Showing posts with label fractures. Show all posts
Showing posts with label fractures. Show all posts

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, 21 March 2017

What Can Speed Bone Healing?

I've been fortunate to never have had experienced a bone fracture in my own life. (I figure that I'll probably get hit by a car in the week following this blog post.) I understand how much fractures are a drag, though. Not being able to do anything except immobilize it and let time heal it enough to start doing any rehab.


A topic that's starting to pop up, however, is if there are modalities which can increase the rate of bone healing and accelerate the recovery process. Well, I decided to surf through the research and see what I could dig up.

Exercise

Let's start with the modality that I'm clearly the most focused on. It's common that weight bearing and physical activity will increase the rate of healthy bone formation in healthy populations and those with osteoporosis. But can early exercise while a fracture is still in its healing phase be beneficial?

Unfortunately, there's not a whole lot of research that I could find on exercise, although it's clear that weight-bearing is a definite factor in increase bone formation. Research does suggest that regular contraction of the muscle around the injured bone may decrease the rate of bone loss, but it's not conclusive.


With this information, the only safe advice to give would be that weight-bearing (standing and walking on a fractured leg, for instance) is beneficial to the healing process, but only under the clearance and supervision by a professional when the bone is stable enough for each progression.

Massage

This will be a short and sweet entry. After a scan of journal databases, I found no research directly on the stimulation of soft tissue over the site of a fracture. Being that a fracture is a widely-taught contraindication of massage, we can only assume that manual therapy is off-limits when it comes to bone healing.



Ultrasound

Here's where we can get interesting!

I found one fantastic journal review that compiled everything nicely for us. It cited multiple studies that found a positive effect of specific ultrasound signals on the rate of bone healing. Even when it came to applying the modality to smokers, who are known to have decreased rates of fracture and tissue healing, ultrasound was able to counteract the effect.


It seems that, despite my recent post about why ultrasound probably does nothing for you, that there is probably some use for it after all.

Electrotherapy

The findings here were interesting, as I was taught in college that electrotherapy such as IFC (interferential current) could accelerate the bone healing process. However, this is another modality that does not seem to have much research behind it, What I was able to find was little more than a suggestion that electrotherapy may help prevent complications of fracture non-unions. On the other hand, one newer study seemed to find that IFC made no difference in bone healing times.


Laser

Laser is a newer therapy on the block. With it emerging more recently, there's been a bit more hype to research it.


The research, so far, has been positive when it comes to the effect of laser on the acceleration of bone healing. However, it's important to note that most of the studies to this date have been done on rabbits and rats. Nonetheless, bones are bones, and this find is still a promising one. I'll be careful about getting too excited until I see a bit more evidence, though.


In short, there's still some research to be done before we can say anything for sure. At this time, it's safe to say that weight-bearing to stimulate bone growth using mechanical stress is the best advice to accelerate fracture healing, although ultrasound shows a lot of promise as well. Massage is a no-go, electricity probably has little effect, and we should probably wait on more results about laser.

Regardless, make sure to do your rehab once the cast comes off.