Category Archives for "running"

Post-Race Recovery

A proper warm-up prior to a run is important to increase the heart rate, blood circulation to the working muscles, and joint efficiency. However, cooling down is an essential component of the training process and should be completed at the end of every exercise session. It is important to cool-down after a run to transition the body back to a steady, resting state by decreasing the heart rate, breathing rate, and body temperature. Cooling down also returns the muscles to their optimal length-tension relationships and returns blood from the extremities back to the heart. Skipping a cool-down or performing it incorrectly can cause your muscles to become sorer and stiffer which may lead to unwanted injuries.

The following is a guide for optimal post-race recovery:

1. Slow jog or walk
Immediately at the end of a run, it is ideal to slow your pace down to a jog or a brisk walk to gradually lower your heart rate. Ending your run abruptly may cause blood to pool in your legs instead of returning it to the heart and brain. This can lead to a risk of fainting or feelings of lightheadedness. Jog or walk for approximately 5 to 10 minutes. 

2. Hydration
Exercising will cause more sweating and loss of fluid in the body which may lead to dehydration. Restore fluid levels in your body by rehydrating with water. It is important to stay hydrated to help manage your body temperature, remove waste from your body, and protect your tissues and joints. 

3. Total Body Stretching
a. Pigeon Pose:

Begin in 4 point position on a yoga mat. To stretch the right posterior hip, including the Piriformis muscle, straighten out the left knee pushing the left foot back. Then bring the right knee forward towards your chest while supporting yourself with your hands in front. Making sure that your left and right pelvises are level with each other, bring your right foot across turning it to the left side. Then reach forward on the mat with your hands bringing your elbows towards the mat while keeping both sides of the pelvis level and down. Hold for 30 seconds and do 3 sets on each side 2 times daily.

b. Hip Flexor Stretch:

Kneel down onto your left knee. Then rotate it about 45 degrees past the midline of your body. To keep your posture nice and tall imagine there’s a string pulling your whole spine upwards from your pelvis, right up your entire back and neck and up to the top of your head. Then engage your inner core muscles tight below your belly button and keep your low back flat. Next, bend the right knee forward and keep your posture nice and tall without leaning backwards. Then reach your left arm up pointing the fingers towards the ceiling nice and high and point your right finger tips to the floor. Hold this stretch for 30 seconds and repeat 3 times for each side.

c. IT Band / Lateral Quad Stretch:

Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. Then, bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. Pull the heel back towards the bum while keeping the core engaged and the low back flat. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily.

d. Lat Stretch:

To stretch the right lat, place the back of your right hand to your left side in front of you while clasping it with your left hand. Reach forward to your left and keep your elbows straight. Keep your knees wide apart and the back of your feet flat on the mat. Reach forward and lean to the right arm pit. Hold for 30 seconds, do 3 sets. Repeat on the opposite side if it’s also tight!

e. Shoulder Stretch:

To stretch out the right side, reach your right hand up and down your back keeping your right elbow pointed upwards. Avoid arching the back by keeping your spine in neutral. Pull the right elbow towards midline with your left hand while keeping the right elbow pointed upwards. Hold this for 30 seconds doing 3 sets on each side daily.

f. Rolling out the Hamstrings:

Put the roller on the ground and bring your hamstring onto it. Roll up and down onto your Hamstring muscle while supporting yourself with both hands. Find the sweet spots (or the areas that hurt in a good way) and continue to roll over these areas for 3-4 minutes in total. Do this 2-3 times a day just before you stretch out the hamstring.

g. Rolling out the Calf Muscles:

4. Additional Measures
Take a 5-10 minute cold water bath to reduce swelling. Allow 1-2 days post-run to allow the body to recover before massaging any tight muscles.

Running Injury Prevention

Running is a great way to improve aerobic fitness and cardiovascular health. Running not only burns calories, but can contribute to one’s mental and physical health. However, a large percentage of individuals who run are exposed to a wide range of running-related injuries, most of which are due to overuse. Up to 80% of the injuries occur in the lower extremities with the knee found to be the most commonly injured body part (Callahan, 2018). Patellofemoral pain, medial tibial stress syndrome (shin splints), achilles tendinopathy, iliotibial band syndrome, plantar fasciitis, and stress fractures are the most common diagnoses. 

RISK FACTORS
In the majority of cases, pain may arise in the lower extremities due to intrinsic factors such as being overweight, having weak core and leg muscles or with changes in foot type such as having flat feet. Extrinsic factors such as poor footwear, not stretching, or an unbalanced diet may contribute to running-related injuries. The main risk factor to running-related injuries was due to having a previous injury in the last 12 months. It is important for your physiotherapist or coach to be aware of all previous injuries that you may have sustained.

TREATMENT
Acute treatment includes stretching the posterior structures, massage, ice, activity reduction, taping, corticosteroid injection, or orthotics. Long-term treatment includes strengthening the intrinsic foot, ankle and hip. New footwear, night splints, or surgery may be indicated if conservative treatments are unsuccessful. Consult your physiotherapist or coach for the appropriate treatment. 

RETURN TO RUNNING CHECKLIST
Ensure there are no signs or symptoms of inflammation and you have gained the full ability to weight bear through your legs and feet. You should be able to hop in multiple directions on each leg and should be able to walk at a speed of at least 5.6 km/h (or 3.5 mph). Toe dexterity, or precise control of the toes, should be present in each foot and you should be able to balance in a wobble-free manner for more than 30 seconds. 

Below are some key exercises to stretch and strengthen muscles essential to improving running performance and reducing the risk of running-related injuries:

CORE ACTIVATION
A) Wall Squat

The exercise shown above can help with the retraining of the core stability, hip, leg and ankle muscles.

  1. Wrap a closed loop resistance band around the thighs just above the knees. 
  2. Position yourself so that your low back is fully leaning up against the big ball on the wall. Keep your posture nice and tall but don’t arch your low back when leaning upright against the big ball. 
  3. Engage you inner core stabilizers by contracting your pelvic floor muscles and pulling your transverse abdominal muscles below your belly button inwards, hugging your spine. Remember to keep breathing. 
  4. Leaning your weight on the ball slide downwards doing a wall squat while you maintain static isometric pressure against the resistance bands. Keep your knees over your ankles and in alignment with your second toes. 
  5. Hold the wall squat for 10 seconds. Repeat this for ten repetitions doing three sets daily.

B) Psoas March

The exercise shown above helps increase hip flexor and core strength.

  1. Being by lying flat on a mat so there is no arching of the lower back. Place your hands just below the belly button to cue engagement of the core muscles.
  2. Bring both knees up to approximately 90 degrees and wrap a band around your feet.
  3. Hold one knee stationary while pressing down the opposite leg. Then bring the extended leg back to the starting position.
  4. Repeat with the other leg while maintaining core activation and controlled breathing.
  5. Complete three sets of five repetitions on each side. Progress to sets of 10 repetitions for more difficulty.

MUSCLE STRENGTHENING & STRETCHING
A) Bridging Hamstring Curls

The exercise shown above helps strengthen the hamstrings, glutes, and core stability muscles to help protect the ligaments of the knee. 

  1. Lie on the ground with the stability ball under your heels with your legs straight and your toes pointing up. 
  2. Engage your inner core muscles below the belly button. Then extend your hips by squeezing your butt and lifting it off the ground. 
  3. Bring the ball in towards you by flexing your knees and hold for a second and then straighten your legs back to the start position while keeping your butt up and hips extended. 
  4. Keep your inner core engaged the entire time. 
  5. Start by doing 3 sets of 10 repetitions and then progressing it to 3 sets of 15 to 20 repetition 4 times per week. 

B) Step-Ups

The exercise shown above helps strengthen the hip, quad, and core muscles to prevent leg injuries.

  1. Start with a tall posture and your inner core engaged below the belly button. 
  2. Bring the opposite arm up while using your glute muscles to fully extend the hip up as you step with one foot onto a step box.
  3. Keep your thigh strong by preventing the knee from buckling inwards, as well as keep your knee over the heel so it doesn’t go over your toes. 
  4. Do 3 sets of 10 on each side. 

C) Wall Plank Resisted Knee Highs

The exercise shown above helps reduce anterior hip pain and weakness that may contribute to running-related injuries.

  1. Place a closed loop light resistance band around your feet. Slightly flatten the lower back and keep the inner core muscles engaged below your belly button to stabilize your posture. 
  2. Going into a plank position on the wall, bring one knee in a straight line up towards your chest and then slowly lower it back down with control. 
  3. Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets, 10 repetitions for each side. 
  4. A progression of this exercise is to perform the knee lift twice as fast but still lowering the leg and foot back down with control while you keep your core muscles engaged and maintain core stability control throughout all repetitions and sets.

D) Lateral Quad Stretch

The exercise shown above is particularly helpful if the Iliotibial Band is tight due to stiffness in the lateral quadriceps muscle. Overuse knee pain can be caused by excessive running. 

  1. Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. 
  2. Bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. 
  3. Pull the heel back towards the bum while keeping the core engaged and the low back flat. 
  4. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. 
  5. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. 
  6. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily.

References:
https://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity

Knee Injury Prevention Guideline

Knee and ACL injuries commonly occur in sports such as soccer, ultimate, and rugby. Athletes may require months to even more than a year to recover and to be able to return to play. There is a vast amount of literature describing a number of ways on how to prevent knee and ACL injuries. However, the most effective prevention strategies are the ones that are based on scientific evidence, a thorough assessment made by the coach and medical team, and the individual’s input.

Strongly suggested by research, programs most beneficial in preventing injuries consist of flexibility drills, running drills, strength training, core strength, and plyometrics. Each session should last approximately 20 minutes with a goal of exercising a minimum of 30 minutes per week. Programs should be implemented through out the year from preseason to regular season. Although most research studies focused on athletes between the ages of 12 and 25 years, these programs may benefit older individuals.

Recommended Exercises

Dynamic Stretches:

1) Toe Taps: Standing tall, kick one leg up and touch your toes to the palm of your hand. Alternate legs. Repeat 10 times on each side.

2) Reverse Lunge & Hop: Step back with one leg until you get into a lunge position. Swing the back leg forward until your knee is bent at a right angle by your chest. Maintain an upright body and repeat on the other side. Perform 10 repetitions on each side.

3) Calf Stretch: Standing tall on one leg, extend the other leg forward with only the heel in contact with the floor. Gently bend forward at the hips and feel a stretch along the front leg. Hold for 30 seconds and repeat on other leg. Perform 3 times on each side.

Running Drills: 

Perform running drills such as forward and backward running or bounding. Watch Physiotherapist Claire lead two athletes through a series of running and other dynamic drills below.

Strength Training: 

Two-legged Squat:

Starting with tall posture, engage your core below the belly button by drawing the inner core muscles towards the spine without arching the low back. With arms in a ready position do a two legged squat with your body weight distributed equally over both feet. Don’t go any lower than a ninety degree bend in the knees, keeping your knees in alignment with your second toe and over your heels as much as possible. Hold for a good long second and then straighten back up with your butt muscles to the start. Do three sets of fifteen repetitions daily.

Advanced Superman Deadlifts:

Start by holding on to a 5 pound dumbbell on the same side as the leg that you are going to extend back on. With nice tall posture, engage your core below the belly button. Keeping your spine flat, bend forward at the hips while you extend the leg back and reaching forward with the opposite arm and holding onto the 5 pound dumbbell with the other hand. Remember to keep that hip down on the side you’re extending the leg back on. Do 3 sets, 10 repetitions, holding for 3 seconds.

Split Squat Jumps:

Start with a nice tall posture and your inner core pulled in to keep your low back flat. Engage your back leg into extension by pushing the back forefoot into a solid bench or a chair supported against a wall. With your arms in the ready position bend the knee to 90 degrees by bringing the butt down and then jump back up. Keep your thigh strong by preventing the knee from buckling inwards. Keep your knee over the heel and don’t let it go over your toes. Do 3 sets of 10 on each side.

Core Strength Exercises:

1) Planks: Begin on the floor resting on your forearms and knees. Extend both legs until your whole body forms a straight line from the top of your head to your feet. Engage the core and glute muscles. Begin by holding this position for 30 seconds. Progress to 60 seconds or more to increase difficulty.

2) Glute Bridge: Begin on the floor with your back flat, legs bent at approximately 90 degrees and both feet on the ground. Place both arms to the side then engage your core as you lift your hips up. Hold for a second or two at the top as you squeeze your glute muscles.

Plyometrics

1) Box Jumps: Use a box that is around your knee height or higher. Stand in front of the box with your feet shoulder-width apart. Bend slightly downwards, swing your arms back, then swing them forward and explode up off the ground onto the box. Repeat 10 times.

2) Lateral Skater Jumps: Begin by standing on one leg and bend the other leg. Jump sidewards and land on the leg that was bent. Then switch sides. Repeat 10 on each side.

References:
https://www.ufvcascades.ca/2018/01/cascades-mens-soccer-program-to-host-id-camp/
https://www.jospt.org/doi/full/10.2519/jospt.2018.0509
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

What is Cuboid Syndrome?

Ever feel pain or swelling on the side of your foot? These symptoms may be due to a condition called Cuboid Syndrome, also known as cuboid subluxation or lateral plantar neuritis. In addition to pain in the lateral mid-foot, redness and a restricted range of motion in the ankle may be present. This syndrome is typically associated with an inversion sprain of the ankle. This is when the foot is forced inwards causing the cuboid bone to sublux, or partially dislocate. The cuboid bone is located near the mid-point of the outer side of the foot and is one of the seven tarsal bones that make up the arch of the foot. It connects the foot and ankle as well as provides stability to the foot.

The peroneus longus muscle is a muscle that runs along the outer side of the lower leg and attaches to the lateral side of the foot. Repetitive strain of this muscle due to activities such as ballet, jumping, or running, may place tension on the cuboid bone. Commonly found in athletes, Cuboid Syndrome may also occur in sports such basketball, football, or soccer. Weight-bearing, uneven pavement, or quick changes in direction that occur in sports may aggravate symptoms. A third cause of this syndrome may be an individual’s altered foot biomechanics. Athletes who have over-pronated feet, also known as flat feet, may be more prone to cuboid subluxation.

Imaging such as x-rays, MRIs, and CT scans can be used to rule out other causes of pain. However, a cuboid subluxation can be difficult to diagnose and therefore, must be carefully assessed by a general physician or other health care professional.

STRENGTHENING

Daily strengthening and mobility exercises should be performed on a pain-free basis to prevent the foot and ankle from becoming weak or stiff. Watch the videos below on how to properly perform strengthening exercises:

Use a resistance band tied to a stable anchor and wrap it around the unaffected leg. With the affected ankle, stand either in front of the band or inside while keeping your posture tall and inner core engaged. Hike the foot with the band wrapped around the leg up off of the ground and slowly push the leg out to the side and then slowly return it back to the middle while keeping the foot off of the ground the entire time. Resist the movement with the standing leg by squeezing the butt muscles. Repeat this 10 times for 3 sets daily.
Start by putting your weight on the side of the affected ankle and hike the opposite foot up off of the ground. Remember to keep your inner core tight below the belly button. Then with the foot that’s off of the ground touch the first point in front of the ground, then to the side and then behind you, and then cross over to the other side of the body. Repeat the 4 points of contact (front, left side, back and right side) for 30 seconds 4 sets 4 times per day. As you get stronger increase it to 60 seconds 4 sets 4 times per day. If you have a fracture as a result of your injury or you are unsure if this is the right exercise for you to do, consult your physiotherapist before starting this exercise.
Starting with tall posture, engage your core muscles below the belly button by drawing the lower abs inwards toward the spine. Avoid arching the low back. With arms in a ready position do a one-legged squat with your body weight distributed equally over the foot. Don’t go any lower than a ninety degree bend in the knees, keeping your knees in alignment with your second toe and over your heel as much as possible. Hold for a good long second and then straighten back up with your butt muscles to the start. Do three sets of ten repetitions daily. 

TREATMENT

Other treatment options include foot support such as padding, taping, or orthotics to help stabilize the bones of the midfoot or correct for over-pronation. Rest from repetitive, weight-bearing actions such as jumping or running may help alleviate pain. Ice affected area for 10 minutes at a time to reduce swelling and inflammation. Consult your family physician, physical therapist, or podiatrist to perform a manipulation if the cuboid bone is suspected to be dislocated.


InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

INSYNC PHYSIO’s Michelle Robichaud in Northern Europe

Insync Physiotherapy’s Michelle Robichaud, RMT, recently returned from her amazing trip to Northern Europe and back in time for the 2018 BMO Vancouver Marathon where she completed an 8-km run! Congrats Michelle!

Check out the photos below of Michelle in Iceland, Scotland, and Denmark:

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

How to Avoid Gastrointestinal Problems During Exercise

What should I eat or drink when exercising?

Many gastrointestinal (GI) problems can occur even if one trys to avoid eating before or during exercise. Studies suggest that approximately 30-50% of athletes experience some type of gastrointestinal issue that can impair performance and delay recovery.

The three main causes of GI problems:

1) Physiological
2) Mechanical
3)  Nutritional
During intense exercise, especially when dehydrated, blood flow to the intestines is reduced. This is believed to be one of the main factors leading to the development of GI symptoms.

General Symptoms:

  • nausea
  • vomiting
  • abdominal angina
  • bloody diarrhea
  • other abdominal symptoms (from mild discomfort to sever ischemic colitis)

Classification of Symptoms:

1) Lower GI Tract
2) Upper GI Tract

Runners tend to experience lower GI tract symptoms such as flatulence (excessive gas), diarrhea, or urgency due to the repetitive impact and reduced blood flow to the gut. On the other hand, cyclists may experience upper GI tract symptoms  due to the increased pressure on their abdomen while in an “aero” or crunched position of the body. These mechanical effects may be minimized with training.

Tips for Athletes:

1) Avoid high fiber foods in the day and several days before competition
2) During training, diet with adequate fiber will keep the bowel regular
3) Avoid aspiring and non-steroidal anti-inflammatory drugs (NSAIDs)
4) Use of NSAIDs prior to a race is strongly discouraged, especially for athletes with a history of GI problems
5) Avoid high-fructose foods (especially drinks that exclusively contain fructose)
6) Avoid dehydration as it can excaerbate symptoms and start races well hydrated
7) Ingest carbohydrates with sufficient water or drinks with lower carbohydrate concentration to prevent very high concentrations and osmolalities in the stomach
8) Practise new nutrition strategies and make sure to experiment with pre-race and race-day nutrition plan many times before the race day to reduce the chance of GI symptoms from occurring
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.