Hamstring injury

Hamstring injuries are common in sports involving running. It is more common in sprinters but I also see a fair bit of long distance runners that pull there hamstrings. The main problem with hamstring strains is there high recurrence rate. Some studies suggest that one out of three athletes will re-injure there hamstring within a year of returning to there sports.

The hamstring is a muscle located at the back of your thigh. When you pull your hamstring muscle, there will usually be a tear in the muscle. This is followed by some bleeding and inflammation inside the muscle. Depending on the degree of the tear you may or may not see a bruise. Soon after, your body will start repairing the area by laying down scar tissue and new muscle cells will start forming.

Traditionally, these injuries have been treated with stretching and strengthening directed to the hamstring muscle itself. Due to the high reoccurrence of these injuries; clinician and researchers have been looking into other type of treatments for this problem. A study published by Sherry & Best (2004) published in the Journal of orthopaedic sports physical therapy has shown that agility exercise and core exercises might be better to prevent hamstring injuries from recurring.

When running, multiple muscles have to work in synergy to help us run efficiently. A lot of runners tend to get muscle imbalances in there core and hip muscle. When running these muscle imbalances often lead to the pelvis being unlevelled. The hamstring attaches right at the bottom of the “sitting bone” which is part of the pelvis. The hamstring is often called the weakest link of the chain. Therefore if your core and hip muscle are not working properly and your pelvis drops every step you take; this will lead to a constant pulling of the hamstring muscle. Over time, the hamstring gets overworked and strained. This could also explain why the study by Sherry & Best helped to reduce the reoccurrence of hamstring injuries, by rebalancing the core and hip muscles.

My personal approach to get athletes back to there sport as soon as possible also involve decreasing the inflammation in the initial stage of the injury (with ice). And after the muscle starts to lay down scar tissue, I use a few muscle treatment techniques. One of them is called Graston Technique. But, the injury can only be prevented from reoccurring by properly addressing the cause of the injury, which is the muscle imbalances present in the hip and core muscles.

Tendonitis or Tendinosis?

A tendon is the structure that connects a muscle to a bone. Endurance athletes are predisposed to tendon injuries due to the prolonged stress that they put on there bodies. Often athletes with tendon injuries are diagnosed with “tendonitis”. The “itis” suffix means inflammation. For example, if someone is diagnosed with Achilles tendonitis this would mean that there is inflammation in there Achilles tendon. However, in the past few years scientific research has shown that tendonitis is rarely present in chronic injuries because there is a lack of inflammatory cells. Inflammation will be present in some cases, if it’s new injury for example. But if your tendon has been painful for a while and not getting better the proper diagnosis might be tendinosis. The suffix “osis” means; affected with, condition or abnormal process. In a tendinosis the tendon is affected with a degenerative process or a build up of scar tissues.

In my practice I rarely find tendonitis problem in endurance athlete but more often tendinosis. The importance of a specific diagnosis in this case will change your treatment. If you are diagnosed with tendonitis, the treatment will usually be geared towards reducing the inflammation. So you will use ice, you might even use anti-inflammatory medications. If you have a tendinosis the treatment will be completely different. The treatment plan will be geared towards breaking down the scar tissue. In my practice I use Graston technique and myofascial release techniques to break down that scar tissue. Eccentric loading exercises have also been shown to be effective in treating tendinosis. It is important to get a proper diagnosis and not try to treat yourself because there is a risk of getting worse or even tendon rupture.

To summarize, tendonitis is rarely seen in endurance athlete, tendinosis is more often found. Proper diagnosis will lead to proper treatment and help you get back to your sport faster and pain free.

Plantar Fasciitis

I often get patients walking in my office with a complain of heel pain. There are multiple causes of heel pain one of them being plantar fasciitis (plant-er-fa-she-eye-tes).

What is plantar fasciitis?
The name plantar fasciitis is somewhat misleading. The suffix “itis” means inflammation. And the plantar fascia is a band of fibrous tissue that extends along the bottom of the foot from the heel to the toes. Therefore plantar fasciitis should mean inflammation of the plantar fascia. However, in recent years it has been found that there is usually no inflammation present. What has been found is degeneration in the plantar fascia (scar tissue).

What is scar tissue?
With overuse of the plantar fascia, tiny tears form in the tissue. In the healing process our body attempts to repair that fascia with scar tissue, much like that scar that forms on the skin when you have scrapped or banged your elbow. As you can imagine, scar tissue is not as strong and flexible as normal, healthy undamaged tissue. Over time we can have a build up of this fibrous scar tissue if too much stress is put on the plantar fascia. This can lead to pain and dysfunction because this replacement tissue lacks the strength and flexibility of healthy tissue.

What are the symptoms of plantar fasciitis?
The classic symptoms of plantar fasciitis is pain under the heel that is worse in the morning or prolonged period of rest. The first few steps are really painful and that pain decreases with walking. When more advance there is also pain during normal activities.

How is plantar fasciitis treated?
Rest, ice and anti-inflammatory have traditionally been advised for plantar fasciitis with limited results. Some people may have this pain for months and even for more then 2 years with improper treatment. Since there is usually no inflammation but a scar tissue build up it important to break down the scar tissue. One soft tissue treatment technique that I use in my office is Graston technique. Patients usually notice an improvement of there symptoms on the first treatment. For more information on Graston technique visit my website at www.inbalancechiro.ca

How's your balance?

One thing I always do when I get athletes coming in my office with lower limb injuries, is to check there balance. Balance is an essential function of the locomotor system. It is often ignored but no less important than flexibility, strength, endurance, or aerobic fitness. Balance is an important part of the rehabilitation of certain injuries. It is also important part of injury prevention programs in runners. Balance training has been shown to improve strength in the hips and legs and is less time consuming than strength training programs. It’s also important to note that in the past few years research has shown that people with weaker hip muscles tend to get more leg and low back injuries.

Poor balance in otherwise healthy individuals may be due to previous injuries that were not properly rehabilitated, muscle imbalance, poor sensation coming from the sole of your feet, or other causes. Balance depends on the somatosensory, vestibular and visual systems. The somatosensory system gets sensory information for balance from the soles of the feet, the neck, and the lumbar spine for inputs. If two of the previously mentioned systems are not working properly, our balance will be affected.

Do the following test at home. Stand on one leg. Begin with eyes open and practice once or twice on each side. Then by looking straight ahead close your eyes and try maintaining your balance. If the foot touches the opposite leg, hopping occurs, the other foot touches the floor, or the arms touch something for support the test is stopped. You have 3 chances on each side to reach your best time.

Depending of your age you should be able to stand on one leg, eyes closed for a minimum of the following length of time.

20-49 year of age→ 24.2 seconds
50-59 year of age→ 21.0 seconds
60-69 year of age→ 10.2 seconds
70-79 year of age→ 4.3 seconds

If you can’t reach these times it may be important for you to get assessed to determine the cause of your poor balance and prevent injuries.

One easy exercise to work on your balance is to try holding your balance on one leg for 30 seconds. Perform the routine three to four times per leg twice daily until you can comfortably keep balance for 30 seconds. After that proceed with your eyes closed until you reach 30 seconds again.