Articles in Category: Training and Performance

Red Flags

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Massage, General Health, Acupuncture, Training and Performance, Chiropractic

Red Flags

Red Flags

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA

 

Health care practice is an interesting and ever changing profession. One of the challenges that keep us on our toes is the assessment and management of different injuries and ailments.

 

The first goal in assessment is (or certainly should be) to identify what the complaint is, whether it is a serious or potentially serious condition that requires urgent intervention.

 

Recently, we have had a number of quite serious cases which have left us a little baffled as to the management they had unfortunately NOT received.

 

So this month I thought I would write an article on important symptoms to watch out for so you are not feeling sore and sorry.

 

Red Flags; this is believe it or not, a technical term for signs and symptoms which may indicate serious underlying pathology. These flags are many and varied and their presence is merely a potential indicator of pathology. This means that just because you have a “Red Flag” doesn’t mean you have a problem.

 

In compiling this list, it is by no means exhaustive and is a reflection of some of the things that we see showing up in our clinic.

 

So regionally, what are the things you should watch out for and what can they mean?

 

Back Pain

If you have back pain with referral down the leg, total numbness or loss of muscle strength it may be important. Loss of bowel and bladder control is certainly something we would want to know about.

 

Chest Pain

Most people know that chest pain can be an indicator of a heart attack. Most people realise that this is more commonly on the left side, however, pain in the lower front of the neck, the left arm, the left upper back and the right side of the chest can also be indicators. This would be reinforced by an increase in pain with exercise and or shortness of breath.

 

Night pain

Pain that wakes you from sleep is a concern, additionally; if this pain is accompanied by night sweats we would be a little more concerned. Sudden loss or gain in weight for no apparent reason is also a concern.

 

Headaches

“The worst headache I have ever had” is not a great thing to hear. If this is in conjunction with vomiting and dizziness it is more of a concern. The feeling that the head is going to explode is more of a concern. Disturbances in any of your higher senses (vision, taste, hearing or smell) can also be a concern

 

Pain

Unremitting pain of 6 months or more of duration may be serious. If this is high intensity pain, then it is more of a concern. If the problem is not responding to conservative treatment then it is more concerning again.

 

If you have had a problem which won’t go away or you have some interesting symptoms that you are just not sure about, then get them checked out. Sometimes they may mean nothing, sometimes they may be important. My thought, always, if in doubt check it out.

How to Run Faster

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Training and Performance

How to Run Faster

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS.   Memb: CAA, FICS, CEA.

 

At this time of year, many people are trying to get in shape to look good on their holidays or just generally coming out of their winter slumber.

 

I always get a good laughing watching the hibernating bears starting to hit the esplanade in the morning for a jog, walk or in some cases some other movement activity which needs to be seen to be appreciated, but does not necessarily fall into the above categories.

 

Many people are trying to improve their running speed, and the evolution and growth of the parkrun groups around Brisbane is testament to an improvement in the public sentiment about improving health and fitness.

 

We do speak to a lot of people about their running and for many a desire or goal to be able to run faster and at the basic level, this is just human nature.

 

There are a number of factors which can play a roll in increasing your speed, or in fact hindering your ability to increase your speed. The aim of this article is to help you identify and address some of these issues.

 

Footwear Choice

At the most basic level, correct footwear is important. This is even more important if you get, foot, ankle, knee, hip or back pain when you run. There are a range of different runners to suit different foot types and also different events, choosing a shoe that suits you and your intended sport is always very important. Correct footwear choice will usually save you money and prevent frustration long term from injuries.

 If you are not sure if your shoes suit, maybe book in and have your gait assessed on the treadmill and we can point you in the right direction.

 

Gait Mechanics

Secondly, gait mechanics. The mechanics of the gait cycle (walking and running mechanics) are really quite complex, so I will keep this section brief and untechnical. Essentially, when we walk, as our leg swings out in front, the heel of the foot strikes the ground (creating a deceleration or slowing moment), then we pull through with the foot into weight-bearing and then the heel lifts, the other heel strikes the ground and we push off with the toes. As people progress into jogging, the mechanics change a little, with one of the big differences being that only one foot is on the ground at any point in time. For slow jogging, this works fine, however, if you want to run fast (probably around 4 minutes 30 seconds per kilometre or faster) we need to improve our gait mechanics to minimise the deceleration phase, so that the foot is travelling backwards when the heel strikes the ground. This is a fascinating area and one which is rich in opportunities to improve. If you have never had your technique assessed, do it. This may have a dramatic impact on your speed and overall enjoyment.

 

Cardiovascular issues and Muscular Endurance

People often think of fitness as a cardiovascular issue. Certainly this is a major component, however, muscular endurance also plays a roll.

To break this down, the cardiovascular system is the heart, lunges and blood vessels and essentially, this system extracts oxygen from the air and transports it to the muscles, and returns the waste products back to the lunges etc. Improving fitness in this area improves the ability or efficiency of our bodies to do this effectively.

Muscular endurance describes the ability of the muscles to contract repeated during an exercise.

Both of these systems will adapt and improve with training. The muscular endurance ability tends to be a little more sport specific and will adapt most effectively to the training you are doing, as in , riding a bike won’t improve your running performance as much as running training will.

Cardiovascular fitness is a little less sport specific and generally, a range of cross training activities can all have a positive impact on your aerobic conditioning.

 

The efficiency and effectiveness of these systems will evidently have a significant impact on your running speed and training can be made much more effective or targeted by understanding what your thresholds are for aerobic capacity, allowing you to train more effectively to increase these thresholds. If you would like to know more about your cardiovascular and muscular endurance, we have a range of testing options to directly test and assess these systems and can then provide you with targets for your training.

 

Injuries

Obviously, injuries can slow us down. Common injuries in runners are calf and Achilles injuries, hamstring strains and tears and low back strains. Knee and hip issues also play a roll.

Many of these injuries can be controlled or prevented by correct footwear choice, effective training strategies and evolving or increasing your training and distance over a period of time.

If you have injuries, address them early and resolve them before returning to training and racing. Mismanagement of injuries can be a major contributor to long term disability and whether you enjoy your running over the long term or retire early, hurt.

 

Training techniques

Lastly, training techniques and the type of training you do can greatly increase your speed.

Often runners will plod along at the same pace every time they run. Their body adapts to the speed and load that they place on it so it essentially “gets used to” that pace.

For these people, altering training to help the body adapt to faster speed when running can be effective. Think of this as training to increase leg speed.

Certainly, it can be much easier to quantify this type of training if you use a running computer or watch. There are a variety of products available on the market, Suunto, Polar and Garmin certainly make some great products which allow you to assess your speed, distance, time, heart rate and more advanced models even look at stride counter, stride distance…and the list goes on.

At Institute of Sports and Spines, we carry the Garmin Forerunner watches, which are and excellent product and the different models will fairly much meet the needs of even the most discerning runner.

I am a BIG fan of using technology to improve training specificity and effectiveness. I cannot stress this enough.

By using a computer, you can accurately measure your speed and time for 1km, 5km, 10 km etc, you can look at your running pace per kilometre, which then gives you the ability to target improvements in speed and time over a given distance so you can gauge your progress.

 

Simple Drills to try

Obviously it is great to do some time trials of the distance and time you want to improve so you know where you are at, then, set some realistic goals of what you want to achieve and in what time frame. For these drills, lets assume you can run 5km at a 6 minute per kilometre pace. Giving a total time of 30 minutes (perfect for those parkrunners in our midst).

 

Speed intervals.

Try running for 1 minute at 5minutes per kilometre pace, then run for 2 minutes at a recovery pace of 6 minutes per kilometre, continue for the duration of 5 kilometers.

 

Distance intervals.

Trial your next run at 5 minutes 45 seconds for 1 kilometer, then do a recovery kilometre at your usual pace. Repeat this to have completed 5 km with 3 at the fast pace and 2 at recovery. You will have knocked 45 seconds off your 5km time.

 

Strength intervals.

Hills are great for this. Find a hill near home, try and run your normal 5km pace when running up a medium incline. This is not great for leg speed but will increase your strength.

 

Speed pyramids.

Trial this on a 400m track or keep a close eye on your computer. This is punishing, but at the same time, can be very good for getting used to running faster. It will help with cardiovascular conditioning, muscular endurance, leg speed and mental conditioning.

 

Run 400m comfortably.

Sprint 100m then coast for 300m. Stop and Rest 1 minute.

Sprint 200m then coast for 200m, Stop and  Rest 1 minute.

Sprint 300m then coast for  100m, Stop and Rest 1 minute.

Sprint 400m, Stop and Rest 1 minute.

 

Then do the drill in reverse back to the start.

 

Hopefully these ideas and concepts will give you a start point if you are trying to get faster this summer. As always, if you have any concerns or issues, get them checked out before you embark on intense training sessions and if you need any assistance with gait patterns, performance testing or injuries, let us know and the team will be more than happy to help.

 

Happy running!

The Knee

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in General Health, Sporting Injuries, Training and Performance, Chiropractic

The Knee

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS.   Memb: CAA, FICS, CEA.

 

This month I thought I would write a brief article about the knee.

 

The Knee is such a fascinating joint and unfortunately, is a regularly injured joint, necessitating visits to our clinic for many people.  We regularly receive referrals to assess knee injuries to identify what is actually wrong and how to manage the problem. This often necessitates us referring out for MRI scans and in some cases on referral to some of the excellent orthopaedic surgeons that we deal with.

 

The Knee 1  

 

Types of Knee Injuries:

Knee injuries and pain associated with those injuries generally fall into 3 categories.

 

Firstly, degenerative problems:

This can be osteoarthritic change or general wear and tear due to age or overuse of the knee.

Often age correlated or a result of lots of aggressive sport in the younger years.

 

Secondarily, biomechanical overload injuries:

These are often the result of;  genetic mechanical issues such as pronation of the feet and ankles, “Knock knee”, “bow legged” posture of the knees,  inappropriate footwear, poor technique in running, walking and other fitness activities, poor setup on bike position or sporting equipment or weaknesses and imbalances of the supporting musculature.

 

Thirdly, the pathological or traumatic injuries:

These are things like anterior cruciate ruptures (ACL), Meniscal tears (often referred to as the cartilage), fractures, and collateral ligament tears and issues. Bursitis and tendonitis issues are sometimes grouped into this category but are often more accurately grouped into the second category.

 

But what makes the knee so susceptible to injury:

Several factors really. The knee can be thought of as a force transducer. When we are walking, running, turning and jumping, our knee is subjected to high forces or loads in a multitude of directions.

 

The mechanics of the knee are complex and this article will be far from exhaustive in the description of the knee. But in basic terms the knee is a rolling/gliding hinge joint. Thinking simply, the knee is not a simple hinge (like a door), as the knee straightens, the femur glides across the tibia as it rolls towards the straightened position. This is why the end of the femur has a lengthened cam-like shape, in contrast to the relatively flat shape of the top of tibia. This means that the contact point and force vectors through the joint constantly change as the knee bends and straightens, combine this with the fact that the knee also pivots slightly right at the end of the straightening process make the knee a regularly injured joint.

 

Many health practitioners are taught at university that for the knee to have a pathological or major injury, there must be a large impact or nasty injury mechanism occurs to cause the damage. However, this is very clearly not the case with many of the patients we see at Institute of Sports and Spines.

 

In fact, the 2 worst knee injuries I have seen this year came from very low force activities; one from standing up after sitting on the ground and one from walking along the ground at work and turning to speak to someone. In fact, my own knee injury was not the result of a twist, fall or accident, but purely jogging along a flat footpath, the articular cartilage got caught and tore and it has been a problem ever since.

 

Scans and Imaging for the knee:

Depending on the injury or suspected injury, a range of scanning options are used.

Xrays and pretty good for looking at fractures of and around the knee, gross degenerative change and biomechanical position, they are not good at assessing soft tissue and ligament issues.

Ultrasounds are used to look at tendonitis and bursitis issues and muscle tears around the knee.

MRI scans are generally the image of choice for the knee and are the only means to effectively view meniscal tears, cruciate ligament injuries, collateral ligament injuries and articular cartilage defects.

I have included a couple of images below for interest.

 

Image 1                                                                                             Image 2

The Knee  2  The Knee 3 

The Knee 4

                                                                                              

Image 1 above, the green oval shows reasonable articular cartilage with some thinning. The red circle shows a tear or defect in the cartilage (the white area), the end of the bone has a light area which is bone swelling.

 

Image 2 The blue circle shows good articular cartilage and a healthy meniscus in the correct position (black triangle on the right side).

The red circle shows the lateral meniscus in the wrong place (this is bad ;)) and the green arrow shows us where it should be.

 

 Image 3 to the left shows a vertical tear in the meniscus and a little bit of swelling to the left of the arrow.

 

Management of Knee Pain:

When you have knee pain, correct assessment and diagnosis of the problem is critical. We have unfortunately seen many patients who have had a lot of treatment for the wrong diagnosis, resulting in poor outcomes.  A comprehensive physical and orthopaedic examination should give a working diagnosis which may then indicate treatment direction or relevant investigations to confirm the suspected diagnosis.

 

At IOSAS, we generally start our assessment with gait analysis, looking at joggers, work shoes etc, analysis of movement patterns and muscle strength to look for weakness and imbalances, followed by an orthopaedic joint assessment. This then directs how we will manage the presentation to move you towards the outcome you desire.

 

Most biomechanical issues of the knee and overload syndromes can be managed conservatively and don’t progress to surgery.  Advanced degenerative change of the knee will often require joint replacements and ruptures of ligaments and meniscal tears which catch or lock will usually require surgery with a degree of urgency.

 

Treatment options:

For many overload / degenerative and biomechanical issues, addressing mechanical issues and contributing factors can be a big part of the solution. Acupuncture, Massage and Chiropractic and other physical therapy interventions can be useful to address the current pain presentation. Progression towards rehabilitation and retraining may be indicated to prevent recurrence.

 

Due to the nature of the cases that we see, some patients require surgical intervention to help resolve their issues. It is vital in the post-operative phase to focus on rehabilitation and strengthening to make sure there is relatively good balance or symmetry in the strength and control of the knees to hopefully prevent future recurrences.

 

Generally, effective assessment and management of knees gives a greater probability of a good outcome.

 

If you have a new or ongoing issue with your knee, come in and see us, we might be able to help you get a better outcome.