Showing posts with label Achilles pain. Show all posts
Showing posts with label Achilles pain. Show all posts

Thursday, 16 March 2017

The pelvis and its role in functional movement

What is functional movement?

Functional movements are movements based on real life situational biomechanics. For example, squatting and lunging. Your body is an integrated system. This means your muscles do not work in isolation. They work together with other muscles to produce movement. For example, the biceps muscle flexes the elbow, but there will be other muscles acting as synergists (pecs and deltoid muscles) to help control the movement. Other structures in the joint such as ligaments also play a role in helping to create movement by providing stability through certain movement patterns. A dysfunction in these movement patterns can cause a decline in athletic performance and therefore injury and pain.


back pain



4 important sling systems of the pelvic region

1.      Anterior oblique system – external and internal obliques and opposing groins, along with the intervening abdominal fascia. This is involved in stabilisation of the lumbar spine, thoracic spine, rib cage, pubic symphysis, and hips. It also helps with whole body pushing movements and helps transfer forces between the upper and lower body (Lee, 1999).

2.      Posterior oblique system – the lats, thoracolumbar fascia and opposing glute maximus and medius. This involves stabilisation of the lumbar spine and sacro-iliac joints. It helps to turn out the kinetic chain, helps with whole body pulling movements and helps transfer forces between the upper and lower body. This system is most commonly seen in gait because of its fight to control rotation of the pelvis which occurs in the gait cycle (Lee, 1999).

3.      Lateral system – gluteus medius and minimus, groins and opposing QL (lower back muscle). This helps to provide lateral stability in the pelvis, for example, walking and climbing stairs etc. It deals with single leg movement patterns and whole body frontal plane (sideways) movement. It also helps transfer forces between the upper and lower body. A weakness in this system can lead to hip pain, knee pain, ACL injuries and ankle sprains (Lee, 1999).

4.      Deep longitudinal system – spinal erectors (lower back), thoracolumbar fascia via sacrotuberous ligament, biceps femoris (hamstring), head of fibula, peroneals and tibialis anterior (shin muscles). This system helps to create stability of the lumbosacral complex and the foot and arch complex. It helps to control supination and pronation of the foot from heel strike through to mid-stance of the gait cycle. During high intensity activity, it provides a communication for proprioceptive information about ground reaction forces (Lee, 1999).

As a population, the focus is more pointed towards “posterior chain” work because of tight hip flexors and quads. Sometimes, this isn’t the case with athletes and the development of exercise programs should be dealt with more profoundly. Understanding the mechanics of the body is an important part of creating better exercises for better pain free movement.
The components of fitness are extremely important for optimum health. Many people workout to become stronger for their sport, run quicker, lose weight, improve mobility, increase stamina and for the general feel-good factor. These are all great reasons to train, but there is so much more to training then this. We need to think about training our neuromuscular system! What about balance, co-ordination, agility, power and reaction time? These components are just as important as strength training or endurance training. If you do strength training in the gym or you do long runs and keep getting aches and pains, maybe you need to think about adding in some of these to help improve your overall health and fitness.

References:

Lee, Diane, “The Pelvic Girdle: An approach to the examination and treatment of the lumbo-pelvic-hip region”: Churchill Livingstone, 1999, Toronto, Canada

Monday, 13 February 2017

Achilles Tendonitis: The awkward “ACHe in the Achilles”!

That really puts the ache in the Achilles!

The Achilles tendon is the largest and strongest tendon in the body. The Achilles tendon is responsible for absorbing shock when subjected to loads and it takes the load before the rest of the body does. The tendon is attached to the heel bone and the calf muscle which helps to push the foot off the ground when moving. The tendon begins on the heel bone and attaches into the middle of the calf. Most runners and sports players are susceptible to Achilles tendon injury due to the high stress and repetitive loads during running and jumping.

Achilles tendinosis


Sever’s disease is heel pain in adolescents because of growth spurts. The heel bone grows quicker than the Achilles tendon, which results in a tight tendon. Over time, repeated stress and impact on the tendon causes the tendon to pull on the growth plate, resulting in inflammation. This condition can resolve with just rest, however some sports massage and kinesiology taping to the calf muscle can help with recovery.

Tendinosis is degenerated tissue whereas Achilles tendonitis is inflammation of the tissue. The difference between the two is tendonitis lasts for a few weeks or less, tendinosis is more chronic. Research has shown that when there is constant and chronic pain, the tendon is degenerative (tendinosis), with thickening, scar tissue and possibly partial tearing. The pain may be in the lower part of the calf, spread along the tendon or at the lower part of the tendon where it attaches to the heel bone. There is pain with activity and when starting to walk after periods of rest.



The main causes are:
  •         Amount of mileage ran
  •          The alignment of the foot (high arch, low arch)
  •          Rotated Pelvis (normally longer leg would reveal thickened Achilles because of impact)
  •          Tight calf muscles and muscular imbalance between calf and shin muscles.


Tendons have a longer healing time compared to other tissues because of their poor blood supply. So, going out running or playing sports and adding repeated amounts of stress on the tendon is going to slow this healing down. Therefore, it is important to rest from these repetitive activities and high impact sports because it will cause more thickening and scar tissue to form. Instead, try low impact aerobic exercises like the cross-trainer, rower or the stepper to help maintain fitness.

60% of athletes benefited from an intensive, heavy load eccentric heel drop exercise routine alone (Maffulli et al, 2008). Therefore, the heel drop exercise will be an integral part of the rehab program for treating tendon pathology. Eccentric loading promotes a greater reduction in Achilles tendon thickness immediately after exercise (Grigg et al, 2009). Most studies show that eccentrically controlled exercise is better than concentric exercise for the recovery of tendons. The 12 week program consists of 3 sets of 15 heel drops with the knee straight and the knee bent. Watch the video below to find out how to perform this exercise.



The treatment is very clear and successful but there can be several other causes contributing to Achilles tendon pain, especially when the pain keeps coming back. It could be poor calf and/ or foot strength, poor movement patterns, unfitting footwear or weakness in the glutes. The glutes eccentrically control foot pronation, if the glutes lack control, it means increased pressure on the Achilles. Nothing works in isolation. Your glutes AND hamstrings help to extend the hip. All muscles and fascia work together to create movement. But if something goes wrong e.g. if your glutes do not extend the hips, the calves will do the movement instead.


TOP TIPS

  •         Wear a brace if walking is difficult and painful.
  •         Avoid repetitive exercise and sports to allow time for tissue healing.
  •     Ice and Heat program (for acute tendonitis).
  •          Gentle calf stretching, including gastrocnemius and soleus (early phase).
  •          Get some sports massage on the calf muscle and cross friction massage to the tendon (later stages, after inflammatory phase).
  •          Foam rolling to the calf muscles (there is a trigger point in the lower calf that can refer pain into the Achilles).
  •          Start the eccentric heel drops to help regenerate and improve the blood flow to the area.



References:

Maffulli N, Walley G, Sayana MK, . Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil 2008; 30: 167784.

Grigg NL, Wearing SC, Smeathers JE. Eccentric calf muscle exercise produces a greater accute reduction in Achilles tendon thickness than concentric exercise. Br J Sports Med 2009; 43: 2803.