Category Archives: Preventative therapy

Running Injuries Part 3: Achilles Tendinopathy

Achilles tendinopathy is an overuse injury that commonly affects competitive and recreational athletes involved in running or jumping sports. The incidence of Achilles tendon injuries is highest in runners at any level of experience due to the repetitive nature. The term tendinopathy encompasses both tendonitis and tendinosis, which are the different stages that may occur with this condition. Tendonitis refers to inflammation of the tendon as a result of micro tears from increased stress caused by repetitive loading, overloading and even natural aging. Tendinosis is a degeneration of the tendon as a result of chronic overuse and lack of adequate healing time. Achilles tendon rupture can occur with improper healing of the Achilles tendon or a premature return to sport. When the Achilles tendon has been stressed repeatedly, it becomes difficult for the tendon to withstand further tension and can result in an injury. Exposure to repetitive micro trauma to tendon tissue overwhelms the tendon cells and decreases their ability to repair the fibre damage, causing the tendon tissue to be fatigued. Furthermore, the structure of the tendon becomes disrupted; the collagen fibers begin to slide past one another, breaking their cross-links and weakening the tissue, resulting in inflammation.

Calve muscles and tendonsThe Achilles tendon is the largest tendon in the body. This tendon originates at the junction of the two calf muscles: gastrocnemius and soleus, and then inserts into the heel. The gastrocnemius-soleus musculotendinous unit is responsible for plantarflexion of the ankle and flexion of the leg at the knee. We use these powerful calf muscles for explosive activities like running and jumping, and the Achilles tendon transmits these forces down to the ankle joint. These constant stresses placed on the Achilles tendon increase the chance of injury. Additionally, due to the poor blood flow of the tendon, overuse or overloading in combination with inadequate healing time can lead to injury.
Achiles TendonitisSymptoms begin gradually as a mild ache or stiffness in the back of the lower leg and will eventually progress to constant sharp pain with each step. Pain may be worse when you first wake up in the morning. Runners may experience pain at the start of their run, which eases during the run, followed by an increase in pain after the run. Pain may be accompanied by tenderness around the tendon as well as swelling in the area.

A detailed assessment of the lower limb should include assessment of alignment in standing and during movement to look for any muscle imbalances or incorrect muscle recruitment. Both walking and running mechanics should be assessed for obvious errors. Several factors may contribute to the development of Achilles tendinopathy. Lack of mobility of the hip, knee, foot and ankle may lead to increased strain on both the muscles and tendons of the lower leg. Alternatively, too much mobility in the foot and ankle such as over pronation can also increase the stress through the tendon. These changes to the lower extremities can impact different phases of the gait pattern and running stride, which would then change the workload of the tendon. Additionally, training errors such as sudden changes in intensity, speed, distance, surface, or improper footwear cause overloading of the tendon. As well, not having an effective warm up and cool down for runs can result in injury. Previously untreated injuries to the foot and ankle, such as plantar fasciitis and ankle sprains, can also lead to Achilles tendon issues.

The initial goal of treating Achilles tendinopathy would be to relieve symptoms by controlling inflammation while correcting training errors, muscle weakness and limb alignment. Therapeutic ultrasound is one modality that can be used to reduce inflammation and promote blood flow to the Achilles tendon, facilitating appropriate healing. Other treatment options include bracing or taping to support the tendon while healing and can be used to prevent further injury. During physiotherapy for Achilles tendinopathy your treatment plan will consist of hands on manual therapy to restore movement, and a personalized set of strengthening and stretching exercises. Similar to recovering from other running injuries, gradual return to running would ensure adequate recovery from the initial injury, and help prevent reoccurrence of injury. Incorporation of dynamic warmups before activity is another great way to help prevent injury. Stay tuned for the next topic in our running series, which will show a simple and effective dynamic warm-up for runners.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000

Running Injuries Part 2: Iliotibial Band Friction Syndrome

A common complaint among runners is knee pain; the first part of our running series covered patellofemoral pain syndrome, commonly known as runner’s knee, as one possible cause. For the second part of our series, iliotibial band friction syndrome will be explained as another possible cause of knee pain. This can affect seasoned runners almost as much as beginners, so awareness and prevention is key for every runner.

Iliotibial-bandThe Iliotibial band (ITB) is a thick band of fascia that runs down the outside of the thigh and on the outer aspect of the knee as it continues down to attach on the tibia. Both the tensor fasciae latae and gluteus maximus muscles insert on the ITB. The attachment of the ITB below the knee joint allows the tensor fasciae latae to abduct, medially rotate and flex the thigh, and gluteus maximus to externally rotate the thigh. Both muscles also function to stabilize the knee during extension in walking and running.

Iliotibial band friction syndrome is an overuse injury as a result of the ITB becoming irritated and inflamed as it moves over bony structures on the femur. As the knee extends the ITB moves anteriorly, and it moves back posteriorly during flexion, thus causing friction. Symptoms begin with a gradual onset of dull aching pain that can progress to a sharp, stabbing pain on the outside of the knee or hip. Over time any running or descending stairs becomes painful, and snapping or swelling of the ITB may also occur on the outside of the knee. Sitting for prolonged periods with the knee in a flexed position will also be painful, similar to runner’s knee.

ITB syndrome and runner’s knee share many symptoms, however it is important to note that the mechanisms of injury and therefore the treatments are not the same. Distinguishing between the two is key for an effective and speedy recovery. With runner’s knee the pain is focused around the patella, while the pain with ITB syndrome is felt on the outside aspect of the knee. This makes sense when considering the anatomy – the ITB runs down the outside of the leg, which is where the irritation and pain is felt at the knee. Once the correct condition is identified, targeted treatment and recovery can begin.

At BodyTech Physiotherapy our assessments are focused on identifying the underlying causes of your running injury, ensuring focused treatment aimed at an effective recovery and prevention of your injury from reoccurring in the future. One contributing factor is tightness of the ITB, which can be felt as a tension down the outside of the thigh. The ITB itself cannot lengthen, however tension can be released through foam rolling. Tightness of the muscles that insert on the ITB can also create tension, and stretching of these muscles will help to relieve stress on the ITB.

Another contributing factor is tension on the ITB caused by internal rotation of the thigh. This can be due to both biomechanical and anatomical factors. Gluteus maximus functions to externally rotate the thigh at the hip, along with the piriformis muscle and a number of smaller muscles around the hip joint. If these muscles are weak then they will be unable to effectively stabilize and prevent excessive internal rotation of the thigh during walking and running. The resulting repetitive stress on the ITB can contribute to the development of ITB friction syndrome. Once the weak muscles are identified, a personalized strengthening program will correct the weak areas and reduce stress on the ITB.

Anatomical factors that can cause the thigh to rotate internally include over pronation of the foot or leg length discrepancy. Both of these can be improved with orthotics. Stress on the ITB can also be caused by an increase in running distance, or other training changes such as more hill work, speed work, or change of running surface.

Weakness of the gluteus medius muscle may also contribute to a tight ITB. Gluteus medius functions similar to the smaller tensor fasciae latae muscle that attaches to the ITB. If gluteus medius is weak then the tensor fascia latae will become more active to compensate, placing tension on the ITB. Additionally, if gluteus medius becomes fatigued during a longer run then the tensor fasciae latae muscle will become more active, further contributing to tension on the ITB.

As with any running injury, if running cannot be done without pain during or after the workout, then rest is necessary to allow inflammation to settle and prevent the condition from worsening. Throughout a break from running, cross training is good to maintain fitness provided it does not aggravate the condition. A gradual return to running following active rest and recovery will reduce the chance of the same or new injuries from occurring. During physiotherapy for ITB syndrome, your treatment plan will include hands on manual therapy, and a progression of stretching and strengthening exercises. Some helpful additions to treatment include taping of the knee to relieve tension on the ITB, ultrasound to reduce inflammation and help with healing, and acupuncture to relieve pain. Stay tuned for part three of our running series that will focus on another complex running injury; Achilles tendonitis.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000

Running Injuries Part I: Runner’s Knee

Sunset RunSpring is a great time for outdoor running with the melting snow and rising temperatures however runners should be cautious when switching from indoor to outdoor surfaces. Increased mileage and change in footing as runners move outdoors increases the risk of developing an injury. One of the most common complaints is knee pain, which can be a symptom of multiple injuries. The first part of our running injury series will focus on one of those injuries; patellofemoral pain syndrome, commonly known as runner’s knee.

Runner’s knee is an umbrella term used to describe anterior knee pain, pain behind or pain around the kneecap mainly as a result of misalignment of the patella and muscle imbalances. Symptoms begin with a gradual onset of dull aching pain and swelling that usually starts during a run. Over time any running, descending stairs, kneeling and squatting become painful from the resulting stress on the patellofemoral joint. Sitting for prolonged periods with the knee flexed will also be painful, and grinding noises called crepitus may be present.

There are a number of contributing factors to the development of runner’s knee, which can make it challenging to treat. Any activity that increases the stress on the patellofemoral joint can contribute to the development of runner’s knee as the surrounding tissues become irritated and painful. This can occur with new runners or those who increase the intensity, speed and duration of their runs. Additionally, downhill running and running on firm surfaces, such as asphalt and concrete, increase the stress on the patellofemoral joint.

Muscle tightness, weakness or anatomical/biomechanical abnormalities in the leg can alter the distribution of force through the knee and affect the alignment and tracking of the patella, placing increased stress on the patellofemoral joint. The main areas to consider are the quadriceps muscle, gluteus medius muscle, gluteus maximus muscle, and iliotibial band.

One key muscle is the quadriceps. The four heads of the quadriceps femoris converge into a single tendon that inserts on the patella and continues through the patellar ligament to insert on the tibia, functioning to extend the leg at the knee and stabilize the hip. Another key muscle is the gluteus medius that originates on the hip and inserts on the femur, which also helps to stabilize the pelvis when the opposite leg is raised. If the quadriceps and gluteus medius muscles are weak and unable to stabilize the hip during running, normal force distribution throughout the knee and leg will be altered.

If the gluteus maximus muscle is tight, it will externally rotate the thigh, altering its angle relative to the lower leg, which will disrupt normal tracking of the patella. The iliotibial band runs down the outside of the thigh and inserts on the tibia, but it also connects to the patella via patellar tendons. Tightness of the iliotibial band can pull the patella slightly laterally, increasing stress on the patellofemoral joint.
Additionally, any tight muscles around the knee can affect movement of the patella, potentially causing excessive stress on the joint. Over pronation of the feet causes the leg to drop and internally rotate with each step, which can alter normal movement of the patella.Knee

The first step in rehabilitation is to determine all of the underlying and contributing factors. A detailed physiotherapy assessment will reveal areas of tightness and weakness, as well as any anatomical and biomechanical factors. Tight muscles will be addressed with education on correct stretching techniques and a personalized stretching program. Specific strengthening of weak muscles and correction of biomechanical changes will be addressed with a progression of strengthening exercises from isometric to dynamic, and eventually functional and activity specific. Any hip, pelvis or lower back restrictions will be treated through joint mobilizations. It is important to consider more than just the structures immediately surrounding the knee because stiffness in these other joints will cause biomechanical changes that become more evident with running, and may cause the condition to reoccur if these areas are not addressed. Corrective taping to keep the patella in proper alignment can relieve pain and help to prevent aggravation of the condition during a gradual return to running. Evaluation and correction of footwear, gait and running stride will help to improve running form and improve biomechanics during running.

The goal following physiotherapy treatment is for a pain and injury free return to the previous level of running. Maintenance or improvement of hip, lower extremity and trunk flexibility as well as strength will not only prevent a reoccurrence of runner’s knee, but also protect against other running injuries. Stay tuned for part 2 of our running injuries series to learn about a different cause of knee pain; iliotibial band friction syndrome.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000

The Importance of Posture

Posture types

Person A shows good posture, with a straight line going through the ear, tip of the shoulder, slightly behind the hip joint, slightly in front of the knee joint and slightly in front of the lateral malleolus (ankle) in the foot. The rest of the postures shown are incorrect, with different points of the body deviating either too far forward or too far behind the line that would indicate correct posture.

Posture is not typically on our minds until it starts to cause discomfort or injury. Today’s lifestyle regularly involves sitting or standing for prolonged periods of time, which is often sustained at the expense of proper posture. Posture refers to the position of our bodies, which is created by the different joint angles and the muscles that control those joints. Correct posture requires minimum muscular activity to maintain, which in turn minimizes stress placed on the joints. The opposite occurs with incorrect posture; muscles fatigue in attempt to maintain the altered position and joints are placed under increased stress.

There are a variety of factors that can cause or contribute to faulty posture. Correct posture may be difficult to maintain if joints are too stiff or too mobile, muscles are weak, too shortened or lengthened, or imbalanced. Over time incorrect posture will cause joint stiffness, thus causing the muscles to work harder and may result in pain. At this point, self-correction becomes difficult as it is harder to correct through joint stiffness. Joint stiffness will also result in some muscles becoming weak and others overused due to a change in the starting position of the stiff joint. Early identification of these contributing factors could prevent an injury from occurring, or from becoming a chronic problem that is more difficult to treat.

Possible consequences of poor posture include neck, shoulder, and back pain, or headaches and jaw pain from increased stress on muscles, joints, tendons and ligaments. Muscles will become shortened and tight from being in a slouched position, and the muscles on the other side of the joints will become lengthened and weak from constantly being stretched. The resulting muscle imbalance limits range of motion, changing the way the body moves, which will affect work or sport performance.

A detailed posture assessment by a physiotherapist can identify the contributing factors to poor posture, and is a smart idea for anyone wishing to be proactive and prevent future injury. Once these contributing factors are identified there a number of treatment options that will target the causes of the poor posture, prevent further injury, and help to decrease pain. A strengthening program will be designed to target weak muscles, and stretching will loosen tight muscles. This treatment combination works to correct these muscle imbalances, making correct posture easier to maintain while decreasing pain. Strengthening has the additional benefit of stabilizing loose joints, and joint mobilizations can correct stiff joints. Joint mobilization is a specific hands-on technique to improve joint movement, and can help to relieve pain and restore function. A combination of exercise, manual therapy and education will improve your course of recovery and assist with further injury prevention. Education about how to maintain correct posture in daily activities will allow you to remain pain free and prevent further injury.

Knee pain: Let’s strengthen your hips

How many times have you heard someone complain of ongoing knee pain that has been treated multiple times with no results? In a lot of cases the knee is the source of the pain, but the cause of the problem is weakness in the hips. Knee pain is a very common complaint we treat at BodyTech Physiotherapy for people of all ages and activity levels.blog20140610

At BodyTech Physiotherapy, we look at all the contributing factors that could be causing your knee pain. One key factor that is often missed is the link between the hip and the knee. Weak hip muscles can cause a person’s form to break down slightly, even for everyday activities such as going up and down stairs. Weak hips cannot sufficiently control the motion of the legs. This weakness and loss of proper form places unhealthy stress on the knee joint, resulting in knee pain. In order to treat this type of knee pain, the mobility and strength of both the hip and knee must be restored, as well as correct form must be retrained.

Many people attempt to treat their own knee pain by doing common hip and knee strengthening exercises. However, the most frequent mistakes made when performing exercises are incorrect form during the exercise or starting with an inappropriate exercise; both of which increases the stress on the knee joint resulting in further pain. Our physiotherapists at BodyTech Physiotherapy are trained to recognize and correct these exercise mistakes, as well as prescribe individualized exercise programs that will target the specific muscles at fault and are appropriate for your recovery and activity level.

In addition to helping you return to pre-injury levels, our physiotherapists at BodyTech Physiotherapy will provide you with the education and exercises you will require to help maintain your proper form and function, which in return will decrease your risk of re-injury.