Overuse injuries are very common among distance runners. The repeated tissue stress can lead to such conditions as achilles tendinopathy, patellar tendinopathy, soft tissue and osseous stress syndromes and plantar fasciosis to name a few.  Think it won’t happen to you?  An interesting study published in Foot & Ankle International examined the injury statistics for 291 distance runners and found that the incidence of injury was actually quite high.  The average age of the subjects was 42 years and they ran an average of 65.2 kilometres each week. The following are some of the more interesting findings…

The injury rate was 0.08 injuries for each 1000 kilometres run.
Overuse injuries were more frequent than acute injuries.
The most predominant injury was achilles tendinopathy, affecting 56.6%.
46.4% of the runners experienced anterior knee pain.
35.7% of the athletes experienced shin splints.
12.7% of the subjects experienced plantar fasciosis.
Runners with more than 10 years experience had an increased risk for achilles tendinopathy.

So does this mean you hang up the runners?  Not at all.  We just want you to be aware of the common injuries associated with this type of vigorous exercise.  Consulting with a knowledgeable health professional can be helpful in providing you with a preventative strategy that is specific to your needs.  If you’re in pain, we always recommend that you get your injury examined and diagnosed early before it turns into a larger, more stubborn problem.  Good luck!

References

Knobloch K, Yoon U, Vogt P. Acute and overuse injuries correlated to hours of training in master running athletes. Foot & Ankle International 2008; 29(7): 671-676.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

As part of our initiative to reduce the number of soccer related injuries this summer, this weeks post is going to teach you a little bit about ankle sprains and how we can try and prevent them.  Ankle sprains account for 25-50% of all injuries in sports and 17% of soccer injuries.  An inversion ankle sprain is the most common ankle sprain injury, accounting for 77%.  It usually involves stepping on the lateral ridge of the foot and “going over” on the ankle, damaging the ligaments around the lateral malleolus.

Proprioception is a term that is commonly associated with ankle sprain.  In technical terms, it is the combination of joint position sense and kinesthesia.  In more simple terms, it’s the mechanism that allows us to know and feel the position of our joints without looking at them. Unfortunately, when we injure a ligament and different joint structures (as with an ankle sprain) this mechanism is disrupted and we are more susceptible to injury.  Proprioceptive training is commonly used in sport specific conditioning and rehabilitation in an effort to optimize our proprioception and prevent injury.  Unfortunately, the literature is conflicting as to the efficacy of proprioceptive and balance training for the prevention of ankle sprains.  Yet, since there really doesn’t seem to be a downside to proprioceptive training, we usually recommend them to our patients who may be at risk.  The following is a sample of progressions for proprioceptive training…

1. Stand on one foot.
2. Stand on one foot and move your hanging foot in a star pattern around you.
3. Stand on one foot with your eyes closed.
4. Stand on one foot with eyes open while bouncing a ball off the wall.
5. Progress to training on unstable surfaces (like wobble boards or bosu balls).

Keep in mind that ankle instability and susceptibility to sprain is a complex issue.  Things such as player position, previous injury, bracing, taping, peroneal reaction time and neuromuscular control can all be important components of prevention for some individuals.  We recommend that you consult a suitable health practitioner who has the knowledge and ability to diagnose your condition and assess your specific risk for injury.  Call or email us today and have one of our doctors examine your condition! 

References

Ergen E, Ulkar B. Proprioception and ankle injuries in soccer. Clinics in Sports Medicine 2008: 27; 195-217.

Greig M, Walker-Johnson C. The influence of soccer specific fatigue on functional stability. Physical Therapy in Sport 2007: 8; 185-190.

Hughes T, Rochester P. The effects of proprioceptive exercise and taping on proprioception in subjects with functional ankle instability: a review of the literature. Physical Therapy in Sport 2008: 9; 136-147.

Kofotolis ND, Kellis E, Vlachopoulos SP. Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period. The American Journal of Sports Medicine 2007: 35(3); 458-466.

McKeon PO, Hertel J. Systematic review of postural control and lateral ankle stability, part 1: can deficits be detected with instrumented testing? Journal of Athletic Training 2008: 43(3); 293-304.

Mohammadi F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players. The American Journal of Sports Medicine 2007: 35(6); 922-926.

Ross SE, Guskiewicz KM, Gross MT, Yu B. Assessment tools for identifying functional limitations associated with functional ankle instability. Journal of Athletic Training 2008: 43(1); 44-50.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinics in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractics clinic in Burlington.

Turf toe is a slang term used to describe a common yet frustrating injury that affects athletes like football players and soccer players. In technical terms, it describes a sprain of the plantar capsule and plantar ligaments of the first metatarsophalangeal joint. In simple terms, you likely pushed your big toe too far and the bottom side of the joint has been damaged. Ask any player who is getting ready for the upcoming football season and it’s a really frustrating and painful injury. So what can be done?

Numerous published studies have been able to identify variables that are commonly related to the condition. Unfortunately, many of these variables cannot be changed such as the age of a player and the number of years they’ve been playing. Yet one finding that has been linked to the incidence of turf toe is the range of ankle dorsiflexion. According to the literature, a higher range of ankle dorsiflexion is linked to a higher incidence of turf-toe. Therefore, particularly for the athlete with a history of turf-toe and those with a rather generous range of ankle dorsiflexion, it may be advised to brace or tape the ankle before competition. Depending on the case, it may also be advised to wear less flexible shoes, tape the first metatarsophalangeal joint and/or wear a rigid orthotic.

Perhaps another example of how an increased range of motion in a given joint (in this case the ankle) may not be such a helpful thing!

References

Rodeo S, O’Brien S, Warren R et al. Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. The American Journal of Sports Medicine 1990; 18(3): 280 - 285.

Sahin N, Atici T, Bilgen S, Bilgen O. Turf toe in a taekwandoo player: case report. Journal of Sports Sciences and Medicine 2004; 3: 96-100.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

As the popularity of paddling and rowing is on the rise, so are the number of injuries we’ve seen at our clinic that are associated with these sports. The most frequently injured area is the lower back which accounts for 15 - 25% of these injuries. Two of the more common lower back injuries associated with paddling and rowing are lumbar disc herniation and a spondylolysis / spondylolisthesis. 

In the case of lumbar disc herniation, repeatedly flexing the spine forward can lead to a weakening of the outermost structure of the disc, eventually allowing the inner “jelly-like” material to bulge out. More often than not, this inner material protrudes posteriorly (backwards) and laterally (to the side). This movement of discal material can cause pressure and / or irritation of the nerves which exit the spine, often leading to sensations of pain, numbness and tingling into the buttock and leg. For many rowers, the repeated flexion and extension of the spine creates muscle fatigue and a loss of support, compression and herniation of the lumbar disc.

Spondylolysis typically involves an acute or stress fracture at the pars interarticularis and can lead to a forward displacement of one vertebrae relative to the one below (spondylolisthesis). The risk of developing a spondylolisthesis greatly increases in sports that demand a significant level of hyperextension or extension and rotation of the lumbar spine. As mentioned above, rowing and paddling are good examples.

Given the fact that these are all non contact injuries, one can assume that they are preventable to a certain degree. Here are some tips to think about as the rowing season goes into full tilt…

1. Maintain a neutral spine throughout the entire stroke. Rowers who adopt a slumped position at the catch or finish tend to have a higher incidence of low back injuries.
2. Maintain an anterior pelvic tilt throughout the catch phase to decrease the amount of lumbar flexion necessary and thus reducing the amount of stress on spinal structures.
3. Endurance training should be emphasized in the lumbar erector spinae muscles to help reduce excess flexion of the lumbar spine.
4. Stretching of the hamstrings and gluteals can help to obtain an adequate anterior pelvic tilt. Stretching the hip flexors may also help to decrease the amount of anterior pull on the spine.
5. Finally, many injuries are actually created or worsened by your actions on land and in the gym. Be sure that you have proper instruction on technique and training regimen before beginning an exercise program.

References

Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Medicine 2005; 35(6): 537-555.

Ho SR, Smith R, O’Meara D. Biomechanical analysis of dragon boat paddling: a comparison of elite and sub-elite paddlers. Journal of Sports Sciences 2009; 27(1): 37-47.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

With the Tour de France in full swing we thought it would be fitting to address a common cycling injury for this weeks blog; patellar tendinosis.

The patellar tendon is located below the patella (or “knee-cap”) and is an extension of our quadriceps muscle (the muscle on the front of your thigh).  It is placed under tension when the quadriceps muscle is active, like when we push the pedal downward during cycling.  Patellar tendinosis is a condition that involves degeneration and a re-organization of tendon tissue, usually secondary to excessive demand being placed on the area.  But why do some cyclists get patellar tendinosis while others do not?  The reality is, there are a large number of factors that can be related to patellar tendinosis in cyclists…too many to mention in this article.  Yet one finding that has been consistent in the literature is that those athletes who experience pain show a different movement pattern than those not in pain.  Specifically, those in pain use a cycling technique similar to the red line in the picture, while those who haven’t experienced a knee injury tend to have a movement pattern similar to the green line.    Unfortunately, it has not been established (and perhaps cannot be established) whether this technique occurs as a result of injury or if it precipitates injury.   Regardless, we recommend that you make every effort to use a cycling pattern similar to the green line in the picture above (and don’t let your knee drift toward the midline).  If you’re having difficulty, it can be due to several reasons.  Poor range of motion in the ankle or an ill-fitted bicycle may prevent proper technique from being possible.  In either case, we recommend that you consult with a suitable professional who can offer you assistance.  If you’re just unsure what the proper technique looks like, turn on your television before it’s too late!

References

Bailey MP, Frederick JM, Messenger N. Kinematics of cycling in relation to anterior knee pain and patellar tendonitis. Journal of Sports Science 2003; 21: 649-657.

Dettori NJ, Norvell D. Non-traumatic bicycle injuries - a review of the literature. Sports Medicine 2006; 36(1): 7-18.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.