Burlington Chiropractic and Physiotherapy Clinic » Blog

How To Tie a Shoe

Kevin — Sun, 15 Nov 2009 22:45:08 +0000

Most experienced runners have a preferred brand of running shoe. Mizuno, Asics, New Balance and Saucony seem to be common choices among our patients, but the jury is still out as to which manufacturer truly makes the best shoe. Since there are no objective, scientific guidelines to direct your purchase, it seems to boil down to personal preference. Thanks to some recently published research, lacing up your chosen shoe is a different story…

This past February, an interesting paper was published in the Journal of Sports Sciences which investigated the various lacing patterns in running shoes. Using force plates, pressure transducers and accelerometers attached to the leg, the authors measured how different lacing patterns would influence pronation of the foot, tibial acceleration and pressure distribution in the bottom of the foot. The authors laced the shoes using one, two, three, six or seven eyelets in addition to investigating the tightness of the laces (weak, regular or strong). The interesting results were as follows…

When shoes were laced tighter, using all the eyelets, there was a lower rate of loading and the foot pronated slower (which is a good thing). This lacing pattern also showed the lowest peak pressure under the heel and the outside of the foot.

When a six-eyelet / cross lacing pattern was used, a higher loading rate and higher peak heel pressure was observed when compared to the seven eyelet method. Interestingly, the participants did not report a difference in perceived comfort between these two lacing patterns.

Reduced impact and lower peak pressures were observed under the third and fifth toes when only the lower eyelets of the shoes were used. This interesting finding was explained by the foot sliding within the shoe during the stance phase.

Therefore, the findings of this interesting study suggest that using each of the eyelets in a running shoe (and lacing them up firmly) allows your foot to experience the full benefit of what the shoe was designed for. Under most circumstances, good running shoes are designed to reduce impact and control excessive rear foot pronation. Lace them up properly and they might actually achieve that!

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References

Hagen M, Hennig EM. Effects of different shoe-lacing patterns on the biomechanics of running shoes. Journal of Sports Sciences 2009; 27(3):267-275.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

One Explanation For Non-Contact Injury

Kevin — Sun, 01 Nov 2009 22:36:25 +0000

Like the various musicians in a symphony orchestra, athletic movements require different muscles to activate and deactivate in a very co-ordinated fashion. When disrupted, this orchestra of muscular activity can not only affect athletic performance, but can also lead to different injuries.

Functional instability of the ankle is an example of an injury that has been shown to affect muscular activity in other areas of the lower limb. With functional ankle instability, many people have a history of repeated ankle sprains. Although their “bad ankles” are not painful, these athletes feel like their ankles may “give way” at any time. Several studies have shown that these athletes can have hamstring, tensor fascia lata and peroneal deficiency during double leg to single leg jumps. The significance of this can be show through an example…

Imagine a soccer player with a previous ankle sprain who moves from standing on two legs to standing only on their previously injured leg (like when they plant their stabilizing leg to kick a ball). Given the findings mentioned above, these players may not have normal muscle activity in the standing hip because of their ankle dysfunction. As a result, they may injure their lower back (for example) because there wasn’t a co-ordinated muscular response to adequately stabilize the spine. This is a case where an athlete incurred a non contact injury to the lower back because of “bad ankles”. Thankfully, identifying functional ankle instability and prescription of individualized exercises can help to prevent these injuries. Feel free to contact us!

Questions? Comments? Please post them right on the site or email us directly. Like what you’ve read? Sign up for our complimentary email feed on the right side of this page so that you can receive these posts every two weeks.

References

Solomonow M. Sensory-motor control of ligaments and associated neuromuscular disorders. Journal of Electromyography and Kinesiology 2006; 16: 549-567.

Van Deun S, Staes FF, Stappaerts KH et al. Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to single-leg stance. American Journal of Sports Medicine 2007; 35: 274-281.

Zampagni ML, Corazza I, Molgora AP, Marcacci M. Can ankle imbalance be a risk factor for tensor fascia lata muscle weakness? Journal of Electromyography and Kinesiology 2009; 19: 651-659.

Gluteal Exercises During Various Exercises

Kevin — Mon, 19 Oct 2009 00:20:01 +0000

This past July, an interesting paper was published in the Journal of Orthopaedic and Sports Physical Therapy which investigated gluteal muscle activation during different exercises. Whether you’re a rehabilitation professional looking to assist someone with an injury or simply looking to tone up the appearance of these muscles, you may be surprised at some of the results found in this study.

The gluteus medius (pictured on the left) is a gluteal muscle that is best described as being on the “side” of our gluteal area. It assists in several motions, including abduction movements (moving the thigh away from the midline) and stabilizing the pelvis during activity. This muscle was definitely most active during side lying abduction. Interestingly, this exercise was approximately twice as effective as side lying clam exercises. In descending order, other useful exercises were single limb squat, lateral band walk, single leg deadlift and sideways hop. Other exercises studied but deemed as being in the lower “tier” of effectiveness for this muscle were (in descending order of muscle activation) the transverse hop, transverse lunge, forward hop, forward lunge, clam at 30 degrees, sideways lunge and clam at 60 degrees.

The gluteus maximus (pictured on the right) is a large gluteal muscle that performs hip extension. This muscle was found to be most active during the single leg squat and the single leg deadlift. This finding is in agreement with other research which found that gluteus maximus activity is greatest during exercises that require single leg balance with hip flexion / extension. Interestingly, the gluteus medius was activated to a similar extent during these exercises, suggesting that they are a great “bang for your buck” in terms of overall gluteal strengthening.

Questions about the exercises? Comments? Please post them right on the site or email us directly. Like what you’ve read? Sign up for our complimentary email feed on the right side of this page so that you can receive these posts every two weeks.

References

DiStefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(7): 532-540.

Disclaimer

The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Bench Press Pointers

Kevin — Sun, 04 Oct 2009 21:41:12 +0000

There is no question that the bench press is a very popular exercise for strengthening the pectorals. Although effective, this exercise can prove painful for many people so attention needs to be given to proper technique. Here are a few tips that are supported by published research…

Not too low - That burning stretch you feel at the bottom of the bench press is not necessarily the good type of “burn”. If you lower the bar to touch your chest, you’re likely to be straining the end of the pectoral muscle at the musculotendinous junction instead of targeting the pectoral muscle tissue. It’s recommended that you keep the bar 4 to 6 centimetres above your chest when performing this exercise. You can roll up a towel and place it on your chest if you need the reminder!

Not too wide - A grip that is too wide forces your shoulder into excessive external rotation. This can damage the passive structures in the front of your shoulder joint leading to chronic capsular laxity. If you’re someone who has dislocated your shoulder in the past or if you are known to have “loose” joints, a wide grip may increase the likelihood for certain types of injury. The recommended grip width is no wider than 1.5 times your acromial width (the acromions are the bumps on the top of your shoulder). Worried that this will reduce your strength too much? According to the literature, you should expect only a 5% deficit in strength with this change.

Keep it flat - When you place the bench on an incline it forces your shoulder into external rotation. If you’re someone with a structural deficit in the front of the shoulder joint (perhaps due to the aforementioned laxity or a history of dislocation) you’ll find that this increases the likelihood of pain or injury. Try keeping the bench flat and see if that makes a difference. Worried about strengthening your upper chest? According to some literature, inclining the bench does not alter the activity of the upper pectoral. Instead, it decreases the activation of the sternal portion of the pectoral (in the midline of your chest).

Questions or comments? Feel free to post a comment on this site or email us directly. Like what you’ve read? Sign up for our complimentary email feed to receive these articles every two weeks.

References

Glass SC, Armstrong T. Electromyographical activation of the pectoralis muscle during incline and decline bench press. Journal of Strength and Conditioning Research 1997; 11: 163-167.

Green C, Comfort P. The affect of grip width on bench press performance and risk of injury. Strength and Conditioning Journal 2007; 29 (5): 10-14.

Lantz J, McCrain M. Modifying chest press exercises for athletes with shoulder pathology. Strength and Conditioning Journal 2005; 27 (3): 69-72.

Injuries in Distance Runners

Kevin — Sun, 20 Sep 2009 20:14:38 +0000

Overuse injuries are very common among distance runners. The repeated tissue stress can lead to such conditions as achilles tendinopathy, patellar tendinopathy, soft tissue and osseous stress syndromes and plantar fasciosis to name a few. Think it won’t happen to you? An interesting study published in Foot & Ankle International examined the injury statistics for 291 distance runners and found that the incidence of injury was actually quite high. The average age of the subjects was 42 years and they ran an average of 65.2 kilometres each week. The following are some of the more interesting findings…

The injury rate was 0.08 injuries for each 1000 kilometres run.
Overuse injuries were more frequent than acute injuries.
The most predominant injury was achilles tendinopathy, affecting 56.6%.
46.4% of the runners experienced anterior knee pain.
35.7% of the athletes experienced shin splints.
12.7% of the subjects experienced plantar fasciosis.
Runners with more than 10 years experience had an increased risk for achilles tendinopathy.

So does this mean you hang up the runners? Not at all. We just want you to be aware of the common injuries associated with this type of vigorous exercise. Consulting with a knowledgeable health professional can be helpful in providing you with a preventative strategy that is specific to your needs. If you’re in pain, we always recommend that you get your injury examined and diagnosed early before it turns into a larger, more stubborn problem. Good luck!

References

Knobloch K, Yoon U, Vogt P. Acute and overuse injuries correlated to hours of training in master running athletes. Foot & Ankle International 2008; 29(7): 671-676.

Are Elliptical Machines Useful?

Leslie — Sun, 06 Sep 2009 20:27:58 +0000

Recently we came across an interesting paper published in the well known journal “Medicine & Science in Sports & Exercise” which investigated the loads imposed on our joints when using an elliptical exercise machine. Some of the more interesting results were as follows…

In terms of cardiovascular exercise, an elliptical machine can give you a workout that is comparable to that of a stairclimber or a treadmill.

In general, there is less impact force with an elliptical machine when compared to a standard treadmill. Therefore, for people with conditions that are aggravated with impact (like osteoarthritis in the hips, knees or ankles) it may be wise to choose an elliptical machine over a treadmill.

An elliptical machine requires a greater amount of hip and knee flexion (pictured below). This places a greater demand on the hip flexors and the quadriceps than that found with the use of a treadmill. For those with an injury in either of these areas (especially overuse injuries in the quadricep complex or the hip flexors) extensive use of an elliptical machine may be unwise.

The pedal trajectory of a standard elliptical machine is usually wider than the trajectory used for walking. Since your feet have to follow the pedals on an elliptical machine, you’ll impose a different set of demands on your hips, knees and ankles than you would with the use of a treadmill. For some individuals, prolonged exercises on the elliptical may lead to alignment injuries like mal-tracking of the patella.

Therefore, the results of this study suggest that elliptical exercise is indeed a worthy form of exercise for the right individual. Consideration of your body type and history of injury can assist you in choosing the right path. As always, we recommend that you consult with a suitable professional who can help you make informed, objective decisions that are based on science. Good luck!

References

Lu TW, Chien HL, Chen HL. Joint loading in the lower extremities during elliptical exercise. Med. Sci. Sports Exercise. 2007: 39(9); 1651-1658.

Preventing Ankle Sprains

Kevin — Sun, 23 Aug 2009 19:36:38 +0000

As part of our initiative to reduce the number of soccer related injuries this summer, this weeks post is going to teach you a little bit about ankle sprains and how we can try and prevent them. Ankle sprains account for 25-50% of all injuries in sports and 17% of soccer injuries. An inversion ankle sprain is the most common ankle sprain injury, accounting for 77%. It usually involves stepping on the lateral ridge of the foot and “going over” on the ankle, damaging the ligaments around the lateral malleolus.

Proprioception is a term that is commonly associated with ankle sprain. In technical terms, it is the combination of joint position sense and kinesthesia. In more simple terms, it’s the mechanism that allows us to know and feel the position of our joints without looking at them. Unfortunately, when we injure a ligament and different joint structures (as with an ankle sprain) this mechanism is disrupted and we are more susceptible to injury. Proprioceptive training is commonly used in sport specific conditioning and rehabilitation in an effort to optimize our proprioception and prevent injury. Unfortunately, the literature is conflicting as to the efficacy of proprioceptive and balance training for the prevention of ankle sprains. Yet, since there really doesn’t seem to be a downside to proprioceptive training, we usually recommend them to our patients who may be at risk. The following is a sample of progressions for proprioceptive training…

1. Stand on one foot.
2. Stand on one foot and move your hanging foot in a star pattern around you.
3. Stand on one foot with your eyes closed.
4. Stand on one foot with eyes open while bouncing a ball off the wall.
5. Progress to training on unstable surfaces (like wobble boards or bosu balls).

Keep in mind that ankle instability and susceptibility to sprain is a complex issue. Things such as player position, previous injury, bracing, taping, peroneal reaction time and neuromuscular control can all be important components of prevention for some individuals. We recommend that you consult a suitable health practitioner who has the knowledge and ability to diagnose your condition and assess your specific risk for injury. Should you have any questions or concerns please do not hesitate to contact us.

References

Ergen E, Ulkar B. Proprioception and ankle injuries in soccer. Clinics in Sports Medicine 2008: 27; 195-217.

Greig M, Walker-Johnson C. The influence of soccer specific fatigue on functional stability. Physical Therapy in Sport 2007: 8; 185-190.

Hughes T, Rochester P. The effects of proprioceptive exercise and taping on proprioception in subjects with functional ankle instability: a review of the literature. Physical Therapy in Sport 2008: 9; 136-147.

Kofotolis ND, Kellis E, Vlachopoulos SP. Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period. The American Journal of Sports Medicine 2007: 35(3); 458-466.

McKeon PO, Hertel J. Systematic review of postural control and lateral ankle stability, part 1: can deficits be detected with instrumented testing? Journal of Athletic Training 2008: 43(3); 293-304.

Mohammadi F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players. The American Journal of Sports Medicine 2007: 35(6); 922-926.

Ross SE, Guskiewicz KM, Gross MT, Yu B. Assessment tools for identifying functional limitations associated with functional ankle instability. Journal of Athletic Training 2008: 43(1); 44-50.

Turf Toe

Kevin — Sun, 09 Aug 2009 23:36:41 +0000

Turf toe is a slang term used to describe a common yet frustrating injury that affects athletes like football players and soccer players. In technical terms, it describes a sprain of the plantar capsule and plantar ligaments of the first metatarsophalangeal joint. In simple terms, you likely pushed your big toe too far and the bottom side of the joint has been damaged. Ask any player who is getting ready for the upcoming football season and it’s a really frustrating and painful injury. So what can be done?

Numerous published studies have been able to identify variables that are commonly related to the condition. Unfortunately, many of these variables cannot be changed such as the age of a player and the number of years they’ve been playing. Yet one finding that has been linked to the incidence of turf toe is the range of ankle dorsiflexion. According to the literature, a higher range of ankle dorsiflexion is linked to a higher incidence of turf-toe. Therefore, particularly for the athlete with a history of turf-toe and those with a rather generous range of ankle dorsiflexion, it may be advised to brace or tape the ankle before competition. Depending on the case, it may also be advised to wear less flexible shoes, tape the first metatarsophalangeal joint and/or wear a rigid orthotic.

Perhaps another example of how an increased range of motion in a given joint (in this case the ankle) may not be such a helpful thing!

References

Rodeo S, O’Brien S, Warren R et al. Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. The American Journal of Sports Medicine 1990; 18(3): 280 - 285.

Sahin N, Atici T, Bilgen S, Bilgen O. Turf toe in a taekwandoo player: case report. Journal of Sports Sciences and Medicine 2004; 3: 96-100.

Lower Back Pain in Rowers

Leslie — Sun, 26 Jul 2009 07:00:33 +0000

As the popularity of paddling and rowing is on the rise, so are the number of injuries we’ve seen at our clinic that are associated with these sports. The most frequently injured area is the lower back which accounts for 15 - 25% of these injuries. Two of the more common lower back injuries associated with paddling and rowing are lumbar disc herniation and a spondylolysis / spondylolisthesis.

In the case of lumbar disc herniation, repeatedly flexing the spine forward can lead to a weakening of the outermost structure of the disc, eventually allowing the inner “jelly-like” material to bulge out. More often than not, this inner material protrudes posteriorly (backwards) and laterally (to the side). This movement of discal material can cause pressure and / or irritation of the nerves which exit the spine, often leading to sensations of pain, numbness and tingling into the buttock and leg. For many rowers, the repeated flexion and extension of the spine creates muscle fatigue and a loss of support, compression and herniation of the lumbar disc.

Spondylolysis typically involves an acute or stress fracture at the pars interarticularis and can lead to a forward displacement of one vertebrae relative to the one below (spondylolisthesis). The risk of developing a spondylolisthesis greatly increases in sports that demand a significant level of hyperextension or extension and rotation of the lumbar spine. As mentioned above, rowing and paddling are good examples.

Given the fact that these are all non contact injuries, one can assume that they are preventable to a certain degree. Here are some tips to think about as the rowing season goes into full tilt…

1. Maintain a neutral spine throughout the entire stroke. Rowers who adopt a slumped position at the catch or finish tend to have a higher incidence of low back injuries.
2. Maintain an anterior pelvic tilt throughout the catch phase to decrease the amount of lumbar flexion necessary and thus reducing the amount of stress on spinal structures.
3. Endurance training should be emphasized in the lumbar erector spinae muscles to help reduce excess flexion of the lumbar spine.
4. Stretching of the hamstrings and gluteals can help to obtain an adequate anterior pelvic tilt. Stretching the hip flexors may also help to decrease the amount of anterior pull on the spine.
5. Finally, many injuries are actually created or worsened by your actions on land and in the gym. Be sure that you have proper instruction on technique and training regimen before beginning an exercise program.

References

Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Medicine 2005; 35(6): 537-555.

Ho SR, Smith R, O’Meara D. Biomechanical analysis of dragon boat paddling: a comparison of elite and sub-elite paddlers. Journal of Sports Sciences 2009; 27(1): 37-47.

Knee Pain in Cyclists

Kevin — Mon, 13 Jul 2009 01:41:29 +0000

With the Tour de France in full swing we thought it would be fitting to address a common cycling injury for this weeks blog; patellar tendinosis.

The patellar tendon is located below the patella (or “knee-cap”) and is an extension of our quadriceps muscle (the muscle on the front of your thigh). It is placed under tension when the quadriceps muscle is active, like when we push the pedal downward during cycling. Patellar tendinosis is a condition that involves degeneration and a re-organization of tendon tissue, usually secondary to excessive demand being placed on the area. But why do some cyclists get patellar tendinosis while others do not? The reality is, there are a large number of factors that can be related to patellar tendinosis in cyclists…too many to mention in this article. Yet one finding that has been consistent in the literature is that those athletes who experience pain show a different movement pattern than those not in pain. Specifically, those in pain use a cycling technique similar to the red line in the picture, while those who haven’t experienced a knee injury tend to have a movement pattern similar to the green line. Unfortunately, it has not been established (and perhaps cannot be established) whether this technique occurs as a result of injury or if it precipitates injury. Regardless, we recommend that you make every effort to use a cycling pattern similar to the green line in the picture above (and don’t let your knee drift toward the midline). If you’re having difficulty, it can be due to several reasons. Poor range of motion in the ankle or an ill-fitted bicycle may prevent proper technique from being possible. In either case, we recommend that you consult with a suitable professional who can offer you assistance. If you’re just unsure what the proper technique looks like, turn on your television before it’s too late!

References

Bailey MP, Frederick JM, Messenger N. Kinematics of cycling in relation to anterior knee pain and patellar tendonitis. Journal of Sports Science 2003; 21: 649-657.

Dettori NJ, Norvell D. Non-traumatic bicycle injuries - a review of the literature. Sports Medicine 2006; 36(1): 7-18.