Tuesday, 26 September 2017

Foot Joints and Running Health

It's trail running season! Runners at the grade school, post-secondary, and recreational level are all out and gearing up for races. City marathons, cross country meets, and more will soon begin.

Many people assume that, to train for running, you simply need to run, but I've spoken at length on important weight-training tips for distance runners as well. After all, do you think that any other type of athlete - be they a wrestler, boxer, football player - only repeatedly performs their sport as training? No, I thought not.

Additional training, however, does not simply mean heavy lifts and explosive forces. The health of each joint of the lower limb needs to be considered in order to have longevity as a runner. There's an important balance of mobility and stability that must be maintained.

Take the foot. You've heard the importance of foot health for most of what you do in life, as it's obviously the first line of defence - so to speak - when it comes to impact forces as you walk and run. This doesn't necessarily mean it's as simple as wearing supportive shoes for good lower limb health, though.

The foot has 26 bones to it. That's a lot of joints! That being said, pliable mobility (allowing the joints to move, glide, and compress) is vital in allowing those joints to absorb shock and impact, as is strength of the muscles of the foot in order to prevent those forces from being too damaging to the tarsal joints.

Modern-day running - specifically, the footwear - has taught the Western world to bypass the majority of these impact-buffering joints by running heel-first. As a result, these forces are greater by the time they reach the knee, hips, and back than they would be if a forefoot strike was used, resulting in an increased injury risk.

However, with the birth of minimalist running, Western runners attempted to make a quick switch back to forefoot running in order to benefit their joint health and performance. This is all and good, but it needs to be remembered that the body takes time to condition itself to new mechanics and activities. After a lifetime of stiffer, highly-supportive footwear use, the joints of the foot are, conversely, going to be stiff and immobile as well. Furthermore, the muscular strength in the foot may be lacking due to years of disuse. As a result, while the foot may now be diverting much of the impact away from traveling up the chain in too-great amounts, the foot's own joints may not be durable enough to accept that force itself. This is why there was a spike in new and previously-uncommon running injuries as soon as minimalist running became popular.

The takeaway here is that, like the rest of the body that you train for performance, the feet must also be carefully conditioned for the uses you intend of it. Adequate mobility through the toes, forefoot, and midfoot as well as enough muscular stability are key if you want to prevent the high-impact of running from developing into pain. That being said, changes to running and training routine must also be gradual and progressive, just like a routine for training any other joint. You need some variability to shock the body into improving, but be kind with how quickly you introduce it.

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Tuesday, 19 September 2017

What Are Shin Splints?

If you haven't had them yourself, you've at least heard of them. Shin splints: the bane of existence for many runners. This delightful condition involves stabbing pain in the inner shin region, exacerbation from running and impact, and can often include radiating pain traveling through the entire calf muscle.

Medial tibial stress syndrome is a condition so common that it affects nearly 10% of all runners. However, surprisingly little is known about it. Often, people boil the pain down to muscle strains, tendinopathies, or stress fractures, but these internet diagnoses are inaccurate.

For the longest time, I, myself, considered MTSS to be something that it wasn't out of error. Among many professionals, it was thought to be periostitis of the tibia - inflammation of the top layer of the bone caused by traction from muscular tension. Unfortunately, upon a journal search for this article, this theory was quickly proven wrong.

As it turns out, science still hasn't completely agreed on the etiology of MTSS. There is one prevalent theory that just cropped up during the new century.

One pair of researchers was able to demonstrate a pathology to do with bone remodeling as related to shin splint pain. As you may know, bones are not a lifeless tissue. The body's cells are constantly breaking down bone and replacing it with new. Usually, this is done at a healthy, even rate, but in examples such as osteoporosis, the breakdown occurs more quickly than the regrowth, resulting in the frail-boned condition.

In the case of shin splints, the breakdown of bone tissue increases when the bone is subject to new and sustained mechanical stress, such as an unconditioned individual who suddenly starts to overdo the pavement running. This is done in order to remodel the matrix of the bone tissue and allow it to adapt to the new stressor, but in the interim of this remodeling being complete, the bone structure is unable to accommodate the stress. As a result, microdamage to the bone itself occurs.

It's like a highway that's in the middle of being converted into a traintrack, except the train has already started being run along the route during the construction. The structure is going to take a beating!

Yeah, something like that.

In terms of the recovery from shin splints, even though many practitioners may not have had the reasoning correct, many of the same rehab and exercise methods still stand. Weakness or excessive stiffness of the calf muscles still must be addressed in order to allow the muscle tissue to transmit forces properly, rather than directing them back into the bone. Hip muscle activation is still key to ensure the impact can further travel up the chain rather than remaining in the lower leg. Finally, gait and footwear should not be disregarded, due to improper loading through the foot and leg resulting in increased fatigue to structures that are needed to buffer impact forces.

So, just remember to be conservative when increasing your training volume, be mindful of your form, and change your shoes regularly. Keep all this in mind, and....

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Tuesday, 12 September 2017

Plantar Fasciitis (And The Nerves That Imitate It)

I thought that this would be a good post to make, as I've now encountered a handful of clients with this issue. Individuals have come to see me with complaints about plantar fasciitis that has been persistent to any amount of stretching or foot massage.

In these instances, my typical process was to assess the injury but have difficulty replicating their pain using any ranges of motion or muscle testing at the foot, ankle, or knee. Pain with pressure was common, however.

After attempting to treat the plantar fascia with no benefit, I had to flip switches and try something different. Having some experience with this before (and with the wonderful handiness of the internet) I zoned in on testing a couple nerves instead.

Most people assume that nerve pains follows the trend of always beginning centrally near the spine and extending down the length of the limb. However, it is only a trend, not a rule. If entrapment of the nerve occurs further than the spine or in several, less severe areas separately, then the symptoms can absolutely manifest at only the end of the limb, like in these "plantar fasciitis" cases.

Both the sciatic and the saphenous nerves have the potential to cause plantar pain that many people may think to be fascial. (Both can be dull, diffuse, or burning pain.) However, upon proper testing where we put the nerve itself on stretch, we were able to determine the root of the cause. Without fail, after treating these clients up at their hips or back instead, we were able to relieve the pain.

Just a good example that therapy and rehab isn't as easy as chasing the pain. Often, you have to go quite a ways up the chain in order to find the cause. In these cases, finding that cause can be a hard thing for clinicians to do, considering that protocol wouldn't normally involve having to rule out joints as high as the spine in cases of foot pain. However, therapist or client, it's important to keep in mind that the body works as whole.

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Tuesday, 5 September 2017

Rest and Wait?

This will be a familiar scenario. You or someone you know experiences an injury, whether it be acute or chronic, having onset gradually over a length of time. Because of the pain, you consign yourself to resting from all activity until the pain recedes. But will it?

The problem with prolonged rest for an injury, as I wrote a bit about before, is that it causes the body to adjust to inactivity. Sure, the tissue may heal, but it without being exposed to any of the types of stimuli that you wish to return to, the chances of it being able to perform those activities are decreased.

To put it into different terms, we know that the body specifically adapts to the demands we place upon it. If that demand is immobilization, then that's what the body adapts to during the entire healing process. If rest is all that you do in order to recover, you have a much higher chance at reinjury as soon as you try to return to activity since the tissue has become unconditioned for it.

What's more, if you do nothing but refrain from any exercise or activity, then it also increases your innate fear of that injury and the pain it causes. Fear-avoidance habits can be quite quick to develop and can cascade into a problematic cycle of further pain and dysfunction.

All in all, absolute rest is not the answer to pain. Graduated exercise is key to help the tissue to reattain its full function and capacity as well as helps to prevent the fear of pain from inhibiting movement and delaying recovery. The sooner you can commence an active recovery/rehab program, the better. Exercise is the best medicine.

That and laughter.

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