Move Well, Live Well Newsletter

Transcription

1 Move Well, Live Well Newsletter August 15, 2016 Volume 4, Number 8 In This Issue: Pelvic Floor Dysfunction in Olympic Athletes Achilles Tendinopathy: A Success Story Post Run Recovery: Why Rest May Be Best Pelvic Floor Dysfunction in Olympic Athletes Rachael Herynk, DPT I hope you are enjoying watching the 2016 Summer Olympic Games. It s a great time to reflect on the amazing capabilities of these athletes. I was extremely happy to see an article recently published by the International Continence Society on addressing the needs of pelvic floor dysfunction in Olympians, as urinary incontinence and other forms of pelvic floor dysfunction are prevalent among athletes. A team of three physical therapists from the Gynecology Sport sector of the Federal University Medical School of Sao Paulo, Brazil provides pelvic floor therapy to Olympic athletes as they compete this summer. Participants are assessed individually using traditional PT methods. After evaluation, athletes participate in Sport Pelvic School, which provides education and exercises to improve function of the pelvic floor muscles 1. Many studies have shown a relationship between sport participation and pelvic floor dysfunction. One recent study looked at the prevalence of urinary incontinence in female young athletes participating in volleyball. It found 65% of young women had at least one symptom of urinary incontinence (stress or urgency) during sport or daily life situations 2. I am pleased that an often overlooked aspect of athletics is being addressed. Pelvic floor dysfunction, either incontinence and/or pain, largely impacts quality of life and should be acknowledged as important. Ultimately, physical therapy has been found to be exceedingly effective in helping people with incontinence and pelvic pain.

2 Sign up for the Sapphire PT enewsletter at sapphirept.com Sources 1. Carboni, Cristiane of Physiotherapy Committee. Pelvic Floor Physiotherapy in the Olympic Games 2016 Rio de Janeiro/Brazil. International Continence Society. ICS.org. Updated July 5, Schettino MT et al. Risk of pelvic floor dysfunctions in young athletes. Clin Exp Obstet Gynecol. 2014; 41(6): Achilles Tendinopathy: A Success Story Allie Molnar, DPT With summer in full swing, Missoulians are outdoors enjoying running, hiking, cycling and all the activities they love. While the weather has been nice, sometimes it becomes less appealing to spend time performing strengthening exercises and cross training. Neglecting this type of maintenance work, or increasing the intensity of one s training program too quickly can lead to dreaded overuse injuries, such as Achilles tendinopathy. During a brief Colorado bike tour in May, I developed my own Achilles Tendinitis, as a result of increasing both mileage and intensity too quickly. This type of training error is common among runners, hikers, and cyclists, and is one of the contributing factors of this injury. Links to Related Sites: SapphirePhysicalTherapy.blogspot.com Related Sites: The Runners Edge: Missoula s hub for running gear, information, and races Run Wild Missoula membership promotes running, training, and racing in Missoula Missoula s choice for core strengthening and ski conditioning. From beginners to elite athletes, Momentum classes will increase your strength and reduce your injury risk. The Achilles tendon is a fibrous tissue that connects the calf muscles to the heel, and assists with movement of the lower leg and ankle joint, enabling standing up on one s toes, walking, and running. It is the thickest and strongest tendon in the body, as it must withstand up to 3-12 times a person s body weight during push-off, depending upon speed, stride, and additional weight being carried or pushed. 4 Despite its strength and thickness, the Achilles tendon is commonly injured, when the demand placed on the Achilles tendon exceeds its strength and/or stiffness. An estimated 50% of runners will experience Achilles pain in their running careers. 3

3 Find us on Facebook: For more information on the services provided by Sapphire Physical Therapy or to read more related articles, see our website or give us a call at Sign up for the Sapphire PT enewsletter at sapphirept.com Contact Us: (406) Us: John Fiore, PT: john@sapphirept.com Rachael Herynk, DPT: rachael@sapphirept.com Jesse Dupre, DPT: jesse@sapphirept.com Holly Warner, DPT: holly@sapphirept.com Allie Molnar, DPT: allie@sapphirept.com Jennifer Dreiling: jennifer@sapphirept.com Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: In early or acute stages of the injury, individuals may experience tenderness in the heel or Achilles tendon, tightness in the ankle, calf, and swelling in the back of the ankle. Due to the poor blood supply of this particular tendon, the tissue s healing capacity is reduced, and it tends to undergo degenerative changes that are seen in the chronic stages of the injury. This results in decreased stiffness and impaired performance, as well as recurrent injury if left untreated. 3 As discussed above, training error (increasing the demands of an exercise too quickly) is a risk factor for Achilles Tendinopathy. Other risk factors include ankle stiffness, calf tightness, calf weakness, abnormal foot structure, abnormal foot mechanics, and improper footwear. A physical therapist can assist with diagnosis of your injury and its current stage of healing, to best prescribe the most appropriate load or level of exercise that will promote healing of your tissue without exacerbation. In addition to addressing your pain with techniques such as taping, orthotics, and iontophoresis, your physical therapist will help address your deficits in strength, range of motion, and may perform manual therapy techniques to improve mobility at your ankle joint, or soft tissue massage to decrease tension in your calf muscles which may be contributing to increased tension at the Achilles insertion. Another important component of rehabilitation will be to identify and correct the biomechanical factors that may have initially caused the Achilles tendinitis, to decrease risk of recurrence in the future. Given the chronic nature of this condition, extensive research has been performed on its rehabilitation, and eccentric exercise training (lengthening a muscle under load) has proven to be highly effective, as it may increase the tensile strength in the tendon over time. 2 Strong evidence was found for the Alfredson protocol, which called for 6-12 weeks of exercises, in which subjects performed 3 sets of 15 repetitions twice daily, both with a straight and bent knee. A reported 82% of patients in this eccentric exercise group were satisfied and returned to their previous activity level. 1 Repetitions this high in volume may seem daunting, and require commitment. From personal experience however, I can attest to the success of this protocol. I spent the summer months devoted to my eccentric exercises, and can proudly report that I enjoyed a 3 week bike tour down the Pacific coast symptom free! If you are battling a nagging Achilles tendon injury, consult a physical therapist to help implement these evidence-based interventions, and get you back outside to enjoy the physical pursuits that you love! Our Services: Orthopedic injuries References: 1. Alfredson, H., & Cook, J. (2007). A treatment algorithm for managing Achilles tendinopathy: New treatment options. Retrieved August 15, 2016, from

4 Functional strengthening Pre and post-operative rehabilitation Core strengthening & conditioning programs Back and neck pain Running overuse injury and prevention High speed 2D video running gait analysis Work related injuries Functional Capacity Evaluations Work Hardening & Functional Conditioning Programs Cycling injuries & biomechanical bike fitting Women s health services All insurance accepted & billed Cash payment option 2. Habets, B., & Van Cingel, R. (n.d.). Eccentric exercise training in chronic midportion Achilles tendinopathy: a systematic review on different protocols. Retrieved August 15, 2016, from 3. Achilles Tendon Injuries (Tendinopathy). (2013). Retrieved August 15, 2016, from 3. Treating Achilles Tendon Injuries - Achilles Tendon. (n.d.). Retrieved August 15, 2016, from Post Run Recovery: Why Rest May Be Best John Fiore, PT Running plays an integral part in the lives of many Missoulians. The training comradery and friendships gained through the Missoula running community are second to none. When your body tires and the miles feel like and eternity of suffering, it is time to listen to your body and rest. Late summer is a common time to feel fatigue. By fatigue I am referring to deeply-rooted fatigue which is not resolved with a solid night of sleep. Deep fatigue is normal following a progressive increase in training intensity and volume as well as following a target race. I speak from experience as I am great at signing up for and training for races, but readily ignore my own signs of fatigue.

5 Fatigue: Ignoring fatigue and depriving your body of the rest it requires to recover, recuperate, and heal increases your injury risk. Muscles such as the gluteus medius, gluteus maximis, and tibialis posterior are among the first to fatigue during a long, hard training run or race. Adequate rest following exercise allows fatigued muscles to recover and rebuild. If you are sore three days following a run, then your muscles are not recovered. Running on heavy, fatigued legs may reinforce the compensatory running gait patterns your body has called upon to get through your previous strenuous effort, which increases your risk of overuse injuries. Rest: The definition of rest following a challenging training run or race is multi-faceted. Everyone recovers at a different rate. Your rest day or rest period must reflect what works for you as an athlete and as a person. If your job requires frequent standing and lifting, then going to work may not count as a rest day even if you forgo your daily run. If your legs are laden with the achy sensation which accompanies delayed onset muscle soreness (usually experienced hours post exercise), then active rest in the form of easy bicycling or walking may facilitate circulation and relieve soreness. Elevating your legs and providing rolling or light massage will also stimulate circulation and expedite muscle recovery. If you are not sleeping 7-8 hours per night, then you are not recovering adequately. Our busy summer schedules and the long daylight hours lead to inadequate sleep. Our bodies to the majority of their healing while we sleep at night. Make sleep a crucial component of your recovery routine. Hydration & Nutrition: Proper hydration and nutrition are extremely important for recovery. Dehydration impacts tissue healing, cardiac function, and malaise. Combining adequate hydration with simple, whole food nutrition results in faster recovery. Guidance: If your run did not go as planned (you felt slower than expected, you felt flat, your legs felt heavy, your legs cramped or felt very sore), perhaps less is more. The common reasoning of runners is to train harder after a sub-par performance to perform better during our next run or race. Such logic ignores the fact that despite being sub-par, your performance was the best you could do on that particular day. Allow your body to recover and rebuild. Failure to do so may result in over-training and/or chronic fatigue syndrome which will result in long-term physiological changes. Utilize the expertise of local and regional experts to assist you in formulating a training plan which incorporates intensity, volume, goals, and recovery periods. One month ago I contacted Mike Wolfe

6 (Mountain Project, LLC) for training advice in preparation for the Bridger Ridge Run and The Rut 28K races. My legs were feeling heavy and my racing schedule had been ambitious. Despite the obvious symptoms, I continued to run through fatigued legs, failing to recover during the rest days I spent working long hours on my feet. Mike outlined a sensible recovery-oriented training plan which enabled me to begin the recovery process. Fatigue has been replaced by a hunger to run, some speed returning to my legs, and a great deal of perspective on proper training and recovery techniques. Utilize a coach will keep your training focused and your recovery real! John Fiore, PT