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Introduction to Running Injuries: Part 2

ACHILLES TENDONITIS

Athletes have high incidences of achilles tendon overuse injury. 75% of total and partial tendon ruptures, involving abrupt repetitive jumping and sprinting movements (McCrory et al, 1999). The back of the heel or calcaneus bone provides the power in the push off phase of walking and running. Large forces are then transmitted through the Achilles tendon. 

Symptoms

Tendonitis is the inflammatory process of a tendon. Pain and stiffness may be felt at the back of the ankle either overtime or in the morning. Acute tendonitis tends to be more painful and occurs suddenly. However, chronic tendonitis builds up over weeks and can niggle, affecting performance. 

Causes

Repetitive or overuse training, and a sudden increase in training are vital factors. Over pronation of the foot, occurs either when walking or running. The arch of the foot collapses upon weight bearing activities, which adds stress on the Achilles tendon. The tendon eventually degenerates and inflammation occurs. 

Treatment: How can we help?

TESTS & MEASURES

·          Functional Movement Test

·          Hakan Alfredson’s heel drop test – shown to be 90% effective

PHYSICAL THERAPY (Noehren et al, 2014)

·          Stabilisation - Focusing on isolating muscle recruitment.

Non weight bearing exercises

Resistance band exercises

·         Mobilisation and Strength - Focusing on strengthening and maintaining control when performing exercises.

Eccentric Strengthening Protocol

Exercises where the gastrocnemius and soleus are contracting whilst lengthening. 

·         Stretches

Dynamic stretches, focusing on gastrocnemius and soleus   

SPORTS MASSAGE

Soft tissue techniques into the gastrocnemius and soleus including effleurage, petrissage, soft tissue release, Myofascial release and muscle energy techniques stretching, specific soft tissue mobilisation and deep frictioning.

FOAM ROLLING: SELF MYOFASCIAL RELEASE

McKenny et al 2013, described myofascial release as a variety of techniques in which pressure is applied to the muscle and fascia.

Static stretching is commonly known to increase flexibility acutely but associated with acute reductions in performance. However, research has been undertaken combining foam rolling and static stretches (Škarabot, Beardsley and Štirn, 2015). Results concluded that combining both foam rolling, and static stretches all lead to increases in flexibility and produced an additive effect.

In terms of athletic performance, self-myofascial release does increase joint range of motion and does not impede athletic performance. It additionally alleviates DOMS (delay onset muscle soreness) and many athletes now tend to use foam rolling as a tool for enhancing their recovery. There is some evidence to suggest that long term, foam rolling may lead to improved flexibility, however more research is being undertaken. 

Foam rolling specifically for achilles tendonitis would focus on releasing tension in the gastrocnemius and soleus. The foam roller is placed on the calf muscles and moves over the roller slowly backwards and forwards along the length of the tendon, for 20 rolls. This is followed by calf stretches. 

RETURN TO RUNNING

After the rehabilitation process and the athlete has no pain, a training programme should be followed. The programme will depend on individual progress, severity of injury and original fitness. This will include a gradual progression incorporating running sessions as well as the stretch and strength exercises, to maintain overall fitness and ensure the injury does not reoccur.

 

 

PLANTAR FASCIITIS

Plantar fasciitis is the inflammation caused by the excessive stretching of the plantar fascia. Repetitive excessive loads occur with long distance running, inducing the inflammatory process, leading to degeneration (Hicks, 1954) 

Symptoms

The plantar fascia ligament is a band which runs from under the heel to the front of the foot. Symptoms include localised tenderness and pain underneath the foot, where the band runs from. It may be difficult to apply pressure on your foot, due to the inflammation and tenderness. This can be associated with tightness in the achilles and gastrocnemius. 

Causes

These tend to be due to over pronation or flat feet, when running or walking. Sudden increase in intensity, duration or running ground can inhibit the foot. External factors such as improper or new footwear may aggravate the foot. 

Treatment: How can we help?

TESTS & MEASURES

·          Functional Movement Test

·          Biomechanical analysis looking at excessive tension into dorsiflexors

PHYSICAL THERAPY (Noehren et al, 2014)

·          Stabilisation - Focusing on isolating muscle recruitment.

Non weight bearing exercises

Resistance band exercises

Cold therapy – Ice and small exercise ball

·         Mobilisation and Strength - Focusing on strengthening and maintaining control when performing exercises.

Eccentric Strengthening Protocol

Exercises where the gastrocnemius and soleus are contracting whilst lengthening 

·         Stretches

Dynamic stretches, focusing on gastrocnemius and soleus  

SPORTS MASSAGE

Reduce tension into gastrocnemius and soleus with effleurage, petrissage, myofascial release, soft tissue massage, neuromuscular techniques and muscle energy technique stretching. Friction to plantar fascia and longitudinal sports massage techniques on plantar fascia with palms, thumbs and knuckles.

FOAM ROLLING: SELF MYOFASCIAL RELEASE

McKenny et al 2013, described myofascial release as a variety of techniques in which pressure is applied to the muscle and fascia.

Static stretching is commonly known to increase flexibility acutely but associated with acute reductions in performance. However, research has been undertaken combining foam rolling and static stretches (Škarabot, Beardsley and Štirn, 2015). Results concluded that combining both foam rolling, and static stretches all lead to increases in flexibility and produced an additive effect.

In terms of athletic performance, self-myofascial release does increase joint range of motion and does not impede athletic performance. It additionally alleviates DOMS (delay onset muscle soreness) and many athletes now tend to use foam rolling as a tool for enhancing their recovery. There is some evidence to suggest that long term, foam rolling may lead to improved flexibility, however more research is being undertaken.

Foam rolling specifically for achilles tendonitis would focus on releasing tension in the gastrocnemius and soleus. The foam roller is placed on the calf muscles and moves over the roller slowly backwards and forwards along the length of the tendon, for 20 rolls. This is followed by calf stretches. Additionally with an ice water bottle, you can reduce inflammation by rolling the bottom of foot. 

RETURN TO RUNNING

After the rehabilitation process and the athlete has no pain, a training programme should be followed. The programme will depend on individual progress, severity of injury and original fitness. This will include a gradual progression incorporating running sessions as well as the stretch and strength exercises, to maintain overall fitness and ensure the injury does not reoccur.

 

 

MEDIAL TIBIAL STRESS SYNDROME (SHIN SPLINTS)

A generic term for having pain in the shin area. It is also known as the periostitis of the medial tibia, due to the attachment of the soleus where it contracts eccentrically.

Symptoms

An athlete will genuinely feel tenderness over the medial tibia (shin) finding it difficult to run without the feeling of pain. The areas of the shin may consist of a small amount of swelling, lumps or bumps over the bone. Additional pain when plantar-flexing the foot. 

Causes

This tends to be due to over pronation or flat feet, when running or walking. Tight soleus muscles or a sudden increase in intensity, duration or running ground can inhibit the foot. External factors such as running in spikes, forefoot striking or hard surfaces. Additionally, insufficient warm ups before each session of training can cause pain. 

Treatment: How can we help?

TESTS & MEASURES

·          Functional Movement Test

·          Biomechanical analysis looking at over pronation, behavioural or training changes.

PHYSICAL THERAPY (Noehren et al, 2014)

·          Stabilisation - Focusing on isolating muscle recruitment.

Non weight bearing exercises

Resistance band exercises

Cold therapy – Ice 

·         Mobilisation and Strength - Focusing on strengthening and maintaining control when performing exercises.

Strengthening the soleus and tibialis anterior. 

·         Stretches

Dynamic stretches, focusing on the soleus and plantar flexion of the foot.

SPORTS MASSAGE

Soft tissue techniques into the gastrocnemius and soleus including effleurage, petrissage, soft tissue release, myofascial release and muscle energy technique stretching deep frictioning to medial tibial border. Stripping up to the medial tibial border, soft tissue release, for tibialis anterior, gastrocnemius, soleus and peroneals.  

RETURN TO RUNNING

After the rehabilitation process and the athlete has no pain, a training programme should be followed. The programme will depend on individual progress, severity of injury and original fitness. This will include a gradual progression incorporating running sessions as well as the stretch and strength exercises, to maintain overall fitness and ensure the injury does not reoccur.