Move Well, Live Well November Newsletter

Transcription

1 Move Well, Live Well November Newsletter November 14, 2016 Volume 4, Number 11 In This Issue: Ankle and Lower Leg Changes with Age (Implications for running efficiency and injury prevention) Evidence on Foam Rolling Why The Iliotibial Band Gets Blamed for Lateral Leg & Knee Pain in Runners Sign up for the Sapphire PT enewsletter at sapphirept.com Ankle and Lower Leg Changes with Age (Implications for running efficiency and injury prevention) John Fiore, PT A September 9, 2015 article in the New York Times brought to the forefront the work of Paul DeVita, a professor of kinesiology at East Carolina University in Greenville, N.C., and president of the American Society of Biomechanics. Dr. DeVita s research compared the lower leg and ankle function of young runners in contrast to runners over forty years of age. His initial research in 2000 looked at gait changes with age at walking speeds, whereas his 2015 research data was gathered at running speeds. While the results are alarming, incorporating the study findings into your training program will greatly reduce running-related overuse injuries. The over year-old running age group has seen a huge increase in numbers in the past decade. As an over 40-year-old runner, I have experience the changes in running performance associated with age which has led to modifications in my training. DeVita s research confirmed a 20% reduction in running speed per decade beyond forty. Both running stride length and lower leg muscle function decline in a linear manner with age. Calf (gastroc-soleus muscle) and ankle dorsiflexion (tibialis anterior muscle) functional strength both decline with age. A reduction in lower leg muscle strength and function shifts the burden of self-propulsion to our knees, hips, and gluts which are already physically challenged by prolonged sitting and tight hip flexor muscles.

2 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. 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 Lower leg, foot, and Achilles tendon injuries become increasingly common in runners over forty. Gradual degradation of muscle and tendon tissue integrity, tensile strength, and nerve innervation sets the stage for an increase in running-related overuse injuries. On a positive note, the information provided by Dr. DeVita s research will serve to guide strength and conditioning programs for runners interested in injury prevention and running performance. Stretching the calf and lower leg muscles, Active Release techniques, dynamic warm-up, and rolling are great ways to improve lower leg muscle tissue mobility. Lower leg, ankle, and foot strengthening exercises should be a part of every runner s training program, especially those over 40 years of age. Strengthening exercises should include single leg heel raises, heel drops, resisted ankle inversion/eversion/dorsiflexion, and intrinsic foot strengthening exercises. Eccentric strengthening exercises (performed in a lengthened muscle/tendon position with emphasis on slow, controlled motion) have been shown to increase tensile strength of the Achilles tendon which reduces tendinitis symptoms and injury risk (Cook and Purdam 2009, 2914 Br J Sports Med). The gluteal and core musculature are also key areas to strengthen to reduce impact loading and torsional stress in the foot, ankle, and lower leg. Single leg and weight bearing gluteal and core stabilization exercises adapted for running, jumping, and directional changes specific to running, skiing, or ball sports will increase the body s resilience and durability during high intensity, repetitive activities. If you have been battling a lower leg, ankle, foot, or Achilles injury, your questions to determine how you can not only return to painfree running, but also prevent future injury recurrence. Functional strength and muscle/tendon tissue mobility are the keys to running faster beyond your forties! References: Reynolds G, Why Runners Get Slower with Age. New York Times. 2015, Sept 9. DeVita P, Hortobagyi T. Age Causes a Redistribution of Joint Torques and Power During Gait. J Appl Physiol (1985), 2000, May; 88 (5): DeVita P, Fellin RE, Seay JF, Ip E, Stavro N, Messier SP. The Relationship Between Age and Running Biomechanics. Med Sci Sports Exerc. 2015, Aug 7. Evidence on Foam Rolling Allie Molnar, DPT Foam rollers have been around since the 1980s, and since then have increased in popularity among athletes of all disciplines. Clinically I ve met individuals that swear by them, some who question their effectiveness, and others who are unfamiliar with foam rollers entirely. For those that don t know, a foam roller is a tool used for self-myofascial

3 Jennifer Dreiling: Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: Our Services: Orthopedic injuries 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 release, which involves freeing restrictions in muscle and connective tissue, which are limiting that tissue s flexibility. A systematic review published in Nov investigated the effectiveness of foam rolling. Specifically, they looked at the effect of foam rolling (or roller-massagers) on joint range of motion, as well as its effect on delayed-onset muscle soreness (DOMS), and post exercise muscle performance. The researchers found studies measuring effects on hip range of motion (foam rolling the hip flexors), on subject s sit-and-reach tests (foam rolling the hamstrings), knee flexion range of motion (foam rolling the quadriceps), and ankle range of motion (foam rolling the calf group). All of the experimental groups were measured against control groups, and some were measured against groups performing static stretching, or in combination with static stretching. The research found that both foam rolling and roller massage may offer short term benefits for increasing sit and reach scores and joint range of motion at the hip, knee and ankle without affecting muscle performance. 1 Other findings suggest that selfmyofascial release may be more beneficial when combined with static stretching (holding a stretch), and following exercise (when the muscle has been warmed up). 1 Lastly, all of the studies found only short-term benefits, which lessened as time went on. Therefore, the long-term benefit is still unknown. Because the studies all measured different dosages (treatment time, pressure, and cadence), the researchers are unable to specify the optimal treatment to reap the benefits of foam rolling. Another article published in the Journal of Physical Therapy Science measured the immediate effect of stretching and ultrasound on hamstring flexibility and hip joint proprioception. The authors assert that self-myofascial stretching improved one s sense of physical awareness and joint sensitivity, and improves thee function of the proprioceptors, which function in balance and motor skills. The result of their study concluded that self-myofascial release stretching

4 immediately increased hamstring flexibility and improved hip joint proprioception. 2 If you re shopping for foam rollers, Cheatham et. al s systematic review found that higher density tools may have a stronger effect than softer density rollers, as they re able to produce more pressure to the target tissues during rolling. 1 For those that already use foam rollers, you can do so now with the knowledge that research supports shortterm benefits. Happy rolling! References: 1. Cheatham, S. W., Kolber, M. J., Cain, M., & Lee, M. (2015, November). THE EFFECTS OF SELF-MYOFASCIAL RELEASE USING A FOAM ROLL OR ROLLER MASSAGER ON JOINT RANGE OF MOTION, MUSCLE RECOVERY, AND PERFORMANCE: A SYSTEMATIC REVIEW. International Journal of Sports Physical Therapy, 10(6), Cho, S., & Kim, S. (2016). Immediate effect of stretching and ultrasound on hamstring flexibility and proprioception. J Phys Ther Sci Journal of Physical Therapy Science, 28(6), doi: /jpts

5 Why the Iliotibial Band Gets Blamed for Lateral Leg & Knee Pain in Runners John Fiore, PT UNDERSTANDING THE ILIOTIBIAL BAND Iliotibial band friction syndrome (ITBFS) is a common running overuse injury. Traditionally, ITBFS is diagnosed by the presence of iliotibial band tightness, pain to palpation along the lateral tibia (Gerdy s tubercle), and pain to palpation along the distal IT band fibers. A common (although only partially accurate) explanation for IT band pain in runners is excessive friction of the IT band as it slides in an anterior-posterior direction as the knee moves from an extended to flexed position. i Further anatomical investigation coupled with the relatively poor results through conservative treatment of IT band pain warrant further explanation regarding the true underlying causes of lateral knee pain and ITBFS. The iliotibial band is a large fibrous connective tissue band extending from the tensor fascia latae (TFL) and gluteal musculature. A closer look at the lateral leg musculature reveals the extensive vastus lateralis quadriceps muscle which travels beneath the IT band (from anterior to posterior). The vastus lateralis (lateral quadriceps) is often a muscle which is hypertrophied, tight, and tender to palpation in runners with lateral leg/knee pain rather than the often-accused IT band. Similarly, overuse of the TLF muscle increased tension which is transferred via the IT band to the lateral knee. The true compensations which occur during running (hip drop, cross-over gait, knee valgus, foot/ankle pronation) must be identified in order to effectively treat the cause of lateral leg/knee pain. A 2D video running gait analysis is an excellent way to identify and quantify biomechanical compensations. ILIOTIBIAL BAND TIGHTNESS AND FRICTION FACT OR FALACY The IT band is not composed of non-contractile tissue. While the overlying fascia can be released through fascial release techniques (active release techniques, contract-relax, muscle energy, integrated dry needling, ISTM, ASTM), the IT band itself is not capable of being tight or stretched. The surrounding structures, such as the vastus

6 lateralis, TFL, hip and gluteal musculature, should be evaluated for weakness and/or dysfunction. The IT band is an extension of the TFL which encases the upper thigh. In addition to its attachment to the tibia (Gerdy s tubercle), the IT band also has fibrous anchors to the femur, making significant movement of the IT band over the femur unlikely. ii A richly innervated layer of fatty tissue beneath the IT band becomes inflamed and painful when tension under load (running) increases through the IT band (Fairclough, it al). The cause of this tension, however, is the key to effectively treating ITBFS. MUSCULAR IMBALANCE AND WEAKNESS Muscular weakness in the gluteus medius and gluteus maximus muscles results in overuse or over-compensation of the TFL, and vastus lateralis. The thin TFL muscle is located on the anterior and slightly lateral aspects of the hip. Overuse of the TFL, which flexes the hip and internally rotates the femur, leads to increased IT band tension and irritation of the insertion on the lateral knee. iii The vastus lateralis, however, is often ignored when evaluating and treating lateral leg or knee pain. Similarly, our sedentary, seated lifestyles cause hip flexor muscle shortening (TFL, psoas, iliacus, rectus femoris) which leads to an anterior tilt of the pelvis and ineffective gluteal muscle activation and function. Without adequate proximal stabilization via the gluteus medius and gluteus maximus musculature, foot strike often results in an internal rotation of the femur, inward motion of the knee, and increased lateral leg and IT band tension. ANKLE JOINT STIFFNESS Stiffness in the ankle can limit dorsiflexion which is necessary for proper running biomechanics. Compensatory ankle eversion (toe-out position) and increased pronation (arch falling inward) increases the likelihood of knee valgus (knee collapsing inward). Such compensations at the ankle and knee joints increase lead to over-active hip adductor and TFL contraction and inhibited gluteus medius/maximus firing. Such compensations may be manifested as lateral leg or knee pain with the IT band being the alleged culprit.

7 STRESS FRACTURE Pain in the area of the lateral knee and proximal tib-fib joint which does not respond to conservative treatment or a thorough assessment of the true underlying cause warrants medical diagnostic testing. Second only to metatarsal stress fractures, stress fractures in the tibia and fibula are common due to the torsional stress through the long tibia and fibula while running. An X-ray may show a stress fracture, but the fracture may not show up on an X-ray prior to the formation of a bone callous later in the healing phase. Magnetic Resonance Imaging (MRI) may more accurately show a stress fracture but the cost is much higher. Evaluation and treatment techniques, therefore, must effectively address each of the possible contributing factors, to bring about a comprehensive, effective, long-term solution. A physical therapist skilled in exercise and manual therapy techniques specific to runners can be a source of information and treatment knowledge to get you back to your favorite running routes and and trails. John Fiore, PT john@sapphirept.com i Barber FA, Sutker AN. Iliotibial band syndrome. Sports Med, 1992;14(2): ii Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat, March 2006;208(3):