It is common knowledge that excessive and long distance running can cause problems with the low back, hip, knees and feet. So how can we protect ourselves from these ailments? In addition to other factors such as regular stretches and effective warm ups and cool downs, a good pair of running shoes is vital to protect your joints in the lower limb.

What do we expect from a good pair of running shoes: stability, support and motion control.

In order to select an appropriate pair of running shoes, one must understand the principle of pronation.

The Normal Foot
Normal feet have a normal-sized arch and lands on the outside of the heel and rolls inwards slightly to absorb shock. It’s the foot of a runner who is biomechanically efficient and therefore doesn’t need a motion control shoe. A semi-curved stability shoe with moderate control features would be best for such runners.

The Flat Foot
This has a low arch, and is an overpronated foot – one that strikes on the outside of the heel and rolls inwards (pronates) excessively leading to potential injuries. The ideal running shoes for these runners would be straight shaped, motion control shoes, or high stability shoes with firm midsoles and control features that reduce the degree of pronation. Avoid highly cushioned, highly curved shoes, which lack stability features.

Flat feet shoe
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The High-Arched Foot
A highly arched foot is generally supinated or underpronated making the foot an uneffective shock absorber. For these runners well Cushioned (or ‘neutral’), curved shoes with plenty of flexibility to encourage foot motion is recommended. Avoid motion control or stability shoes, which reduce foot mobility.

underpronators shoe
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Factors to consider when shopping for new running shoes:

• Your feet are at their largest in the last afternoon, and this will be the best time to shop as your feet will expand while running.
• Bring your old shoes to check where the most wear and tear on the sole is
• Bring your orthotics and usual running socks to try on with your new shoes

Useful tips to choosing your running shoes is a post from: Musculoskeletal Consumer Review

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It is very common for people to wake up complaining of neck and back pain after a night of rest. Although there are several organic causes for this including inflammation and possible disc protusion,  a person with a healthy spine can still be troubled with pain and stiffness.

What does this suggest? Perhaps sleeping in awkward postures for x number of hours, can do us all harm….So what is the best sleeping postures?

Neutral spine
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Obviously modifying sleeping postures is tricky especially as we are not actively aware of what position we toss and turn into during the night. However with a help of a few pillows and some useful tip, we may be able to suggest a more comfortable and ideal sleeping position.

Sleeping postures

Sleeping on back

They key with any posture is to ensure a neutral spine. Imagine a plumb line down the nose and along the length of the spine. Your left and right side if the body should be like a reflection of each other. The ears should be parallel to the bed not kinked upwards (if the pillow is too high) or kinked downwards (if the pillow is too low).

In addition if you feel a strain on the lower back, or an increased arch, popping a pillow under the knees will alleviate the tension.

Sleeping on stomach

This posture can be the most harmful to the spine, as not only does it encourage lumbar lordosis but its also involves twisting the neck to either side.

If this position remains a favourite, try modifying it by popping a small pillow under the tummy, and ensuring the neck pillow is not too high kinking your head upwards.

Note: Although resting your head on your hands may be more comfortable for the neck it may contribute to shoulder impingement symptoms.

Sleeping on side

Similarly to the other postures, a symmetrical body is the ideal posture. Once again the imaginary plumb line should be running straight down through the nose, along the length of the spine and parallel to the bed.

Again using pillows to prop between your legs will stop the individual’s leg from dropping forward and twisting the lower spine. In addition a couple of pillows to rest your arms on, will also prevent you from rolling forward and twisting your mid back.

Needless to say posture, is important at all times of day, and therefore the same principles apply when you are at the desk, watching tv and driving.

If you have a specific condition of the spine you may want to discuss sleeping postures at length with your therapist.

Sleeping positions is a post from: Musculoskeletal Consumer Review

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Extreme Yoga Pose
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“Yoga is for people in good physical condition. ” – Glenn Black

If you have been a regular reader of our articles, you will know that we strongly advocate understanding the situation first – what’s causing what, then only do we ‘treat’. And that treatment choices will change over time as we progress along the pain management pathways. One treatment technique that worked for you at the acute or painful stage of pain may not be very appropriate or even wrong when the pain has lessened to a more dull and persistent nature.

Two common mistakes – not moving along and jumping the queue

A common mistake made here is not progressing along the treatment pathways. An example is when someone continually seeks relief for a persistent problem instead of working to resolve the underlying problem. Popping pill is one such activity or repeated seeking massages for a recurrent muscle ache.

The second common mistake is skipping the next step in the treatment pathways, or sometimes, several steps. Some with persistent back problems may suddenly start doing yoga because they heard that it was good for the back muscles without a) understanding their underlying problem and b) they may not be in the best shape for the strain that yoga places. It is not unheard of for people to get worse after yoga or pilates.

In healthcare, beware the practitioner that has the “right” tool for every occassion.

The Right Tool for a Specific Occassion. is a post from: Musculoskeletal Consumer Review

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Now as with any injury, you should always consult your GP and or physiotherapist before commencing any new exercise…

So a big mistake when rehabilitating the hamstring  is the lack of eccentric work… people tend to stretch and concentrically strengthen muscles which does not protect the hamstring when it is under the most strain. Eccentric contraction involves contracting a muscle in a lengthened position- in the case of the hamstring this would be from knee flexion through to knee extension. This differs to concentric muscle activity where muscles are both contracted and shortened at the same time, this would be the equivalent of performing a hamstring curl

Nordic hamstring exercises are found to be quite useful in strengthening the hamstring muscle

Look out on MCR for a detailed hamstring rehabilitation programme in the coming weeks

Recurrent Hamsting injuries? is a post from: Musculoskeletal Consumer Review

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Historically we have seen clients suffering from tennis elbow, bakers cysts, runners knee and mummy thumbs,  as with the advance of technology, a new form of repetitive strain injury is fast emerging: blackberry thumb.

The thumb is designed to act as a stabilizer for pinch gripping with the  fingers; and is therefore the least dexterous digit on the hand. For this reason repetitive and extensive typing can cause the thumb to muscles to fatigue and strain. Symptoms include pain, swelling and associated numbness from potential nerve damage.

Image from mobile whack
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Advice:

BlackBerry thumb can be prevented by use of other fingers to press buttons on handheld devices, and regularly vary which fingers are being used.

Avoid using these devices  for lengthy typing

Have a break from your phone

Treatment for blackberry thumb involves wearing a splint and applying ice and Ultrasound to the affected area. Gentle exercises and massage can be recommended to relieve the tension and reduce inflammation.  If the pain persists however, doctors may opt to inject the thumb area with a cortisone shot. Surgery may be required as a last resort to reduce symptoms.

Blackberry Thumb: 2012 is a post from: Musculoskeletal Consumer Review

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Smoking-213x300

Travis Saunders in Obesity Panacea:

Could smoking really be beneficial for distance runners like myself?

Here are Ken’s arguments:

1. Serum hemoglobin is related to endurance running performance. Smoking is known to enhance serum hemoglobin levels and (added bonus), alcohol may further enhance this beneficial adaptation.

2. Lung volume also correlates with running performance, and training increases lung volume. Guess what else increases lung volume? Smoking.

3. Running is a weight-bearing sport, and therefore lighter distance runners are typically faster runners. Smoking is associated with reduced body weight, especially in individuals with chronic obstructive pulmonary disease (these folks require so much energy just to breath that they often lose weight).

In the discussion, Ken goes on to point out that:

Cigarette smoking has been shown to increase serum hemoglobin, increase total lung capacity and stimulate weight loss, factors that all contribute to enhanced performance in endurance sports. Despite this scientific evidence, the prevalence of smoking in elite athletes is actually many times lower than in the general population. The reasons for this are unclear; however, there has been little to no effort made on the part of national governing bodies to encourage smoking among athletes.

Now at this point I assume that people are wondering how something this insane came to be published in a respected medical journal (as of 2010, CMAJ was ranked 9th of out 40 medical journals, with an impact factor of 9). The answer, of course, is that the point of Ken’s article was to illustrate how you can fashion a review article to support almost any crazy theory if you’re willing to cherry-pick the right data.

Posted by Robin Varghese at 11:57 AM | Permalink

Cigarettes May be Useful for Distance Runners?!? (or, How to Prove Anything with a Review Article) is a post from: Musculoskeletal Consumer Review

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The purpose of pain in a healthy person is to alert the brain and body that potential damage has occurred to the bodily tissues. Pain is considered as a protective reflex response to a physical stimulus (such as trauma). Hence, the bigger the injury, the greater the pain. Traditionally, it was assumed that all pain was a symptom of an underlying organic cause. Once the cause of pain is healed/ mended, the patient should be relieved of this pain.
If the cause of pain was not found, the patient was thought to be perhaps lying or imaging this pain.

But we now know that this is not always the case, because sometimes the pain that we experience is much more complex and different from the traditional pain where there is a actual tissue injury. We may experience pain suddenly with no apparent reason, does that mean the pain is “bad”? Pain in this scenario no longer serves its traditional purpose of alerting one to tissue damage.

“Normal” or Nociceptive Pain is pain that is proportionate to the degree of actual tissue damage. A more severe injury results in a pain that is perceived to be greater than that pain caused by a less severe injury. Such pain serves a protective function. Examples of nociceptive pain include acute burns, bone fracture.

“Abnormal” or Neuropathic Pain occurs through changes in the peripheral nervous system, especially during diseases involving damage/ changes to the nerves (nerve compression/impingement, cancer or diabetes) that leads to “impulses” being sent to brain that is then perceived as pain.
Likewise, damage to the central nervous system (involving the brain and/or spinal cord) can also cause non-painful sensations from the peripheral nerves to be wrongly interpreted as pain by the brain.
Finally, prolonged or increased exposure to painful stimulus may also cause changes to the central nervous system leading to the condition called central sensitisation where pain is disproportionate to the degree of tissue damage and can also persists even in the absence of continued tissue damage. Thus, neuropathic pain serves no protective function and provides no benefit to the overall health of the person.

Neuropathic pain patients may experience certain emotions especially when doctors and other healthcare professionals are not able to appropriately diagnose and recognise the cause of their pain. Such emotions include, feeling depressed and thinking that the pain felt is actually “all in the mind”; disappointment when others are not able to empathise with their ordeal; or even defeated when management for pain has been unsuccessful. A person can begin to think they need to ‘resign themselves to a lifetime of pain’.

Image from Docakilah.com
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Every one’s pain has a different cause; fortunately here are some personal coping strategies you can apply when dealing with pain.

Coping with one’s mood and emotions especially during pain exacerbation

• Primary goals is to view pain as a controllable experience and decreasing the use of maladaptive coping strategies.
• In the case of skill development, a new skill is introduced and patients are encouraged to develop and refine the skill during low pain periods before attempting to implement the coping skill during an actual period of pain exacerbation. The skill is shaped over time, so that the skill is gradually applied to increasingly challenging (i.e. painful) episodes as the individual becomes more proficient in that skill. A similar approach is taken to the application of many pain coping skills, including cognitive or behavioral distraction, relaxation, pacing of activities, and the appropriate use of social support.
• understanding one’s cycle of pain and anticipating potential aggravating and easing factors/ actions
• being positive and minimise negative thoughts such as “I’ll never get better!”, “Everyday it’s getting worse!” and “I should just give up and suffer the pain!”

Minimising one’s disability in terms of functional activities

• start with graded exercise, and breaking an activity into segments to reduce fatigue. Once you have gained confidence in a specific part of activity, for example sitting over the edge of the bed and standing, in this case, having sufficient strength to lift your bottom over the bed, you can try getting out of chairs of different heights or bed of different firmness.
• Every little success is still a success. Start practising with common activities that you frequently do at home, such as washing the dishes, standing and ironing clothes then gradually progress to brisk walking and other gentle sports.

Cultivating health behaviours (exercise, appropriate use of medications)

• reducing reliance on medications (don’t start popping pills at the first sign of symptoms!). Frequent consumption of painkillers may gradually cause you to develop an increased threshold to its effects which leads you to increase your dosage or have to have a stronger form of medication instead.
• always aim to reduce dosage of medications gradually. For example, having to take painkillers one pill a day. This SHOULD ONLY BE DONE AFTER THOROUGH DISCUSSION AND CONSENT FROM YOUR GP.

Coping a loved one’s pain

• be supportive of your loved one’s attempts to manage their pain
• trusting that their pain is real and it is truly upsetting even if you do not understand how they may experience such pain of such intensity
• providing a listening ear to their complains may help to settle them down and increasing their confidence in managing their pain

Tips to cope with Chronic Pain is a post from: Musculoskeletal Consumer Review

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Every woman wants her breastfeeding experience to be comfortable, hence, here are some tips for the Cradle hold and the Cross Cradle hold, the most commonly used breastfeeding position.

The Cradle Hold

This is a classic breastfeeding position which is used very often. However, it may not be that comfortable for newborns as newborns may need more head/neck support. In this position, you cradle the baby’s head in the crook of your elbow on the side that you would be feeding from i.e. right elbow for feeding on right breast. Your other hand will be holding the baby’s body. Bring the baby towards you and do not bend towards the baby. You may have to use your free hand to cup your breast to fit your baby’s mouth.

The Cross Cradle Hold

This position is typically more comfortable for the inexperienced mummys and babys. It may take a bit of effort to adopt this position initially, but it keeps your baby’s head in control which allow easy access to your breast.

Hold the baby’s head and support the baby’s body in the hand and arm opposite to the side you will be feeding, i.e. left hand and arm for feeding on right breast. Then lead the baby to the breast, Use the free hand (i.e.right hand) to help your baby to latch on. As you can see, this position requires you to hold the baby in one arm, hence it is not suitable for older babies.

Ergonomics Advice

Look for a comfortable place to breastfeed. If it is a place which you breastfeed often, such as in a designated chair in the corner of your room, or on your bed, try checking if it has the proper ergonomic requirements before you start your routine.

Basic requirements for good breastfeeding ergonomics in sitting:

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• Experiment various breast feeding positions and decide on the one which is most comfortable for you and your baby.
• Use pillows, or a nursing pillow to support your baby- the support allows your shoulders and arms to rest. You may also use a pillow to support your back while sitting in a chair.
• Adjust the chair’s height till the back of your thighs are NOT cutting into edge of the chair, i.e. till your hips, knees and feet form an inverted “L” shape. If the chair’s height is not adjustable, use a stool to prop up your feet .
• When breastfeeding, bring the baby to the breast. Never bend towards the baby as this would strain your neck and back.
• Switch between different positions as prolonged static positions would strain your muscles and spine.
• Stretch your neck and back often in between feeding.

Stretches 1
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Stretches 2
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Stretches 3
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Stretches 4
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Breastfeeding Tips is a post from: Musculoskeletal Consumer Review

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Bernardino Ramazzini
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Source: European Foundation for the Improvement of Living and Working Conditions, 1994

18th Century Ergonomics is a post from: Musculoskeletal Consumer Review

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“I have some shoulder pain and was wondering what is the difference between a regular injury and sports injury? Do I see a regular physiotherapist or a sports physiotherapist?”

- Joel

Hi Joel,

The terminology used by physiotherapists can ben confusing sometimes. Body parts other than the main body trunk such as your spine and hips are referred to a peripherals by physiotherapists. So a shoulder injury such as yours is a peripheral injury.

Regular peripheral and sports injuries over-lap significantly. You can get knee ACL injury from incidents that are not sports related even though ACL injuries are common seen in athletes.

The main difference in approach in treating regular injuries and sports injuries are

• the speed of recovery
• the intensity of the treatment

Speed of Recovery

The pace of sports therapy is generally much quicker and more aggressive. This is due to the demands of the sports. The longer the athlete is down and out from training, the harder and longer it is for them to return to peak performance as their conditioning can deteriorate quite quickly. So treatment sessions tend to closer together and more frequently, several times a day in some cases.

Regular therapy would be spread out over a longer period of time to allow the body to heal more gradually.

Intensity of Treatment

Also, the demands of the sports can place a lots of stress on the injuries body part. As such the treatment such as strength and conditioning are generally more intensive to build up support – stronger muscular balance and finer motor control to prevent re-injury.

Such treatments is generally not called for with regular injuries as high-stress is not expected to the placed on the injured body part.

What is the difference regular injuries and sports injuries? is a post from: Musculoskeletal Consumer Review

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