Pilates for runners with Achilles. tendonitis

Transcription

1 Pilates for runners with Achilles tendonitis Melinda van Tonder September 2018, Basi CTTC Pretoria

2 Abstract Running is a great form of exercise with many health benefits. Some of its benefits include improving cardiovascular strength, promoting healthy bone density, creating strength in lower extremities, and clearing the mind. However, running has some potentially serious disadvantages and can create a lot of imbalances in the body, particularly in the lower extremities, that can lead to many injuries. Imbalances in runners can lead to tight hips, lower back pain, knee pain, difficulty in keeping their balance, and stiffness in the thoracic spine. Pilates is a great form of cross training for runners and provides rehabilitation from various injuries. Doing Pilates on a regular basis can have the following benefits for runners: Improved lung capacity; Proper breathing control; Core strength, which gives an upright posture during the run; Postural faults and imbalances are corrected; Reduced injury time; and Increased endurance and flexibility. The selection of proper Pilates exercises can help runners to have a more efficient and sustainable running practise. 2

3 Table of Contents Title Page Abstract... 2 Table of Contents Anatomical Description Case Study Conditioning Program... 9 Conclusion Bibliography

4 Anatomical description I believe it s really important to have at least a basic understanding of our running anatomy as it can help in so many ways. The movement of the leg while running happens as follows: the leg is pulled forward by the hip flexors while the quadriceps is responsible for extending the knee. The foot action of being flexed and placed on the ground originates from the tibialis anterior. The leg is then pulled back by the gluteal as well as the hamstrings. There are many joints involved when it comes to running, but for the purpose of this research paper I will look at the larger joints of the lower limbs which are most commonly affected by running; the hip; knee-; and ankle joints. 1. Hip joint anatomy The hip joint is a ball and socket joint formed by the head of the femur (thigh bone) which is the ball part and the socket known as the acetabulum on the lateral, lower pelvis. Injuries around the hip area tend to be muscular. There are a lot of muscles around the hip joint which can be grouped together as follows: 4

5 The hip flexors- raise the leg in front. These muscles are found at the front of the hip joint, passing from the pelvis down on to the femur, or even the tibia below the knee. The adductors- groin muscles which move the leg inwards and across the body. The adductors attach to the inner pelvis and either to the inner femur, or the tibia just below the inner knee. The gluteal - perform movements such as abduction (moving the leg out to the side, away from the body); extension (moving the leg backwards) and both medial and lateral rotation. They all attach superiorly to the iliac crest and / or sacrum and pass laterally and downwards, across the buttock to the two trochanters (bony lumps) at the top of the Femur. Injuries to the muscles and tendons of the hip joint are the most frequent type of injury in runners due to the massive demands on these muscles, not only to move the joint forwards, but also to stabilise the pelvis and control frontal plane (sideways) and rotational forces. 2. Knee joint anatomy The knee joint itself is a hinge joint formed between the femur (thigh bone) and the tibia (shin bone). Some basic muscles that affect the knee joint are The quadriceps (straightens the knee); 5

6 The hamstrings found at the back of the thigh (extends the hip joint and flexes the knee). The adductors; The gastrocnemius is the biggest muscle found in the calf (plantar flexes the ankle). The popliteus (small muscle found at the back of the knee joint). 3. Ankle joint anatomy The ankle joint allows the up and down movement of the foot known as dorsiflexion (pulling the foot up) and plantar flexion (pointing the foot away). Muscles which affect the ankle joint tend to be found in the lower leg and pass a tendon across the ankle joint to attach to one or more of many foot bones. The plantar flexors or calf muscles: These are found in the back of the lower leg, and are known as the gastrocnemius. This is the largest and most superficial of the calf muscles which originate above the knee joint on both sides. Underneath this is the soleus muscle. Soleus is a little smaller and less well known but still very important in ankle function. It originates lower down on 6

7 the tibia bone. These two muscles meet to form the Achilles tendon, the biggest tendon in the body. The dorsi flexors or shin muscles: The largest of the dorsi flexors is the tibialis anterior muscle. This muscle is found at the front of the lower leg, with a tendon which passes across the front of the ankle. Its function is to dorsi flex the foot and to assist tibialis posterior in inverting it. The peroneus muscles: Also called the fibularis muscles are found on the outside of the lower leg. Their function is to evert the ankle (turn it so the sole faces outwards). Case study Since my early school years I have been a passionate dancer and long distance athlete. I continued running after school, doing half marathons and training almost every day. A few years ago I developed Achilles tendonitis, due to over training errors such as not stretching enough and not strengthening important muscles used when running. Achilles tendinopathy is a condition which involves inflammation and/or tendon breakdown from excessive loading. It is characterized by point tenderness on the tendon and pain with forceful plantar flexion or extreme dorsiflexion. It is often a persistent injury that may be related to underlying biomechanical problems, such as tight calf muscles, over pronation, tight hip flexors, muscle imbalances, and training errors (Study guide, Comprehensive Course. Body Arts and Science International, ). A hump formed at the back of my right heel where the tendon started to thicken and my hips and calves became very tight. As the time went on the hump became bigger and more painful. Activities like walking in the shops or standing for too long 7

8 became challenging, my balance also got affected and I could not balance on my right leg. In 2017 my Pilates journey started and I also went for physiotherapy. They recommended exercises where the muscle focus is to strengthen my gluteus medius and hip adductors and stretching my hip flexors; calves; quadriceps and hamstrings. In my conditioning program I will focus on strengthening and stretching these muscles. I will also focus on strengthening my core muscles and stretching my upper body to create a better running posture. This conditioning program is designed for six weeks with three one hour Pilates sessions per week, but continued Pilates sessions on a regular basis will deliver better long term results as Pilates is not a quick fix. I started doing this program after I had a good understanding of the fundamental exercises and principals of Pilates. 8

9 Conditioning Program (runner with achilles tendonitis) Weeks 1-2 BASI block Exercise(s) Desired results Warm Up Fundamental warm up: Thoroughly warm up pelvic curl, spine twist the spine, deep supine, chest lift and chest abdominal muscles lift with rotation. and oblique abdominal muscles. Warm up the hamstrings (pelvic curls). Bring awareness to body and powerhouse. Establish pelvic and lumbar stabilisation. Foot Work Footwork series on the Stretch and Cadillac (medium/heavy strengthen the setting). hamstrings and Hip Opener (light/medium knee extensors. setting). To correct foot alignment and to get feedback. 9

10 The calf raises and prances strengthen the foot plantar flexors and helps with control of foot stabilisers. The hip opener will stretch the adductors. Abdominal Work Abdominal work on the Abdominal work on Pilates arc: chest lift; the arc will reach; overhead stretch strengthen and and teaser prep. stretch the abdominals which will help with a stronger core and better posture while running. Exercises like the reach and overhead stretch will stretch the thoracic spine and shoulders which gets tight from running and 10

11 everyday activities like sitting at the computer. The teaser prep will add some challenge and build hip flexor strength. Hip Work Single leg supine : frog; This series works circles down and up; hip great for the extension and bicycle imbalances in my hips as I find it difficult to control both springs with the basic leg springs series. Hip work focuses on hip disassociation while keeping a neutral pelvis; this helps the hip to work more smoothly while running. Spinal Articulation Monkey original (medium This exercise will resistance). stretch the spine; 11

12 hamstrings and calves which gets very tight from running. It will also help with abdominal control and spinal mobility. Stretches Ladder barrel: shoulder These stretches will stretch 1 and 2; gluteals; increase flexibility hamstrings, adductors; and improve my and hip flexors. running in the long term if done regularly. Full Body Integration F/I Thigh stretch with RUB The thigh stretch and kneeling cat stretch with RUB will (medium resistance). strengthen and stretch the quadriceps, which will improve running and help prevent common injuries. The kneeling cat stretch will strengthen the back extensors and 12

13 abdominals while also stretching the shoulders. Arm Work Shrugs and triceps press These arm sit (medium resistance). exercises will bring some focus to improved posture. Full Body Integration A/M Tendon stretch on the The tendon stretch reformer (light resistance). will stretch out my calves which will help with the achilles tendonitis. It will build abdominal strength. Leg work Gluteals side lying series These exercises and adductor squeeze. will strengthen the gluteus medius and hip adductors which becomes weak from running. It is also done in a supported position which helps if you have imbalances in your hips and 13

14 struggle with controlling the hips and pelvis if too much weight is added. Lateral Flexion /rotation Side lift on Pilates arc. Stretch the lateral flexors and strengthen the oblique muscles. Back extension Prone 1 and 2. Strengthen the back extensors which help with a better posture. Prone 2 have the added benefit of a shoulder and chest stretch. Weeks 3-4 BASI block Exercise(s) Desired results Warm Up Fundamental warm up: pelvic curl, spine twist supine, chest lift and chest lift with rotation. See weeks

15 Foot Work All footwork on the Using more reformer (medium/heavy resistance will help resistance). to strengthen the hamstrings and quadriceps. The calf raises and prances will stretch the calf muscles while strengthening the ankle plantar flexors. Prehensile is added for a foot stretch. Abdominal Work Abdominals legs in straps These exercises (light resistance): double will strengthen the leg; and double leg with abdominals, oblique rotation. and hip flexors (when drawing the legs in towards the fore head.) Hip Work Hip work on the reformer Strengthen and (medium/light resistance): stretch the hip frog; circles up and down; adductors. and openings. To help with knee extensor control 15

16 and neutral pelvis. Spinal Articulation Short spine and long spine The short spine will (light to medium stretch the resistance). hamstrings. The long spine will help to strengthen the gluteals, hamstrings, and quadriceps, as I will have to use these muscles to keep my legs at a 90º angle when rolling up and down. Stretches Kneeling lunge (light The kneeling lunge resistance). will stretch the hamstrings and hip Gluteal stretch on the flexors which is ladder barrel. important for running. Full Body Integration F/I Knee stretch series (light This series will resistance): scooter; round strengthen the back; and flat back. hamstrings, quadriceps and 16

17 abdominals. It will help with hip and knee extensor control. Arm Work Rowing series (light To create better resistance). shoulder mobility, trunk stability and control. It will add flow and challenge to the routine, which is great being a dancer also. Full Body Integration A/M Tendon stretch on the reformer (light resistance). See weeks 1-2. Leg work Gluteals side lying series Add more and adductor squeeze. repetitions than in the first two weeks. These exercises will strengthen the gluteus medius and hip adductors which becomes weak from running. Lateral Flexion /rotation Side stretch on chair Lateral flexor 17

18 (extra light/light stretch. resistance). Teach abdominal and oblique control if the ribs tend to thrust forward. Back extension Swan prep with magic Strengthen the circle. shoulders and back extensors. Strong back extensors will improve running posture. Weeks 5-6 BASI block Exercise(s) Desired results Warm Up Fundamental warm up: pelvic curl, spine twist supine, chest lift and chest lift with rotation. See weeks 1-4. Foot Work All foot work on the chair To strengthen the (medium to heavy hamstrings and resistance). quadriceps. To develop hip flexor control, as 18

19 the legs move up and down while keeping the upper body stable. The calf raises will stretch the calves and hip flexors, strengthen the calves and help with correct foot alignment. Abdominal Work Torso press sit (extra light Control the hip resistance). flexors (keeping the legs stable and parallel to the floor). The position of the arms will stretch the shoulders and chest. Hip Work Supine leg series on the Stretch the arc: openings; scissors; hamstrings and hip helicopter; bicycle and; flexors, and bicycle reverse. develop control of all muscles surrounding the hip 19

20 joint. Stretch and control hip adductors. Maintain abdominal support. Spinal Articulation Tower on the Cadillac To improve (medium resistance) hamstring and lower back flexibility. Maximize the stretch of the calves and hamstrings when the feet are dorsiflexed. Stretches Ladder barrel: shoulder These stretches will stretch 1 and 2; gluteals; increase flexibility hamstrings, adductors; and improve and hip flexors. running in the long term if done regularly. Full Body Integration F/I Reverse knee stretch (light To strengthen the resistance) abdominal muscles and hip flexors. Strong abdominal 20

21 support is needed as the hip flexors pull the legs backwards. Arm Work Arms standing series: chest expansion; hug-atree; circles; punches and; biceps. Full Body Integration A/M Saw To stretch the hamstrings and chest. Leg work Squats To strengthen the quadriceps and core. To develop knee control. To improve alignment. Lateral Flexion /rotation Side over on box To strengthen the abdominals with special emphasis on the oblique muscles. Back extension Breaststroke prep (light To strengthen the resistance) 21

22 back extensors for better posture. Conclusion Over the course of my Pilates program, I started noticing more flexibility in my hips and calves. The range of motion in my ankles improved and the swelling and pain at the back of my heels was reduced. After a few months of Pilates I could continue with my running without any foot or hip pain. Pilates also made me more aware of how I run and my running posture. Although I still avoid steep uphill running and running on very uneven surfaces, I noticed a great improvement in my running. Due to all the foot work, hip work, leg work and stretching my legs feel more weightless when I run and I can also run more comfortably. Pilates is a great form of cross training for any athlete as it can be tailored to each specific need and can bring balance to the body to avoid many overuse injuries. 22

23 Bibliography Perfect Pilates, Leg muscles used during running, Sited 18/08/2018. The pros and cons of running, Sited 18/08/18. Running injuries, Sited 18/08/18. Running Anatomy, Sited 19/08/2018. Complete guide to mat work and apparatus exercises. Pilates second edition. Rael Isacowitz,