Results of an International Journal of Sports Medicine Study analysing the injury & training characteristics of male elite, club and recreational athletes over a year period found:
- 75% of elite athletes suffered at least 1 overuse injury
- 75% of club athletes suffered at least 1 overuse injury
- 56% of recreational athletes suffered at least 1 overuse injury
The Patella tendon, Achilles tendon and ITB showed to be the most common injuries sustained
What Causes these injuries and why are they so common?
First of all you need to try and establish the origin of the problem…
In future posts I will be discussing the Footwear and Training issue, but for this post I will focus on the Flexibility and Biomechanical issues associated with these injuries.
90% (umm and that’s being conservative!) of Athletes I get into the clinic would state categorically that they don’t follow a proper stretching routine, let alone warm-up. Their stretching routine will consist of a quick 10 second stretch on the quad and hamstring and maybe throw in a calf stretch for good measure (if they have time?).
Well… what’s that old saying of “If you don’t have time for health now, you WILL make time for injury later?”
And now there are studies to prove it!
A quick way for me to assess the flexibility of a person is by performing the overhead squat. Here is how that is performed…
And this is the way it should look:
Used to assess:
- lower limb symmetry
- Immobility of shoulders, thoracic spine, hips, knees and ankles.
In addition to the Overhead Squat I will also perform a One Leg squat to determine symmetry between left and right sides and also go on to do a full…
- Video Analysis to determine Biomechanics
- Functional or Structural problem? i.e Bony Malalignment / Muscle Imbalance
- Assists in determining correct shoe wear
- Assists in clinical reasoning for fitting custom orthotic devices
- Assists in quantifying orthotic prescription to allow person to function in neutral zone
Common Injuries associated with altered biomechanics:
- Tight Lateral Structures
- Patella Femoral Joint Pain
- Altered Tibial alignment
- Tight Achilles Tendon
- Plantar Fascia strain
- Tibialis Posterior tendon
- Patella & Achilles Tendinopathies
- ITB Friction syndrome & Trochanteric Bursitis
- Plantar Fascitis
- Medial Shin Pain
- Tib/Fibular Stress fracture
The Patella tendon joins the knee cap to the shin.
The injury that occurs most often here is due to repetitive stress placed on the tendon.
Like the achilles, patellar tendinitis is when the injury is at its early stage and indicates inflammation in the area.
If allowed to progress micro tears and degeneration can occur in the tendon leading to a tendinosis.
Warning: The longer the injury is left, the more difficult it becomes to treat.
I will discuss the anatomy and treatment of this in more detail later.
Achilles Tendonitis is inflammation within the tendon
If left untreated and you continue to push through it, it can develop into a Tendinosis
Achilles Tendinosis is a degenerative condition where inflammation over a period of time breaks down the Achilles Tendon fibres!
Treatments for Patella/Achilles tendinopathy
- Deep tissue massage to free up tight myofascial structures
- Self Myofascial release with foam roller to promote healing of the tendon
- Eccentric Exercises to facilitate healing and increase strength in the supporting muscles
- Dry Needling acupuncture to increase blood flow , promote healing and free up tight muscles
- Kinesio-Taping to relieve muscle tension and promote healing
- Orthotic prescription if needed
Self Myofascial Release using the Grid Foam Roller
Eccentric strengthening: Patella Tendon
- In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction (VAS scores fell from 74.2 to 28.5 after 12 weeks) when compared to standard single leg squats ( VAS 79.0 to 72.3 after 12 weeks ) (Purdam et al, 2003)
- Young et al (2004) found that the decline squat protocol offers greater clinical gains during a rehabilitation programme for patellar tendinopathy in athletes who continue to play with pain over a 12 month period.
Eccentric strengthening: Achilles Tendon
- 89% of patients with chronic painful achilles tendinosis were back to their pre-injury level after 12 weeks (Fahlstrom et al , 2003)
- Pain levels decreased in this group significantly from 66.8 to 10.2 %
- Physicians Dr. Travel and Simons defined the myofascial trigger point (the point at which the dry needle is inserted) as a ‘hyperirritable spot in skeletal muscle’.
- Dry needling works by changing the way your body senses pain (neurological effects), and by helping the body to heal muscle spasm associated with trigger points.
- The trigger point is painful on compression and can give rise to referred pain or tenderness
- Pain Referral: calf & may radiate into the lower thigh
- Pain may also refer to the achilles tendon & heel
- Medial gastrocnemius MTrP’s can cause plantar fascia type pain
- Reduce local pain
- Improve Circulation
- Modulate muscle activity (tone up/down)
- Alter Fascial alignments
- Support Joints
- Alters the relationship between foot and ground reaction forces
- Weightbearing realignment of the foot and lower limb
- Redistributes the force and or shock attenuation in gait
- Allows the foot & other joints to function within their neutral zone & prevent tissue stress
Physiotherapy treatments available @ Physiozone
- Massage therapy to facilitate healing, circulation and release tight myofascial structures
- Specific Eccentric exercises to facilitate Type I collagen production and tensile strength of the tendon
- Kinesiotaping to support the tendon and encourage circulation, lymph drainage and healing
- Dry Needling acupuncture to increase circulation to the tendon and release trigger points in the muscle
- Gait analyses and Orthotic prescription if an underlying biomechanical problem exists.