PODCAST CONVERSATION : Running Injuries and prevention with Swapnil Mate and Mr. Rajagopal

 

In general,when we talk about sports injuries – irrespective of contact or non-contact injuries, I often have seen many athlete suffering from Low back pain, which goes highly ignored, considering just a spasm, the athlete just continue to play with it. 

There are many reasons to get a backache, but it is usually because the center of force transmission or entire body weight is kind of concentrated or transferred around the lumbar region. 

Knee and shoulder injuries are also commonly seen, which are complex joints and take time to heal and rehabilitate.

 

In the case of long-distance running, usually lower limb injuries are seen more clinically, especially load-bearing knee joint, followed by hip joint, shin pain, ankle and muscle/ligament injuries.

 

Common are

Lateral knee pain (IT band Friction syndrome) 

Anterior knee pain (patella tendinitis)

Fat pad impingement syndrome.

Shin Splints.

Ankle Sprain.

Plantar Fascitis.

Metatarsalgia.

OA knee. (Patellofemoral Dysfunction)

Lateral Knee Pain  

 

Q2.     What is the best way for athletes to work on injury prevention? Is it thru’ an annual physiotherapy evaluation around mobility, flexibility, etc.? 

 

Yes absolutely, understanding your sports biomechanics and knowing your body anatomical position is the most important aspect. A proper physical therapy assessment of your structural and physiological dysfunction should be encouraged by every runner before they start the training and to ensure its injury-free. 

 

Especially if you are a runner, undergoing a foot analysis by podiatrist or foot specialist, will help you to know foot alignment during the phases of the running cycle. 

A sports physical therapist will initially do a thorough observation of your body planes in standing, check your active and passive ROM of individual joint; assess your strength and functional movement pattern, gait analysis, proprioception and try to note your weakness and strength to set a goal for your fitness regime.

 

A proper physical evaluation also acts as a base for your rehabilitation protocol, and will also help in diagnosing the cause of the injury. Follow up should ideally be every 6 months.

 

Q3.     What can athletes do to prevent the above injuries in particular, and what are some of the warning signs one should look out for in each of these?

For prevention, as we mentioned earlier, once an athlete had the physical examination report

he/she needs to define a strict fitness regime, where they need to work on the weaknesses,

this will contribute to 60 percent to stay injury-free.

 

Give immense importance to the flexibility of the muscles and joints. 

(the primary reason why most of the sports injuries happen)

Go for regular sports massage  (Deep Tissue) or FASCIA RELEASE with IASTM 

(Instrument assisted soft tissue manipulation) every 15 days or 7 days  (if intense training)

1.     To maintain the length of the connective tissue. (Length – Tension Relationship)

2.     To remove the metabolic waste product of metabolism.

3.     To enhance your inflammatory process to recover faster.

4.     To reduce the load on tendons and joints.

Nutrition to muscles and joint and general well being

 

For muscles – Protein or BCAA.

Joint supplements: Chondroitin-Sulphate, Glucosamine, and vitamin C.

Multivitamins and collagen supplement (type 1 – 3)

RECOVERY - Zinc and Magnesium.

 

HYDRATION, GOOD SLEEP, and Protective gear. (Good running shoes / Compression wear)

 

 

Warning Sign :

1.     Repetitive injuries.

2.     Tightness.

3.     Pain and swelling.

4.     Fatigue.

5.     Tiredness.

6.     Cramps.

7.     Joint and ligament pain.

 

 

 

 

4.      How do you approach stretching before and after activity? Do you recommend dynamic stretching before an activity and static stretching after an activity?

 

There had been a lot of controversy about stretching technique, to be used pre and post exercises, but you need to understand here,

 

The basic aim of stretching: LENGTHENING.

 

According to recent advancements in clinical research surrounding the stretching and discovery of new connective tissue recently being studied on i.e. fascia.

 

It is highly recommended that you need to perform Dynamic stretches in both pre and post. 

Static stretching is anyways not recommended as it does nothing that we are aiming at.  

With stretching, we need to stretch the tissue to get an increased length in the tissue. Static stretches are all about maintaining the length, whereas dynamic aims at lengthening. 

Dynamic stretches have been encouraged these days by many fitness trainers and rehab specialists abroad post exercises, as the muscles go into the contracted state.

 

FASCIAL YOGA OR FASCIA STRETCH - Helps to maintain the flexibility – since fascia is viscoelastic and follow the principle of plasticity.

 

 

 

 

 

Q5.     Most single sports like running, cycling, and swimming are in a single plane or sagittal plane. We do very little rotational or lateral movements while doing these sports. So what exercises do you recommend to address this? How important is weight training?

 

 

We need strength basically to pull up any sports, the same is the story with all endurance sports, the only difference, is while resistance training, you are focusing more on the load (Weight)

 

Endurance activity needs more repetition.

 

The important muscle that you need to train here in running is basically your hip and knee muscles.

Also important is a powerhouse – the core. 

A weak core will forcefully adopt a compensated movement in the kinetic chain of lower limb esp- hip, knee, and ankle and similarly with the upper body chain.

 

G. Medius Muscle, Pelvic stabilizer in running, you need to focus more on it and then on quadriceps group of muscle, hamstring, and calves.

 

The anterior part of GM – Flex and Internal rotation of the hip.

Posterior part of GM – Extension and external rotation of the hip.

Working together helps in pelvic stability.

 

What are the common recovery tools you recommend?

(Post RUN- immediately)

 

Ice bath. (cryotherapy)

Epson Salt Bath.

Stretching.

Good Hydration and Recovery Drink. (Good Osmolarity electrolyte)

 

 

Followed by : (after 24-48hrs)

 

Cryo cuff/compression garment.

Sports massage.

Acupuncture or dry needling.

Cupping (Dry or Wet)

Fascia line yoga poses.

ZMA - Recovery and sound sleep (minimum 7 - 8 hrs)

 

Q6. Once an athlete is injured, please take us thru’ some general principles to adopt. What yardsticks do you use to determine if the athlete is ready to return to at least some light training?

 

An injury goes through these 3 phases :

1.     Inflammation.

2.     Repair.

3.     Regeneration.

 

Earlier principle of RICE (Rest, Ice, Compression, and Elevation) is outdated now. 

The recent sports medicine protocol what we Practice is "POLICE" 

(Protection, Optimum Loading, Ice, Compression and Elevation)

 

Acute Injury – always apply ice (Cryotherapy) for an initial 24 – 72 hrs.

 

Complete rest if any strain or sprain occurs (Grade2 - 3).

 

Q7. Return to light training?

 My personal recommendation – 3 parameters.

 

1.     From a medical point of view – NO PAIN AT ALL – sign to go ahead with some light training,

2.     Same flexibility range pre-injury.

3.     Correct Biomechanics of running.

 

Q8.What are your views on the following, all of which you use in your treatment protocols

-       Dry needling and how is it different from acupuncture.

 

Dry Needling has recently proven to be quite effective and beneficial in sports athletes. It is widely used nowadays, not only in the rehabilitation phase but also in the prevention phase.

 

While acupuncture is more superficial and highly concentrated on the flow of energy (CHI), 

Dry Needling targets to a much deeper structure like a muscle, bones, ligament, fascia, and cartilage.

 

I recommend taking a dry needling session 48 hrs pre-marathon event, to activate the cell responsible for healing.

 

-       Cupping

 

Cupping is a decompression technique, used in promoting the good vascular supply in the area which is been treated. It also helps in the removal of toxic substances from the body.

 

 

-       Massage

 

            Deep Tissue Massage Esp _ Sports Massage as we discussed post 36 – 48 hrs. avoid taking any                form of massages immediately post-run.

 

-       Foam rolling

 

Foam Rolling at present is quite controversial, as it leads to harm is done incorrectly. 

I personally do not advise my client for foam rolling.

 

 

-       Taping

 

Used widely for prevention, support, protection and to alleviate the pain – TAPING IS BEST !!!

It should always be used as an adjunct in your rehabilitation protocol.

 

 

 

 

Q8 SELECTING THE IDEAL RUNNING SHOES

Running - considered to be the simplest form of exercise, but feel more complex when you actually start to perform it.

 

It's recommended that running shoes should always be customized to your foot biomechanics and anatomical abnormality. 

 

A detailed foot evaluation from a podiatrist or foot specialist will help you to understand the shoe requirement. DO NOT GO FOR LOOKS, BRAND, AND PRICE. 

 

Optimal Running Shoes are the ones that match with runner's mechanical features during the Gait pattern.

3 Important Factors while choosing a perfect fit.

 

 

HINDFOOT - STABILITY

 

The first part of the shoe to be considered is the heel counter, the upper rear part of the shoe.

The heel counter should be made of rigid, firm plastic to assist in rear foot stability.

 

It should be an easy fit on the rear foot, difficulty in removing the shoes from the rear part indicates that shoes are tight. 

 

FOREFOOT  - FLEXIBILITY

 

Ideal running shoes should be flexible enough to provide good easy motion during toe-off. Choose the shoes which have a layer of plastics covering the entire woven-net of the forefoot. 

Avoid purchasing the one which has entire forefoot netted. Durability is compromised as repeated movement may tear the Net at the junction. most of the customized and branded shoes are netted to provide good air circulation to prevent moisture.  

 

There should be a gap of 1 - 2 cm gap, from great toe to determine the perfect size of the shoe. 

 

MIDSOLE 

of the foot is most important, should be made up of EVA, and acts as a string shock absorber. The sole should be thick enough with either Gel or air packs for shock absorption.

The insole of the shoes should have a medial arch supporting the plantar fascia, to provide stability and for even distribution of weight. FLAT MIDSOLE should be avoided. 

Some personal Recommendation:

ASICS Gel-Nimbus 22

ASICS Men's Gel-Kayano 26 (4E) Running Shoes

• Adidas UltraBOOST.
• Brook's Glycerin 18./Brooks Dyad 11

• Brooks Men's Beast '18
• Nike Zoom Fly 3. 
• HOKA ONE ONE
  

THANK YOU !!! 

for more queries or information mail - swapnil.physio@gmail.com