Category

Prevention

Change your running posture & reduce running injuries

By | Prevention | No Comments

This article will answer the question ‘how does changing my running posture help reduce running injuries?’

What is Running Posture?

It is simply the position of your upper body, head and arms as you run. It can vary depending on the incline your are running up or the type of running you are doing too.

 Why does it matter?

It is estimated that over 68% of runners in any one year have a running related injury during that 12 months (Source: Runners World 2009 poll). That seems high but even if it is  +/- 10% that is still most of us at some point have had a running injury

If we optimise our running posture we can run more efficiently. This in turn will reduce the load on muscles, tendons and joints. It is the overloading of these that can cause most running related injuries around the hip, knee and ankle such as hip bursitis, ITB syndrome, runners Knee, patella femoral pain syndrome, achilles tendonitis, plantar fasciitis, heel spurs. recurring calf and hamstring strains.

Running slightly flexed at the hips?

Less efficiency

If you run more like the image on the left then your hip flexors – the muscles that make you bend at the waist- are constantly engaged and shortened. This means that when you run you do not get full extension at the hip and the leg does not straighten. In turn you do store as much potential energy in that muscle which is then turned to kinetic energy as it propels you forward to your next step. This means that you are wasting energy with every step.

Greater load on calf and quad muscles, heels and knees

With less extension in our hips our bodies tend to compensate by increasing our stride length. This in turn means that we tend to heel strike rather then plant our mid foot when we run. It creates a greater impact on our heels and increases the load on our calf muscles. With greater load going through heels and calf muscles you can become more prone to achilles tendonitis and plantar fasciitis.

Greater strain on the Knee

Patella Femoral Pain Syndrome (PFPS) occurs in 22.7% of the general population. Research has shown that this can be caused by increased internal rotation at the hip. Hip Flexor contraction whilst running slightly bent forward will cause increased internal rotation. So whilst often these injuries are multi- factorial it is highly likely that this will be part of the cause.

What to do next?

If you are running pain free and rarely have injuries then my advice would be to continue  as you are. However if you do tend to suffer regular running injuries then a review of your running posture may help.

When we were kids we had natural extension at our hips but unlike top athletes life gets in the way and we tend to have sedentary jobs which encourage constantly tight hip flexion. After all we are sitting down for long periods of time. So rediscover child like running! (and always look when you cross the road)

 

Changing your Running Posture

  • Look up when you run
  • Keep your shoulder back and chest forward
  • Keep your arms relaxed
  • Don’t lean forward at the hips and try and keep your body in a more upright position

Stretch your Hip flexors before and after every run and am and pm e.g. before and after work. If you want to change the way your hip flexors work you need to retrain them and that takes repetition.

This exercise is very good at doing just that- do each one 10-15x am and pm for best results and before running. If any pain then just stop.

Assessment of Running Posture

If you would like me to assess your running posture and provide you with specific exercises to help reduce running injuries and treat any existing problems then please get in touch.

Hugo Firth Osteopath and Sports Injury rehab specialist (GOsC 8887) BOst, BSc, MA

www.osteopathypartnership.com

 

Lower back pain prevention

A Different Approach to Prevent Lower Back Pain

By | Back Pain, Osteopathy, Prevention | No Comments

If you suffer from recurring back pain and your current rehab exercises that work on strengthening your core don’t seem to stop your back pain from recurring then perhaps it is time to take a different approach.

For at least the last 20 years there has been a focus on advising people to strengthen their core stability muscles that in turn  will prevent back pain. However the research to support this is thin at best. Much of the research has been carried out on small non representative samples (1). When the samples are representative then whilst some short term benefits can be found no long term benefits (over 6 months) can be seen (2) in back pain prevention. Alternatively it was found that core stability rehab is no more effective than general exercise (3).

Does the following scenario sound familiar? 

I hear this quite frequently from my patients.

A patient has experienced back pain and through their physical therapist they have been given a series of cores stability exercises. Such as ‘The bridge’, the ‘1 legged bridge’, ‘the plank’, ‘superman’ etc. The patient has done them frequently and noted increased muscle tone and an ability to do the exercises for longer or more frequently. However 6-12 months later they have a recurrence of their back pain.The patients blame themselves for not doing the exercises correctly or not frequently enough. Wait for the pain to subside, perhaps receive some treatment then carry on with the same exercises.

If you can relate to this then may be it’s time to take a different approach. After all Einstein’s definition of insanity is doing the same thing over again and expecting a different outcome!

What’s the thinking behind Core stability exercises?

In essence the theory is by activating your core stability muscles such transverse obliques, rectus abdominus, pelvic floor, internal and external obliques, diaphragm you can help support the lumbar spine and so help reduce its work load. However if the research is right and there is a lack of effectiveness then perhaps we need to ask the question ‘Why can’t our backs cope with the work load in the first place?’And – “Why does it need extra support?”

An Alternative approach

I would argue that the area of your spine that is in pain is a result of it trying to cope with extra work load because other parts of the spine or body are not moving as well as they should.

The body has this amazing ability to adapt and deal with reduced function in one part of the body to maintain our overall function. The spine is a key part of this.

24 interlinking segments that act liked a coiled spring. If a section of the coil stops moving then the sections above and below move more to ensure our bodies can achieve the movement we require. It’s this extra movement of muscles and joints that over time can lead to muscle fatigue and joint inflammation. These are two main symptoms of lower mechanical back pain.

Address the causes through treatment and rehab

Of all the hundreds of patients that I have seen through my practice with lower back pain the common factors are reduced mobility in the upper back and shoulders and reduced mobility in the pelvis and hips.

Coincidentally these are the two main areas of our body that we keep static for long periods of time every day of the week!

Our sedentary lifestyles reduce our mobility

It is this lack of movement in these two areas that can cause us lower back pain pain in the long term.

back pain whilst at your desk

causes of back pain

We sit at our desk, shoulders forward, fingers ready to type on our key boards, heads forward, upper back arched. Our hips flexed. Sometimes for hours at a time.

Our bodies take these inputs as a desired position and start to adapt accordingly. The body is always looking for efficiencies to reduce energy expenditure. So it reduces blood supply to muscles. Joints stop moving so nerves receive less innervation.

Muscles in our upper backs become fibrotic and joints become less mobile.

We do this day in day out for up to 8 hrs a day for months and even years! Then we go home and watch TV or use our laptops at home, or alternatively try and get the stress of our work out the system and go cycling and assume the exact same position. Or we go to the gym and contract the same muscles that were contracted at our desks (our pectorals and biceps and hip flexors)

Implications for our Lower back 

If the middle section of our spine can no longer rotate or bend forward as much as it used to do then the lower back (the lumbar spine) will have to move more to ensure that there is no reduction in functional ability and range of movement.

Likewise if we cannot rotate from the hip or our hips are flexed forwards because our hip flexors are permanently contracted from all the sitting down we do then our lower back muscles become more involved in simple daily activities such as walking and standing.

Our bodies make these adaptations without us being aware of them. Day in day out for months and years.

Then add in the role that the lower back was designed for and the wear and tear that can take place without this extra work load and you can start to see why an upper back or hip that can’t move optimally can help increase the risk of fatigue, strain and ultimately, injury in the lower spine.

How can you help?

# Change the inputs in your upper back

From a static 8 hrs. Stop every 30-45 mins and make your upper back and shoulders move. Your body will respond by increasing blood supply. Muscles will change to become more flexible. Joints and innervation inputs will increase.

Here is a simple exercise you can do at work whilst sitting down to start changing the inputs. Do it every 45-60 minutes that you are at your desk. Your colleagues might think you are mad at first but soon they will all start doing it! It really works.

# Change the inputs to our hips and pelvis

We need to reduce the tightness in our hip flexors that builds up over time as we sit at our desk, cars, TV, dinner table and on our bikes . Here is a really effective exercise to do just that.

Do it daily am and pm 10-15x. Include it into any activity warm ups and warm downs too. Especially after cycling or running.

Next we need to improve the mobility and rotation of the hip as well as activating the gluteals and hamstrings.

This exercise combines hip flexion stretches with hip rotation.  Do it am and pm 10-15x for each exercise.  These exercises should all be pain free so if you experience pain after or during then just stop and consult your professional physical therapist.

To Conclude

If you have been doing your core stability exercises and you have had no recurrence of lower back pain, then please continue but consider if you are really addressing the cause. With our increasingly sedentary lifestyles we are placing increasing work load on our lower backs due to a lack of mobility above and below in our upper backs and hips. So if you are doing core stability exercises then add hip and upper back mobility exercises into the mix. If you are not doing any exercise then start to work on hip and upper back mobility with the above exercises. The exercises should always be pain free.

References

(1)Stuber KJ1Bruno PSajko SHayden JAClin J Sport Med. 2014 Nov;24(6):448-56. doi: 10.1097/JSM.0000000000000081.Core stability exercises for low back pain in athletes: a systematic review of the literature.

(2) Xue-Qiang Wang,1 Jie-Jiao Zheng,2,* Zhuo-Wei Yu,2 et al. Public Library of Science. 2012; 7(12): e52082.Published online 2012 Dec 17. doi:  1371/journal.pone.0052082A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain

(3)George SZ1, Childs JDTeyhen DSWu SSWright ACDugan JLRobinson MEBMC Med. 2011 Nov 29;9:128. doi: 10.1186/1741-7015-9-128.Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial.

 

.

 

 

Antidote to sun lounger back pain

By | Back Pain, Osteopathy, Prevention | No Comments

Is your back feeling bit worse after the summer? Here’s a possible antidote.

If like many of us this Summer involved long car drives, traffic jams, some cycling and may be some sun lounger action then your hip flexors could now be tighter than normal. These muscles help us bend forwards at the hip. But tighter Hip flexors and in particular Psoas and Iliopsoas can lead to lower back pain.

How?

Tight Psoas can cause back pain

Tight Psoas causes reduced movement in lumbar spine

If you have been sitting for long periods of time either in the car, on your bike or with your feet up on a sun lounger (lucky you!) or at your desk (not so lucky!) then your hip flexors become tighter.

This would normally cause your body to lean forwards. However your body adapts to ensure you are standing up straight by contracting your postural muscles in your lumbar spine (lower back). This can lead to greater pressure on your lower vertebrae and the associated facet joints as the muscles attached to them tighten up. The extra work load on the postural muscles can lead to strains and spasms. Back pain!

How to help Yourself

The antidote to this is to start a concerted exercise to stretch these hip flexor muscles out from their contracted state. As you can see from the image below the Psoas originates from the lumbar vertebrae in the lower back and connects to inside of the femur (thigh bone).

Tight psoas can be a cause of back pain

Psoas helps flex hips

So any exercise must work the muscles fibres that run vertically and those that go at an angle to attach to the femur. This exercise does just that and so is very effective.

 

 

 

 

The Hip Flexor exercise

The key to this exercise is that it is what’s termed dynamic. It is a movement rather than a static stretch. Research has shown that the body responds better to dynamic movement based exercise designed to increase range of movement than static stretches. It makes sense. Our bodies were designed to move not hold static poses and so our muscles are designed to adapt to movement.

Important points to note

At no point in the exercise is the stretch held as a static stretch

Your hips move forward to dynamically stretch the vertical muscles fibres

Your arm comes up and you bend to the side to dynamically stretch the muscle fibres that attach into your femur.

Do not arch your back in an attempt to gain a greater ‘stretch’ sensation.  This can make the muscles in your lower back even tighter and put more pressure on the lumbar vertebrae. Just push forward with your hips.

Repeat the movement 10-15x am and pm daily for best results. Incorporate it into exercise warm up and warm downs too.

It should be a pain free exercise. If you experience pain just stop and contact your Osteopath or other professional physical therapist.

For more information on this exercise and how Hugo can help you return you to your personal best call  0208 226 3767.

The role of Gluteals in Back Pain or running a PB

By | Back Pain, Osteopathy, Prevention | No Comments

 

From  Back Pain to running a PB – effective Gluteals are an important factor

If you suffer from back pain , even infrequently, or you’re aiming for a personal best for your next race or training harder for your chosen sport whether it be running, rugby, football, tennis, swimming, cycling, skiing or golf.. the strength and effectiveness of your Gluteals will be a factor. Read More

Is “Getting Fitter” a perennial New Year’s Resolution

By | Back Pain, Prevention | No Comments

Getting Fitter? A perennial New Year resolution?

Help and advice is at hand.

If your New Year’s resolution is to get fitter, faster, stronger or to be more active then hopefully this advice will help you achieve your goals.

Normally in January and February my Sports Clinic starts to see a steady rise of people who have taken up an activity, sports or increased the frequency of their chosen activity as they achieve New Year’s resolutions or may be just a promise to themselves to get fitter.

The most common is a recurring pain or old injury that has flared up or new aches and pain in neck, shoulder upper or lower back. Read More

Osteopathy and prevention of hamstring strain recurrence

By | Hamstring, Prevention | No Comments

preventing-ham-string-reoccurence-issuesOsteopathy and recurring hamstring strain prevention

Introduction
The prevalence of hamstring strains amongst people who play sports that involves running and or jumping is high. Also once a hamstring strain has occurred the risk that it will happen again is much higher.
Research (Sherry MA , Best TM et al 2011) has confirmed what osteopaths have long understood that the angle of the pelvis and trunk strength often play an integral role in the strength of the hamstring and the prevalence of repeated strains in sportsmen and women.
Osteopathic treatment to realign the pelvis combined with therapeutic exercise to increase core stability and hamstring strength is a very effective way of addressing this.
I am going to share a recent case which illustrates how an osteopathic approach helped an amateur runner break the cycle of recurring hamstring strain.

Read More