good way to test this is to get a small hand towel, roll it up, and place underneath your knee. Next flex your quad as hard as you can, imagining you are trying to crush the towel into the table/ground/etc. Look at the inside of your knee, do you see a bulge form? Push there, can you feel a muscle flexing? It’s more common in women to see a deficit in this muscle than men.

How can I fix this? Using the towel test as an exercise is a great way to strengthen the VMO as well.  Try to “crush the towel” for a long 5 second hold, and then relax. Repeat this 10 to 15 times. If you still feel like you aren’t tired, find an ankle weight and hang your ankle off the table to add some more resistance, or hold for longer than 5 seconds.

Before, relaxed. Arrow points to the VMO

 

After, contract the quad to “squish” the towel

Area: Gluteus Medius

Common injury: ITBFS, General pain in back, hips, knees, many more. This muscle is a very important stabilizer in the repetition of running and skiing.

Am I imbalanced? In the athletic training realm, the test for checking for gluteus medius weakness is called Trendelenburg’s Test. The best way to try and check yourself is to perform this in front of a mirror. Start by putting your hands right on your hips. Then, trying to keep your hips level, lift your foot off the floor and flex your knee behind you to 90 degrees. Watch your hands on your hips, do they move? Can you feel yourself wanting to shift all your weight to one side? If you can’t keep your hips level while balancing on one leg, you definitely have a weakness. See if you can keep your hips completely level for 30 seconds to a minute.

Correct position, keeping hips level

The hips drop slightly when there is a weakness

How can I fix this? Two great exercises are Hip Hikes and Fire Hydrants. You can’t target the muscle properly unless you do these correctly. To perform a hip hike, find something to stand on that is at least 8 inches tall or so. Start by standing with one foot on the surface, and on foot hanging off the side. Start in a position with your hips level, just holding your foot over the edge. Using ONLY your hips, try to drop your foot down to the floor. Do not bend your knees in any way. You should only feel your hip muscles trying to lift you. Repeat at least 20 times on each side, repeat 3 times.

 

Start position on the left, end position on the right. Notice how much my foot drops below the start position. Use only hip muscles to drop

The second exercise is called Fire Hydrant because it simulates they position dogs assume when nature calls. The key to this exercise is to not use your back and rotate all over the place. Start by balancing on your knees and hands on the floor. Then, lift one leg up to the side, going until you feel yourself begin to rotate. Repeat 20 times each side, repeat 3 times to really feel the burn.

Area: Weak or Tight Hamstrings

Common injury: Low back pain, Chronic hamstring strains, Hip alignment issues, knee injuries, etc

Am I imbalanced? The easiest way to tell if you are imbalanced is to find a wall in your home or gym, and lie down facing it.  Try to place your feet on the wall and scoot yourself as close to the wall as you can. If you can get your butt to touch the wall without a problem, you have at least 90 degrees on hamstring flexibility which is a good start. If you can’t get to 90 degrees, you have very tight hamstrings. Another test is simply to see how close you can touch your toes. Also, if your quadriceps are a lot stronger than your hamstrings you can be predisposing yourself to problems down the line.

How can I fix this? A few different hamstring strengthening exercises are available, and creativity can make them enjoyable. The first, which is one of my favorites to use on athletes who are rehabbing from ACL surgery, is stool racing. Find an office stool or chair on wheels. Find a nice long clear space to either do laps, or straight lines and using only your heels, pull yourself across the space. Make sure to be pulling yourself forward for at least a minute at a time. Repeating at least 3 times.

The second exercise, which can help with double poling even since you will be getting your hips forward, is a hip fall. Find a heavy enough couch/chair, and put your feet underneath it. (I didn’t have anything that could hold me in the picture, so just imagine I did) Then, fall forward and try to hold your upper body as long as you can before gravity takes over and you drop. The key to this is keeping your back as straight as possible, if you bend at the hips, you can cheat on this exercise all day.

Make sure to secure your feet, and let yourself fall forward trying to use your hamstrings to resist gravity.

Keeping these muscle groups flexible is important too, see my previous post about Hamstring Flexibility.

Area: IT Band

Common injuries: ITBFS, patellar tracking issues, bursitis, hip pain, low flexibility in stride length

Am I imbalanced? The IT band is difficult to “test” on yourself necessarily, you need to think back of any symptoms you’ve had. Is there pain directly on the outside of your knee? Do you feel like someone is pushing your knees together when you’re running? If you touch the outside of your leg, does it feel extremely tight? Can you not foam roll the outside of your leg without wanting to cry?

How can I fix this? If you haven’t invested in a foam roller, do so as soon as you can. It can do wonders for many injuries.  Typically what I have seen is that athletes suffering from ITBFS (IT Band Friction Syndrome) usually has a weak gluteus medius, so doing this exercises are a smart idea. Otherwise another good exercise is to take a theraband (if you have one) and wrap on your ankles for resistance. If you don’t have a band, you can use ankle weights. Be creative, but find some sort of resistance at your ankles that you can tolerate. Lie on your side, and lift your leg up. The motion you will make is a scissor kick, or a “Jane Fonda” style leg lift. Make sure your body stays straight, and you don’t roll forward or backward. Do 20, repeat 2 times.

 

There is a lot to process on this post, if any reader is interested in one particular aspect, I can dedicate a single post to it in the future. Stay tuned for the next post, Part 2, which will address upper extremity deficiencies such as the core, pectoralis muscles, shoulder strength, and others.

FOOSH!

Monday, January 16th, 2012

As athletic training students, and any other allied medical area of study, acronyms are used all the time. Early on in my studies we learned the acronym FOOSH to remember the mechanism of injury (how an injury occurred to cause it) of many wrist pathologies. I thought this post would be good because of Holly Brooks recent wrist injury could have occurred from a FOOSH. Alright, so what is FOOSH?

FOOSH: Falling On (an) OutStretched Hand

We’ve all probably heard this before, but when you are falling you’re supposed to roll or let your body absorb the fall? The last thing you want to do is throw your arm straight out, stiff as a board, to try and catch all of your body weight. Last time I checked your body weighs a lot more than one arm. Of course, we don’t have much time to process how to soften our fall as we are doing the said falling. This causes us to hurt our wrists! FOOSH can lead to multiple injuries including, but not limited to: TFCC injury, dislocation of the lunate bone, Kienböck’s Disease,  scaphoid fracture, hamate fracture, strained wrist ligaments, etc

Don’t think that since we are skiers we are safe from this injury! I was cheering on some junior skiers, and chatted with a boy who did the exact thing I am describing. 

See the large glove and padding attached to the pole? FOOSH injury, he was protecting his cast underneath.

Be careful out there!

Plantar Fasciitis

Monday, May 23rd, 2011

Walking boots really slow ya down, one of the track athletes gave me a helping hand while I covered the conference track meet with Athletic Training

Walking boots/casts are one of the most unfortunate things that can be clamped onto an endurance athlete’s leg. I spent the last six weeks rocking one on my left foot. (The previous owner? Michael Cuddyer of the Minnesota Twins!) Since last summer I started experience pain in my heel, and it persisted and never got better. Being the obsessive student I am, I developed a differential diagnosis to see what could possibly be wrong  with me. My diagnosis was confirmed, and I have plantar fasciitis! What is plantar fasciitis? Well the plantar fascia is connective tissue going from your heel to each toe, and it acts almost as a web holding in the muscles of your foot and helps support your arch. Plantar fasciitis is the irritation of the fascia, caused by repetitive overstretching. My own personal injury is the inspiration for this post. Below I will describe the mechanisms of the injury, warning signs, and how you can try to fix it!

Causes: Multiple things can cause plantar fasciitis, and usually it is a combination of more than one thing. The biggest reason is amping up your training, especially running, at a fast pace.

Symptoms: The biggest indication of plantar fasciitis is heel pain, feeling that your arch is tight, pain with the first few steps getting out of bed, and pain with dorsiflexion (trying to point your toes to the ceiling).

How do I fix it?: The problem with plantar fasciitis is that it is an overuse injury, so don’t expect it to go away in a week. It can last up to 3 months, or in my case about 9 months and counting. Here are some tips to alleviate the pain and help out!

-Wearing a night splint (bought at running stores, or make your own with a compression sock like me!)

-Arch taping/Orthotics

-Kinesio tape (really cool stuff, check out their website… http://www.kinesiotaping.com/kinesio/method.html )

-Plantar Fascae Strip, tape job

-NSAIDs (Ibuprofen)

-Ice massage the bottoms of your feet after activity (freezing a water bottle and rolling it under your feet helps)

-Thorough calf and plantar fascia stretching before and after activity (The plantar fascia is part of a kinetic chain with your Achilles and calf, stretching them all is beneficial)

-Graston, or other forms of massage to break up crepitus (cool stuff again… http://www.grastontechnique.com/)

-Therapeutic Ultrasound

-Iontophoresis (a way to get medication through the skin using electrical current without an injection)

Other suggestions would be to ask your athletic trainer, physical therapist, doctor etc. for help finding the biomechanical source that is causing the problem. A gait analysis might helpful! I hope this injury doesn’t happen to any of you during your training, it is so frustrating!