3 Knee Exercises to Keep You Running Pain Free

You may be training for your first 5km, or be a more seasoned runner striving toward a half marathon or marathon. Whatever your end goal, the key to completing your race is to remain injury free as your running starts to build-up.

Knees are often the most problematic of injuries sustained through running. Knee injuries such as Patellofemoral Pain (Runner’s Knee) and IT Band Syndrome are two of the most common injuries experienced by distance runners.

Thankfully there are some simple, but often forgotten steps, you can take to help prevent such injuries, and keep you running without knee pain. These preventive exercises are likely the same as exercises your health care professional may give you to treat such running knee injuries.

Simple Runner’s Knee Exercise Routine

It’s always best to perform the following exercises after a gentle warm-up, rather than stretching from cold.

  • Side Lying Quads Stretch: 3 x 30 seconds on each leg
  • Resistance Band Glute Bridge: 10 x 5 second hold
  • Romanian Single Leg Deadlift: 3 x 10 reps on each leg

Aim to complete this routine 3-4 times weekly alongside your running.

Shoulder Rehabilitation

Shoulder injuries are very common in athletes who play overhead sports ie swimming and baseball, as well as individuals who do a lot of work overhead ie. Electricians and carpenters.
The shoulder consists of two anatomical joints: the Gleno-humeral joint and the Acromio-clavicular joint. The Gleno-humeral joint is the connection of the arm with the scapula (“shoulder blade”) The Acromio-clavicular joint is the connection of the clavicle (“collar bone”) and the scapula.

A large number of muscles and ligaments are important to the shoulder. The most important are the rotator cuff muscles (supraspinatus, subscapularis, infraspinatus and teres minor) and the Acromio-clavicular ligaments along with the Gleno-humeral joint capsule. The rotator cuff is a group of muscles and tendons, which hold the Glenohumeral joint together and help lift the arm overhead, such as throwing a ball or swimming.

A typical shoulder rehabilitation protocol consists of two major components; flexibility and strength. 

Flexibility is the first component of shoulder rehabilitation and consists of range of motion (ROM), static stretching, and dynamic stretching. ROM is desired degrees of range of motion of movement pattern that is pain free and maybe assisted with a stick/ towel or unassisted.
Static stretching are stretches that are pain free and held for 20-30 seconds and repeated 3-6 reps. Dynamic stretching are stretches that are pain free and held for 1-5 seconds and repeated 10-15 reps. 

Strength is the second component of shoulder rehabilitation and consists of dumbbell, tubing, and functional exercises.

 

Lower Body Injury Prevention

Lower body injuries are common in athletics and often result from poor body mechanics, particularly poor control over the motion of your knee. When you are running, forces from the ground run up into your feet and travel along a kinetic chain throughout your leg.  Injury may result if those forces add up to be too much, or in the wrong place, along that kinetic chain (e.g., ACL tear).  

Knee pain

Knee pain is a common overuse injury often caused by patellofemoral pain syndrome – when the cartilage behind the kneecap gets roughened and irritated. Pain occurs when there is increased pressure between the femur (thigh bone) and patella (kneecap). Although some may be prone to such knee pain due to genetic factors, other causes include overuse, weak thigh muscles, obesity, flat feet, knock-knees, and worn out shoes.

In order to prevent knee problems, be sure to warm up, cool down, and stretch in the time surrounding workouts (especially after work-outs). It’s particularly important to keep your front and back thigh muscles flexible. Wear shoes appropriate to the sport you’re playing, and make sure they’re not worn out and that they have good arch supports.

If you suffer from a painful kneecap, avoid kneeling or sitting with your legs crossed. Don’t sleep on your stomach because this puts direct, constant pressure on the kneecaps. Instead, sleep on your back with a pillow under your knees or on your side with a pillow between the knees. If you like to use stairclimber machines, try taking smaller steps. Once you no longer suffer knee pain, try doing exercises such as straight-leg raises. Either sitting in a chair or lying down, hold your leg out straight and raise it off the ground to strengthen the quadricep muscle without irritating the patella. (Lunges and squats are good exercises, too, but could be damaging to the knees if done improperly).

Shin Splints

Shin splints are a common overuse injury that develops over time in athletes who pound their legs – runners, sprinters, figure skaters, gymnasts, etc. Pain occurs on the inside of the lower leg, where the soleus muscle of the calf attaches to the shinbone, or tibia. Running and other weight-bearing exercises exacerbate pain. In order to prevent shin splints, train on softer surfaces, such as grass or a treadmill, or engage in lower-impact workouts, such as swimming or cycling. Proper footwear is essential for runners to reduce the stress of impact. Ice is the best treatment for shin splints, and massage can help as well. Taping the shins can relieve pain, but should not be used to enable exercise on injured legs.

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Stress Fractures

Stress fractures are tiny cracks in the bone, which occur when muscles are overexerted and lose the ability to absorb shock, which is then transferred to the bone. People who develop stress fractures are usually those engaged in repetitive weight-bearing activities, such as running, tennis, basketball, and gymnastics. Having flat feet, rigid arches, or osteoporosis will increase your risk of a stress fracture, which typically occurs in the lower leg or foot. To prevent such injury, build up the intensity and duration of your exercise routine gradually so your muscles have time to strengthen. Symptoms include pain that increases with time and is still painful after a few days. The pain increases with activity, and there may or may not be swelling. You should go to a doctor if the pain doesn’t go away after 2 days of rest.

Sprains

A sprain occurs when a ligament (the fibrous tissue that connects bones) is overstretched or torn, but there is no dislocation or fracture. The sprained joint will cause immediate pain, swelling, bruising, and warmth at the injured site. As the sprain heals, the damaged ligaments and connective tissue will be replaced by new fibrous tissue that is stronger, but not as flexible. This is why it’s important to move and stretch the injured site during the healing process, as long as it doesn’t cause pain. The joint may not fully recover for many weeks.

To treat sprains, follow R.I.C.E. (described below), and make sure ankle sprains are elevated above heart level even during sleep. Standing or dangling the leg can lead to more swelling, throbbing, and pain. Do not treat acute sprains with heat, only ice.

The best pain reliever to take right after injury is Ibuprofen because it is also anti-inflammatory (decreases swelling). Acetaminophen (Tylenol) is not an anti-inflammatory and Aspirin will increase internal bleeding if taken within 24 hours of the injury. Always consult a physician for information on use of medications. Crutches are useful if the leg cannot bear weight fully, but early walking is important to prevent tightening of the tendons that connect muscles to bones.

Strains

Strains are often the result of overuse or injury, when muscles or tendons are overstretched or overexerted. While sprains concern ligaments, strains affect tendons, the tissue that connects muscles to bones. Strains cause pain, tenderness, swelling, and bruising at the injured site. Because sprains and strains affect different types of tissue, you can have both types of injury at the same time. For example, an ankle sprain and a strain of the Achilles tendon.

Tendonitis (also spelled “tendinitis”)

Tendonitis is any inflammation or irritation of a tendon, which connects muscles to bone. The condition causes pain, tenderness, and stiffness near a joint, usually around the shoulders, elbows, and knees, and is commonly the result of injury or overuse. The pain of tendonitis is aggravated by movement, so rest, ice, and pain medication is usually the best treatment. In order to avoid tendonitis, don’t participate in activities that place abnormal amounts of stress on your tendons, such as running uphill. Also, try cross-training to limit and spread out high-impact workouts, such as running.

Treating Sprains, Strains and other Sports Injuries

If the injury does not appear serious, stop what you’re doing and use R.I.C.E.:

  • Rest the injured area as much as possible for 24 to 48 hours.
  • Ice the injured area as soon as possible for 20 minutes on and 20 minutes off. After a couple hours you can reduce icing to 20 minutes 4 times a day.
  • Compression. Apply an elastic bandage to the area to control movement, but loosen it if you feel numbness, tingling, or increased pain.
  • Elevation. Raise the injured area above heart level.

Full return to activity should be avoided until full range of motion no longer causes pain.

 

Patello-Femoral Pain Syndrome

Patello-femoral pain syndrome is an inflammation to the front of the knee joint caused by the patella (knee cap) not tracking properly over the distal femur (thigh bone at the knee). The patella normally rides in a groove on the femur. The patella is like a fulcrum, it gives leverage to the big muscles on the front of the thigh. These thigh muscles are called the quadriceps because they consist of four muscles

With patello-femoral syndrome (PFS), you get an imbalance in these muscles—usually the lateral or outside muscle overpowers the inner medial muscle, and this pulls the patella out of its normal groove. When the patella doesn’t track properly, it causes pain under the patella. PFS can have multiple causes, which can include foot problems, such as foot pronation, weak lateral hip muscles, genu valgum (knock-kneed), and a larger Q-angle (the angle from the front hip to middle of the knee cap). These can all affect the biomechanics of the patello-femoral joint. When experiencing these problems with your knee, it’s important to find ways not to keep it irritated.

Occasionally, the injuries start with a clear-cut onset, like stepping in a hole or falling on your knee. Usually, though, it feels like it comes out of nowhere. This means that you’ve been gradually creating the injury over a longer period of time like a few days or weeks. Something that you do during the day sets it off, but it’s commonly very hard to figure out was exactly is the aggravating activity. Nonetheless, you’ve overdone it. Try not to worry if you can’t figure out exactly why your knee got sore. That may not be necessary to determine in order to get better. The more often you make your knee sore, the longer it will take to get better.

The inflammation seldom builds up to a level where it keeps you in bed, so it’s tempting to keep up and about on it. This may keep it stirred up. Try to avoid all the activities that make it sore, i.e., sitting with your knee bent for a long time, walking a lot, going up and down stairs, or exercising. While it doesn’t cause more damage, it does keep the inflammation from going away. You may find it helpful to sit with your knee straight or get up and move around occasionally. Also, try stairs one step at a time using your uninjured leg. These knee injuries can be very stubborn before they get better. The sooner you stop aggravating it, the sooner you can get back to the activities you like.

Low Back Pain & Core Strength

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Low back pain can be the result of many different things. Pain can be triggered by some combination of overuse, muscle strain, and/or injuries to the muscles, ligaments, and discs that support the spine. Over time, a muscle injury that has not been managed correctly may lead to an overall imbalance in the spine. This can lead to constant tension on the muscles, ligaments, bones, making the back more prone to injury or re-injury.

Since low back pain can be caused by injury to various structures in the spine and its supporting structures, it is important to consult your professional health care provider if you have had back pain lasting longer than 1-2 weeks. They can provide a diagnosis and explain what structure is injured so that appropriate treatment and exercises can be prescribed for your specific injury.

Each diagnosis is treated with different protocols, therefore it is important that you consult a health care professional before beginning any strenuous rehabilitation program. Low back exercises and flexibility can be the best treatment option for almost all types of back problems as it is likely to help restore balance in the spine. Low back exercises concentrate on strengthening with the abdominal muscles, to be able to give stabilization of the spine. Rehabilitation programs or preventative rehabilitation programs that focus on strengthening lumbar muscles combined with core stability and proprioception will reduce the risk of low back pain if exercises are done correctly, and on a regular basis.

Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS) is the result of inflammation and irritation of the distal portion of the iliotibial tendon (see illustration) as it rubs against the bursa that lies underneath the tendon and lateral femoral condyle (outer part of the thigh bone at the knee), or less commonly, the greater tuberosity (outer part of the thigh bone at the hip). This overuse injury occurs with repetitive flexion (bending) and extension (straightening) of the knee. This could also occur because of a lack of flexibility of the ITB, which can result in an increase in tension on the ITB during activity. When experiencing these problems with your knee, it’s important to find ways not to keep it irritated.

Occasionally, the injuries start with a clear-cut onset, like stepping in a hole or falling on your knee. Usually though it feels like it comes out of nowhere. This means that you’ve been gradually creating the injury over a longer period of time like a few days or weeks. Something that you do during the day sets it off, but it’s commonly very hard to figure out was exactly is the aggravating activity. Nonetheless, you’ve overdone it. Try not to worry if you can’t figure out exactly why your knee got sore. That may not be necessary to determine in order to get better.

The more often you make your knee sore, the longer it will take to get better. The inflammation seldom builds up to a level where it keeps you in bed, so it’s tempting to keep up and about on it. This may keep it stirred up. Try to avoid all the activities that make it sore, i.e., sitting with your knee bent for a long time, walking a lot, going up and down stairs, or exercising. While it doesn’t cause more damage, it does keep the inflammation from going away. You may find it helpful to sit with your knee straight or get up and move around occasionally. Also, try stairs one step at a time using your uninjured leg. These knee injuries can be very stubborn before they get better. The sooner you stop aggravating it, the sooner you can get back to the activities you like. If you have given it enough time to rest and it still persists, it is time to make an appointment to have it properly assessed and suggestions on possible treatment and rehabilitation.

 

Five Things You May Not Know About Back Pain

Low back pain is a major health issue. It affects 84 per cent of the working population at some point in their life and is second only to the common cold as a cause of lost work time. But back pain doesn’t have to hijack your sick days. Here are some universal ‘back facts’ to keep in mind if you catch yourself suffering from this pesky problem:

Rest vs. Staying Active

If you’re injured, you may have been told to rest until your injury has healed. However, avoiding exercise is the worst thing you can do when you are experiencing minor back pain. It is important to stay active when recovering from injury, but it is best not to exert yourself. You should reduce normal physical activities but continue to be as active as possible. At the end of the day, those who maintain active therapy recover quicker.

Slipped Disc

Your spinal column is made up of 26 bones (vertebrae) that are cushioned by disks. The disks protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting. Injury or weakness can cause the inner portion of the disk to protrude through the outer ring. This is known as a slipped or herniated disk and can cause pain and discomfort in your lower back. In most cases, a slipped disc will revert back to its position spontaneously, but it can take four to six weeks to fully recover. You may have heard it’s best to rest your back if you have a slipped disc, but actually, remaining moderately active is ideal in order to keep muscles and ligaments warm and reduce the risk of creating more tension in your back.

Hot vs. Cold

Most people believe that a hot bath reduces back pain. The reality is that even though it may sound soothing, getting into a hot bath when muscles are inflamed can make matters worse by increasing the inflammatory response in an acute injury. Generally, it is better to apply ice to an injury for 15 to 20 minute intervals, during the first 48 to 72 hours after the injury.

Massages

When people have back pain, they often book the earliest massage. The truth is, when you’re in pain, a massage may help in some cases and hurt in others, depending on the cause of the back pain. For instance, the lower back may feel tight because of a muscle spasm occurring in an unstable region. A massage to this area without truly assessing the source and the reason for its tightness can inhibit the body’s way of protecting itself and cause more instability, thereby causing more pain.

Back pain and aging

No matter how many birthdays you celebrate, back pain should not become a normal part of aging. As we age, it‘s true that we can become more susceptible to certain types of painful back conditions. However, with all of the treatment options available today, back pain does not have to be a part of the aging process.

Anyone experiencing back pain is encouraged to consult a health care professional to assess your specific needs and identify a course of action that’s right for your specific condition.

Sources:
https://www.chiropractic.on.ca/public/your-back-health/5-things-back-pain/
http://www.huffingtonpost.com/2014/04/20/back-pain-_n_5126343.html
http://www.healthline.com/health/herniated-disk#Overview1
http://www.knowyourback.org/Documents/9myths.pdf
http://www.nhs.uk/Conditions/Slipped-disc/Pages/Treatment.aspx

 

Plantar Fasciitis (Foot Pain)

Our Feet are our Foundation – What can you do about foot/heel pain?

Most people can identify with taking the first few steps out of bed in the morning and feeling a searing pain in the bottom of their foot. It appears to get better when further steps are taken. It can come back often if you are on your feet for long periods of time, or at the end of the day. You can also experience it during or after exercise; such as running, or with weight changes; such as with pregnancy.

If you have had this foot pain, you are not alone. We have all had this issue at one time or another. It is part of the charm of being human and upright, bearing our full body weight on our feet.

The clinical name is Plantar Fasciitis pronounced (PLAN-ter fash-ee-EYE-tis) or Plantar Fasciosis, if it has been around for a while.

What is plantar fasciitis and why does it happen?

The plantar fascia is a band of tissue (ligament) in the bottom of our foot that connects the heel bone to the toes. Its job is to support our foot when we stand, walk or run. When we bear the full weight of our body on our feet it exerts an immense amount of force through this ligament. Excessive force can cause the plantar fascia to overstretch from the toes into the heel, much like a thick elastic band. If the strain continues enough, it then pulls on the heel causing small micro tears. These tears lead to pain and swelling. However, your body is an amazing machine, and it will try to repair itself. The constant tugging at the heel bone can cause a boney growth to form on the bottom of the heel bone. This is called a bone spur, and can be detected by an x-ray. Most people forget that bone is a living, growing tissue in our body. It continually changes based on the forces you apply to it. So if the plantar fascia is constantly pulling on the heel bone, more bone will form to support that extra force. It will attempt to strongly attach the fascia to the heel bone to prevent it from pulling the tendon right off of the bone. Our bodies are truly amazing!

How do health care providers diagnose plantar fasciitis?

We examine your feet and speak with you about the history of your problem. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. That is done with a thorough examination of your feet testing the muscles, joints and function of the foot while you are standing and walking.

One thing we often over-look are the basics we learned in school, which comes in the form of a song. The foot bone’s connected to the..ankle bone, the ankle bone’s connected to the…knee bone…to the hip bone…etc. Not only are we upright creatures, but walking is a very complicated process for all of these joints and muscles to work together in concert to move us around. Often as a chiropractor I see a foot problem show up as pain in the hip, knee or even the low back. Again, this shouldn’t come as a big surprise. If a problem goes on long enough, our body responds by trying to correct itself. Unfortunately, it doesn’t always do so in a positive way.

Thus, it is important to further assess your muscles and joints of the entire leg and hip, to determine if there might be a bigger issue at play here. Why did you get the foot pain? What can be done in the future to help prevent it from happening again?

Once your examination is complete, and we have confirmed that it is plantar fasciitis, we have treatment options that will help speed your recovery. Treatment will often help you return to your active lifestyle more quickly. Most often, in fact 90% of the time plantar fasciitis will resolve with non-invasive and non-surgical treatments.

How is it treated?

It is important to note, there is no single treatment that works best for everyone with plantar fasciitis.

Here are a few things to try first on your own:

Give it some rest. If you are a runner, change to a softer surface. Or change to biking, swimming or an elliptical machine.

* Roll it out with a tennis ball a couple of times a day, for a minute each time.

* Stretch out the foot, toes and also the calf with basic heel stretches off of a step or toes against a wall.

* Roll it out on a frozen water bottle at the end of the day, to help relieve pain and bring down inflammation.

If it is persistent and you have given it some time to “work itself out”, then it is likely time to see a therapist. Don’t wait too long, 6-8 weeks is enough time.

A doctor may recommend splints worn at night, non-steroidal anti-inflammatory medications or possibly an injection of medication into the heel. An x-ray may be ordered to rule in or out other possibilities.

A therapist (chiropractor, physiotherapist, massage therapist, osteopath) may recommend more advanced non-invasive techniques.

Often the first treatment we use is to control pain and swelling with use of ice packs and soft tissue massage. We also give you exercises to improve flexibility in the calf muscles and plantar fascia. (these are similar to the suggestions listed above).

Although a customized orthotic can be useful, it is used conservatively if the problem is persistent. An orthotic is often not a long-term solution, unless there are structural issues that will not change with therapy. To provide temporary relief, we may recommend the use of a heel cup or a silicone heel pad which can reduce the pressure on the area of pain.

One of the most effective non-invasive techniques I have encountered so far has been Extracorporeal Shockwave Therapy, simply known as “Shockwave”. There has been scientific research to support its effectiveness (75-95%), along with our success clinically. It is a non-surgical treatment, with no side effects, available at a reasonable cost. The treatments are non-invasive and promote a rapid recovery of injured soft tissue, bone and heel pain.

What is Shockwave?

It is an intense, but very short energy wave traveling faster than the speed of sound. This technology has been used for decades for millions of people for issues such as breaking up kidney stones.

Therapy sessions are short, usually 20-30 minutes, and provide successful relief of chronic pain and restore mobility. Permanent relief typically begins about 72 hours following treatment. Typical treatment plans consist of 3 treatments, spaced a week apart. Most insurance companies will cover this therapy.

In addition, there are often joints and muscles in your foot &/or leg &/ hip that are not working properly. These mechanical issues often cause or contribute to the foot pain. We often perform soft-tissue massage, mobilize joints and teach strengthening exercises to further provide pain relief and prevent future problems.

Often the best results take a combination of different approaches and can take some time. You may have less pain within a few weeks, but it may take a month or so for the pain to go away completely. It really depends on a number of variables. In some situations, it can take up to a full year or more for the problem to be completely resolved. So don’t get discouraged. Continue to be diligent with your exercises and therapy recommended by your health care professional.

Please book a consultation at our office if you would like us to provide you with more information regarding Plantar Fasciitis or other muscular and skeletal complaints you may be experiencing. We are here to help you bring your optimal health back into balance.

as published on Huntsville Doppler