October, 2010

Top 5 Running Injuries

October 14, 2010

Up to 80% of runners are injured every year and there's a greater prevalence in industrialized countries. Here are the top five running injuries we see in the clinic.  You will learn about the characteristics of the injury, the biomechanical cause, and what type of stress caused the injury.
  1. Patellofemoral Pain Syndrome (PFPS):  PFPS is pain in the front of the knee or around the knee cap experienced most with descending stairs and running.  It can also occur after prolonged sitting.  Many factors can contribute to PFPS such as biomechanical dysfunction, muscle imbalance, patellar maltracking, reduced flexibility, hip or foot dysfunctions.  Clinically, we see problems usually with the hip.  Movement MRIs now show that the femur moves off track, causing rubbing of the patella on the femur.  It was once thought that the patella move off the femoral groove and thus was the culprit of pain.  However, research and clinical experience is now telling us the hip is responsible for patella tracking problems.  PFPS can be an excessive repetition, range of motion, and load injury.
  2. IT Band Syndrome:  IT Band Syndrome is characterized by pain on the outside of the knee.  Downhill running and stairs can exacerbate it.  The Iliotibial Band (IT Band) is a band of connective tissue that runs from the outside of your hip, down the outside of your thigh and inserts in the lateral knee area.  Pain can be experienced anywhere from the hip to the knee.  Irritation typically occurs near the outside of the knee when the IT Band rubs across the femur bone, causing friction with every step. Causes can be due to foot or hip dysfunction.  IT Band Syndrome is mostly an excessive repetition injury.
  3. Plantar Fasciitis:  Plantar Fasciitis is characterized as pain along the connective tissue on the bottom of the foot.  Pain can also be experienced in the small toe flexor muscles of the foot.  Typically patients feel pain when they first get out of bed in the morning and at the beginning of a run.  Plantar Fasciitis can be caused by foot or hip dysfunction.  Plantar Fasciitis can be an excessive load and repetition injury.
  4. Achilles and Patellar Tendinopathies:  Achilles and Patellar Tendinopathies are characterized by pain along the Achilles tendon in the back of the ankle or pain in the front of the knee (Patellar Tendinopathy).  Typically patients experience pain in the Achilles Tendon when they first get out of bed in the morning or at the beginning of a run, or with running hills.  Patellar Tendinopathy patients typically experience pain going down hills, down stairs or with jumping. Causes are typically due to hip or foot dysfunctions.  Achilles and Patellar Tendinopathies are typically due to lack of range of motion.
  5. Shin Splints/Medial Tibial Stress Syndrome:  Shin Splints are characterized by pain along the inside of the shin, typically on the lower (distal) third of the bone.  Pain is usually just with running, although if it's very inflamed, patients can experience pain with walking.  Causes are due to hip or foot dysfunctions.  Shin Splints are typically an excessive load injury.

Now you are probably asking:  WHICH injury do I have and WHY is it there and WHAT can we do about it?

Clinically,  we:
  1. Take a complete  and comprehensive history.
  2. Do a proper examination.
  3. Test your biomechanics, breaking down the running movements and find the weak links.

Example of Dynamic Functional Analysis

4.  Analyze a video of you running.

An example of stride angle

5.  Evaluate the soft tissue for fibrotic adhesions that de-activate muscles and cause restricted movements.

Dr. Jess and friend treat six-time Ironman champion, Natasha Badman

6.  Test your range of motion, joint restrictions, alignment and imbalances.

Dr. Jess assessing a triathlete at Ironman World Championships

How do we treat these injuries?

ART

ART® is the only treatment designed to effectively treat soft tissue injuries within nearly every structure of the musculoskeletal system. Combining the understanding of biomechanics and movement with hands-on applied techniques, ART® treatment protocols normalize the relationship of moving tissues to one another – thereby eliminating pain and dysfunction.

Graston

The Graston Technique® Instruments, much like a tuning fork, resonate in the clinician’s hands allowing the clinician to isolate adhesions and restrictions, and treat them very precisely. Since the metal surface of the instruments does not compress as do the fat pads of the finger, deeper restrictions can be accessed and treated. When explaining the properties of the instruments, we often use the analogy of a stethoscope. Just as a stethoscope amplifies what the human ear can hear, so do the instruments increase significantly what the human hands can feel.

Spidertech

You’ve seen the Olympians with the blue or pink or black taped shoulders, calves, or knees. A while back, we had to cut the Kinesiotape ourselves before applying. Now, SpiderTech has created very effective pre-cut tape for most joints and body parts as well as a lymphatic drainage tape to improve micro-circulatory flow.   The tape, made with hypoallergenic acrylic glue, is manufactured to be the same weight, thickness and elasticity as the skin and is therefore able to integrate with the body’s sensory system naturally.

Rehab

Dr. Greaux has attended numerous conferences and seminars as well has researched functional biomechanics to better serve her clients. She is highly regarded as a biomechanical expert in sports and is a consultant to University of California Sports Medicine to diagnose dysfunction and appropriately rehabilitate their athletes.

Our purpose of rehabilitation and exercise training is to:

  • Recover from injury
  • Prevent injury
  • Enhance performance
Using the knowledge of biomechanics of the spine and extremities, Dr. Greaux incorporates balance, stability, and activity/sport specific training to accomplish our purpose. We strive to help you do the activities better than you were once able to do.

Gait recommendations

Dr. Greaux stays current on research pertaining to running biomechanics and technique.  She attends numerous courses around the globe to learn from top researchers.  Using this knowledge and after analyzing a video, Dr. Greaux will make recommendations of form, technique, and biomechanics as it relates to the running videos.

Chiropractic

Along with being a biomechanics specialist in sports medicine, Dr. Greaux is a board certified chiropractor.  This allows her to accelerate the rehab process by removing restrictions in joints leading to dysfunction in movements.

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Short Leg Syndrome. What Does the Research Say?

October 6, 2010

Dr. Jess assessing a triathlete

Leg length Discrepancy (LLD) is a controversial subject amongst chiropractors, physical therapists, podiatrists, and medical doctors. In the medical community, there are two main types of LLD.  Functional LLD occurs when alignment or dysfunction of a joint causes an appearance of a short leg. For instance, the pelvic bone can rotate and cause the femur to move up or down, creating an apparent short or long leg.  Another common functional cause can be hip rotator tightness and/or psoas tightness which, for lack of a better word, sucks up the femur giving the appearance of a short leg. Structural LLD occurs when the tibia (shin bone) or femur (thigh bone) is literally shorter than the other side.  This can be congenital, but it can also be caused by a healed fracture. Many of you are told you have a long leg or a short leg from various techniques such as:  The practitioner measures your legs while you are lying on your back or stomach.  Some look at the height of your pelvis while standing.  Some will have you lie on your back and bend your knees to see if the femur or tibia are longer.  Some of you even have had x-rays. But how do we know if a patient REALLY has a so-called Leg Length Discrepancy.  And, how do we know if the LLD is the actual cause of pain. Unfortunately, research shows that there are errors between examiners and even in x-ray machines.   (2005 Terry, 2002 Gurney, 1995 Rhodes.) X-Ray:
  • Errors of the machine = 0.9cm
  • Intra-examiner (reading the x-ray) error = 0.4cm
  • Inter-examiner error = 1 cm
  • Measurement error between lying down and standing = up to 12mm
Clinically:
  • Intra-evaluator error = 2cm
  • Inter-evaluator error = 2.5cm
Research also shows that LLD is universal and that 90% of the population has it with an average of 5.2mm.  (Knutson, 2005)  Two literature reviews have concluded that 20mm of a LLD is necessary to negatively affect the patient with regard to pain, function, and biomechanics. (Knutson, 2005 and Gurney, 2002.)  That is very significant.  Personally, I don't believe I have ever come across such a LLD in a patient who has not fractured a leg bone. Given the errors in x-ray machines, in reading x-rays, in evaluating legs in the clinic, AND that 90% of the population has a LLD, AND 20mm of LLD is significant to cause pain and affect biomechanics, do we really need to put a lift in shoes or build up orthotics?  Are we barking up the wrong tree? As clinicians, we often find that some patients display anthropometric asymmetries, but are asymptomatic while other patients have equal flexibility, leg length, and ranges of motion, yet are in chronic pain.   Yet, many clinicians are very quick to put in a heel lift or beef up an orthotic to create symmetry in leg length. Let's review why repetitive stress injuries in running occur:  80% of the injuries are caused by an overload to soft tissue.  In other words, soft tissue becomes injured/inflamed if the stress applied is greater than it's ability to adapt.  This is usually due to training errors and too much too soon.  The rest of the 20% is divided among intrinsic and extrinsic factors.  Intrinsic factors include muscle strength, flexibility, and biomechanics.  Extrinsic factors include shoes, orthotics, surface. Given that 80% of running injuries are caused by soft tissue overload, we may need to look more closely at training errors in addition to biomechanics and shoes and less into leg length discrepancies.
Dubois, Blaise. New Trends in the Prevention of Running Injuries.  Conference September 2010, Saskatchewan, SK, CN.
Gurney, B. Leg Length Discrepancy. Gait Posture. 2002 Apr;15(2):195-206.
Knutson, Gary.  Chiropr Osteopat. 2005; 13: 11. Published online 2005 July 20. doi: 10.1186/1746-1340-13-11.
Terry, Michael et al. Measurement Variance in Limb Length Discrepancy: Clinical and Radiographic Assessment of Interobserver and Intraobserver Variability. Journal of Pediatric Orthopaedics:March/April 2005 - Volume 25 - Issue 2 - pp 197-201.
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Mammoth Mountain

October 6, 2010

Mammoth Mountain

Mammoth Mountain

For those of you who prefer nubby tires to skinnies, Mammoth Mountain will be right up your alley.  I took a little mountain bike vacation a couple of weeks ago and biked above June Lake and then Mammoth Mountain and brought both the Santa Cruz Blur (full suspension) and Ellsworth Enlightenment (hardtail).  Didn't need the very light hardtail as most of the climbing wasn't terribly steep.  The Santa Cruz Blur handled the easy and moderate trails without a problem. Mammoth Mountain consists of miles and miles of dirt trails up, down, and across the mountain with varying degrees of required skill levels.  The trails are very well maintained and well designed, and worth more than the $10 day use.  If you choose, you can take the Gondola up to the top, and bike your way down, which costs about $40.   The trails are all rated like a ski slope, green circle, blue square, black diamond, and double black diamonds. Next year, I plan to stake out some prime photography locations as there are many tricks to perform off the black diamond and double black diamond trails.  You won't see me on them, but I can get some shots of teenagers flying through the air off ramps, tree trunks, over tunnels, etc. So, instead of seeing me fly through the air, I have a couple of me just trying to navigate some lines through rocks near the edge.  I know, nothing technical or tricky, but beautiful scenery nonetheless.  Enjoy!

Sunset over the Minarets

Dr. Jess on the Santa Cruz Blur

Dr. Jess and the Minarets

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