Runners Knee

Iliotibial Band Syndrome (IT Band Syndrome / Runners Knee)

By Darren Macfarlane, Sports Injury and Rehabilitation Specialist

Iliotibial band syndrome is very common among runners so much so, that it is known as, runner’s knee. It affects up to 10% of all runners at some stage. Iliotibial band syndrome is a painful overuse knee injury that affects the outer part of the knee.
The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches to the tensor fascia latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone) just below the knee joint. The IT band acts as a stabilizer of the pelvis and to extend the knee joint (straighten it) as well as to abduct the hip (move it out sideways).

As the ITB passes over the lateral epicondyle of the femur (bony part on the outside of the knee) it is prone to friction. At an angle of approximately 20-30 degrees the IT band flicks across the lateral epicondyle. When the knee is being straightened it flicks in front of the epicondyle and when it is bent, it flicks back behind.
Iliotibial band syndrome is common in runners as 20-30 degrees is the approximate angle at the knee when the foot strikes the ground during running. IT band syndrome is an overuse condition that is aggravated by excessive training which causes the band to tighten which then rubs off the knee bone causing pain and inflammation on the outside aspect of the knee and is often more intense when descending stairs, or getting up from a seated position.

Signs and Symptoms of Iliotibial Band Syndrome:

• Sharp or stabbing pain located on the outer side of the knee joint.

• Pain aggravated by running, especially running downhill or climbing stairs.
• Pain will usually worsen as activity continues
Causes of Iliotibial band Syndrome:
• Athletes who fail to perform adequate stretching exercises to quadriceps and lateral thigh.
• Overtraining and overuse
• Running on a cambered road surface. Because most roads slope off to sides, running in the same direction leads to the outside foot being lower than the inside foot. This in turn causes the pelvis to tilt to one side and stress the it band.
• Biomechanical abnormalities that can lead to it band include, excessive pronation of the foot, leg length discrepancy, lateral pelvic tilt and bowed legs.
• Weak hip muscles i.e. gluteus medius.
• Naturally wide and tight it band.

Prevention and Treatment of Iliotibial band Syndrome:

• Rest from any activity that causes pain and inflammation. No one likes to be told to rest but movements like running will aggravate the pain. Rest will allow inflammation to decrease and area to heal. Start with at least five days of complete rest from training.
• Apply ice. This will reduce inflammation. Apply ice at least three times a day. Wrap ice in cloth to prevent burns.
• Try swimming or cycling if pain free or work on upper body strength during recovery period. Rest and low impact cross training can lead to a faster recovery.
• Stretch the Iliotibial band, quadriceps and piriformis muscles if tight after training.
• Avoid overtraining
• Make sure running shoes are in good condition. Many it band injuries are as a result of worn out shoes.
• Foam rollers are useful way to self massage the it band and help stretch out tight and painful areas.
• Strengthening the gluteus medius, if weak it overloads the it band and it has to do all the work and tightens up.
• Increase weekly mileage and training time gradually.
• Get regular sports massage; this will eliminate any tightness or adhesions that cause the IT band to tighten up and turning into pain and leading to time off training.
• Attend a physical therapist to get a full biomechanical assessment to determine the underlining cause of the IT band pain. They will assess your posture and lower limb alignment and correct any dysfunction with a corrective exercise rehabilitation programme and with soft tissue techniques.

Don’t Suffer with IT Band Pain! For a Sports Massage Treatment or to Have a Biomechanical Functional Assessment .Give me a call at the Galway Clinic for an Appointment on 086 1957378

www.sportsinjurytherapy.ie 

How can Functional Rehabilitation help my pain

HOW CAN FUNCTIONAL REHABILITATION HELP YOU WITH CHRONIC INJURY?

By Darren Macfarlane, Sports Injury & Rehabilitation Specialist

If you are suffering from a reoccurring injury, there is usually an underlying problem where something is not functioning correctly in your body and over time this has lead to causing your injury. This is known as a chronic injury .Instead of focusing on the injury alone, you have to look at the bigger picture to see what is causing it and time and thought must to be taken to rehabilitate this injury properly.

This is where Functional Rehabilitation can help you.

In functional rehabilitation there are four different assessments which are: Postural, Core Function, Range of Motion & Movement. When all of the assessments are carried out and the data is put together, you are given a functional corrective exercise programme. This will prevent future injury and help with your chronic injury.

If your posture is incorrect while standing still then it will be incorrect when you move, this will result in restricting your movement and will make your body unstable through your joints, which will lead to injury and muscle imbalances.

Your body’s Core is designed to work automatically without us knowing, its function is to stabilise the joints of the spine and pelvic girdle therefore if this is not functioning properly it will lead to injury and especially injury of the Lower Back.

The range of motion assessment allows you to assess the flexibility of your muscles and the health of your joints, it also lets you know where there is a presence of pain and inflammation. In everyday life we move, that is why movement needs to be assessed so that we can see if the muscles that move us, and the muscles that stabilise us during movement are working efficiently.

Why Rehabilitate using Functional Exercises?

As upright human beings we have to combat gravity daily, we do this through all of the movements we make. We climb mountains; take part in all kinds of sports, walk, and run, everything we do involves movement. There is no point in training or rehabilitating your muscles in isolation because we do not use our muscles in isolation – we train with a view to excelling in our chosen sport. Functional exercises tailored to your body will increase your ability to move efficiently and reduce your chronic injury.

A strong foundation of muscular balance and core stability is essential for any athlete. In many athletes their core is not fully developed, weakness and lack of coordination in your core can lead to compensatory movement and strains, overuse and injury. A functional corrective exercise program will prevent future injury as well as improving efficiency & performance.

For more information and advice on Functional Rehabilitation contact our Galway clinic on 086 1957378 
www.sportsinjurytherapy.ie 

What is a Functional Assessment and why do i need one

What is a Functional Assessment and Why Do I Need One?

By Darren Macfarlane, Sports Injury and Rehabilitation Specialist

An athlete needs to have his body optimal to perform at the highest level; any deviation from this can lead to poor performance or even injury. Functional assessments are very important to athletes because it can let them know what strengths or weakness they have in there body. Any weakness or dysfunction in the body i.e. lack of mobility, weak core which are left undressed can severely impact upon your performance and increase risk of injury. Staying injury free is a key to success in sport. By understanding what’s dysfunctional in your body you then know what is needs to be corrected.

The tests I perform at Darren Macfarlane Sports Injury Therapy are:

• Posture

• Core Strength (using a pressure biofeedback monitor)

• Comparative Range Of Motion

• Movement (Lunge and Squat)

Why have these tests done?

Posture

The posture test can give me a good visual feedback of any deviation from optimal posture. It can highlight can excessive curves in the spine i.e. Hyperlordosis in lumber spine which can lead to lower back pain or Kyphosis in the thoracic region which can lead to shoulder and neck injuries. If your posture is incorrect while standing still then it will be incorrect when you move, this will result in restricting your movement and will make your body unstable through your joints, which will lead to injury and muscle imbalances .As part of the posture test I measure your spinal curves and pelvic tilt. Any tilt in your pelvis can lead to back pain or this can also highlight that there is any muscle imbalances. Any visual signs of fallen arches from posture test will then also be confirmed by gait analysis. Fallen arches can lead to shin splints, knee problems, quadriceps strains and hip pain.

Core Strength

Your body’s Core is designed to work automatically without us knowing, its function is to stabilise the joints of the spine and pelvic girdle therefore if this is not functioning properly it will lead to injury and especially injury of the Lower back. By assessing the core you determine where the weaker portion of it are and more importantly that it is working properly, this is important to provide spinal and pelvic stability needed to protect you from damaging forces as a result of gross movement during your particular sport or daily activities.

Comparative Range of motion

I use goiniometers and an inclinometer to measure range of motion in athletes. The range of motion assessment allows you to assess the flexibility of your muscles and the health of your joints, it also lets you know where there is a presence of pain and inflammation. It assesses the asymmetries which occur between the right and left hand side of body and lets me know what’s happening throughout the kinetic chain. This assessment can be made specific to your sport. Tight and inflexible muscles can lead to muscle strains which will frustrate athletes because they will need to rest for weeks which can hamper there training and fitness levels.

Movement

Movement is assessed by recording clients doing a lung and squat. This shows whether the athlete has stability and movement competency in order to train or compete without getting injured. In everyday life we move, that is why movement needs to be assessed so that we can see if the muscles that move us, and the muscles that stabilise us during movement are working efficiently.

Once the postural, core strength, flexibility, mobility and stability dysfunctions have been analysed a therapeutic corrective exercise program is designed specific to your individual needs.This program will get you to a level of function that you require which will allow you to do your sport properly without the risk of injury, staying injury free is one of keys in any sport, it will also improve your efficiency and performance level.

The assessments are done at your initial consultation which takes about an hour and then you return one week later to receive your individual corrective exercise program, where I address your dysfunction. I then take you through the exercises so that you do them properly with good form and understand them. Five weeks later the you return for re-assessment to monitor your progress.

You cannot determine a proper course of training and strengthening without a proper

Clinical assessment. You need to determine the correct course of action to correct any imbalances and apply the right training methods.

Have a functional Assessment today. Or for any information on functional assessments Call Darren at our Galway Clinic on 086 1957379
www.sportsinjurytherapy.ie 

Have I strained my muscle

HAVE I STRAINED MY MUSCLE AND IF SO WHAT SHOULD I DO?

By Darren Macfarlane, Sports Injury & Rehabilitation Specialist-Galway

Muscle injuries are among the most common injuries and they account for 30% of all injuries in sport.

If you’ve ever been involved in a sport you’ve most likely heard your manger tell you not to pull a muscle. A muscle tear is more properly described as a muscle strain, which means the fibers of a muscle in the body have been overstretched resulting in a severe injury. Strains are caused by overstretching or eccentric overload and are located in the muscle-tendon junction.

Strains frequently occur in sports that require explosive muscular effort over a short period of time e.g. sprinting, jumping, soccer, gaa football and hurling. The rupture occurs when the demand is greater than the strength or elasticity of the muscles fibers. The muscle becomes torn as the force exceeds the contractile strength of the muscle. Examples in sport are sudden stopping, slowing down or a combination of slowing down and acceleration when turning cutting jumping and when a change in direction is involved.

Strains mainly occur in muscles that move two joints, i.e. the hamstring muscle which flexes the knee and extends the hip. Other examples of muscles susceptible to the distraction ruptures are the quadriceps, gastrocnemius (calf) and the bicep muscle in the upper arm.

Muscle strains are caused from extreme physical activates, improper warm up prior to these activities or simply a lack of flexibility and conditioning needed for the sport or fitness regimen.

TYPES OF STRAINS

Strains are classified by the degree of rupture.

·                    First and Second degree strains: this is a partial rupture

·                    Third degree strains: this is a complete rupture   

SIGNS AND SYMPTOMS OF A MUSCLE STRAIN

• A sharp and stabbing pain felt at the moment of injury and when muscle is contracted later. Usually there is little pain at rest.
• Partial rupture, pain will inhibit muscle contraction.
• Complete rupture, muscle unable to contracted
• There is often localized tenderness and swelling over damaged area.
• After 24hrs bruising and discoloration may be seen. Often below site of injury there are signs of bleeding within the damaged muscle.
• In some very serious cases you may also hear a popping noise at the same time you feel the sting of the tear.

TREATMENT OF AN ACUTE MUSCLE STRAIN INJURY
THE PRICE PRINCIPLE (WHEN INJURY FIRST HAPPENS) USE IN THE ACUTE PHASE FIRST 48-72 HRS. DO PRICE TO PROMOTE HEALTY HEALING OF TISSUE.

• PROTECTION-Protect area from further damage. Take player of pitch or stop activity you are doing.

• REST-Rest the injured area from exercise and other day to day activities. Any movement will continue to open and aggravate the tear and cause more bleeding .Rest enables fibers to begin to knit together quickly before any more damage is done.

• ICE-Ice should be applied as soon as possible as this reduces the amount of bleeding and swelling in the tissues, less bleeding reduces the amount of scar tissue developed. It also has an analgesic effect which reduces pain and also reduces the protective spasm around the area of the injury and makes it more relaxed .Ice for the first 3 days only every 3hrs.Never apply the ice directly to the skin, place the ice in a plastic bag and wrap within a towel .Leave the cold pack on the torn muscle for no longer than 15mins or it could exacerbate the injury. Always check contraindications to using ice.

• COMPRESSION-Immediately apply to restrict blood flow to injured area and to limit swelling .Do not apply around whole limbs it will starve other areas of blood.

• ELEVATION- Done as much as possible, a leg or arm should or arm should be comfortably supported so that it is raised higher than torso .This elevation slows the arterial blood flow to the area and therefore helps in restricting the amount of bleeding gravity also helps in the removal of swelling from the area and so aids recovery.

NOTE: All acute injuries should be seen by a medical practitioner as soon as possible. Majority of strains and sprains are minor and the inflammation soon stops and patient may choose not to seek medical help .IF Swelling, pain and inflammation remains after 48hrs of good price, this suggests that it could be more than a minor soft tissue injury and you must be medically assessed.

CONSIDERATIONS

To safeguard from a muscle tear make sure to properly train and condition the body for the specific sport or activity. This will not only increase your flexibility and strength for your chosen sport but also make your muscles more resilient and adaptable to the exercise.

·                    Sports massage is a great way of preventing muscle strain injuries.

·                    Muscles have a great capacity to regenerate but the new muscle fibers will be shorter and incorporate inelastic scar tissue. If the scar tissue covers a large area, function will be impaired because contraction is restricted. Areas of different elasticity may be formed in the muscle which increases the risk of recurrence of the rupture. It is therefore important to have all muscle strains treated and rehabilitated properly

.

If you have a Muscle Strain you need Treatment. Call Darren at our Galway Clinic for Appointment on 086-1957378

www.sportsinjurytherapy.ie

How can sports massage improve your performance

THE BENEFIT OF SPORTS MASSAGE FOR ANYONE INVOLVED IN SPORT:

By Darren Macfarlane, Sports Injury & Rehabilitation Specialist

Sports Massage is an energetic form of massage with benefits that can be felt by both elite and amateur athletes alike. It works the soft tissues of the body e.g. muscles, ligaments and tendons. It is a very effective form of therapy for releasing muscle tension and restoring balance to the musculo skeletal system. Received regularly it will help athletes prevent injuries which might be caused by over use.

A constant build up of tension in the muscles from regular activity may lead to stress on the joints, ligaments tendons and muscles themselves. This may impede sports performance and in the long run lead to more serious injuries. The overall aim of the treatment is to enhance performance at what ever level the sports person has reached.

The biggest risk in the quest for enhanced performance is of course injury, Sports Massage has a great potential in this area as you can use it to prevent injury, and this is why many top competitors use it as part of their training regime. With regular treatment, they are in a better position to sustain high levels of performance without getting injured.

Sports Massage Benefits:

• It is an essential part of Event Specific Training Plans where mileage increases e.g. Marathon, Triathlon or Adventure Races
• Increases fitness capabilities and performance, it aids your recovery time and flexibility
• Prevents future injury by identifying and treating current muscle weakness, tiredness and problem area’s
• Sports Massage should be used as a preventative tool to keep the body healthy
• Post Event Massage clears out toxins and lactic acid from the muscles, it delays the onset of muscle soreness and enables a faster recover time than post event rest
• It speeds up the healing of damage of overworked tissues or muscles which reduces recovery time and allows your to regain your health and performance  - it repairs an injured muscle 5 / 6 times faster
• It breaks down any adhesions that restrict your normal range of motion
• Injury has a lesser risk of reoccurrence by preventing scar tissue and it also breaks down any existing scar tissue you may have

Don’t wait until you are injured to have a Sports Massage!

For more information and advice on Sports Massage & Sports Injuries (prevention and treatment) you can contact at the galway clinic on 086 1957378.

www.sportsinjurytherapy.ie 

Good Static Stretchs

LOWER LEG:

Gastrocnemius stretch

·                    Stand with the leg to be stretched at the back and hands on a wall at shoulder height.

·                    Bend the front knee and lean forwards, keeping the back knee straight and the heel down.

·                    When you can feel a stretch, hold for 20-30 seconds.

·                    If you feel the stretch ease off, lean further forwards until you can feel it again.

Repeat 3 times each time and 3-5 times a day

Stretching the Soleus muscle

·                    Stand in front of a wall, with the leg to be stretched at the back and hands on the wall at shoulder height.

·                    Bend both knees into a squat position, keeping the heels on the floor.

·                    Lean forwards slightly so your weight is on the balls of your feet, but keep the heels down!

·                    Once you can feel a stretch, hold for 20-30 seconds.

·                    If the stretch eases off, lean further forwards or bend the knees lower until you can feel it again.

Repeat 3 times and do this 3-5 times a day

Stretching using a step

·                    If you have very flexible calf muscles, or as you progress you may need to use a step to achieve a better stretch.

·                    This should be performed instead of the above gastrocnemius stretch. You don't need to do both!

·                    Stand with the toes on the step and heel off the back

·                    Make sure you have something to hold on to

·                    Lower the heels off the step until you can feel a stretch

·                    Hold for 20-30 seconds

·                    If you feel the stretch ease off, drop the heels further until you can feel it again.

Repeat 3 times and do this 3-5 times a day

Seated shin stretch
Stretching the muscles on the front of the lower leg can be difficult to achieve. The following are the two easiest ways of doing so.

·                    Kneel down and sit on your heels.

·                    Gently push down on the heels to stretch the front of the leg.

·                    Hold the stretch for 30 seconds and repeat 3 times.

·                    This stretch can be increased by stretching one leg at a time and gently pulling the knee up

         Standing shin stretch

·                    Stand with your toes of one foot on the floor on the outside of your other foot.

·                    Bend the weight bearing leg to push your other ankle towards the ground.

·                    Hold this position for 30 seconds and repeat 3 times.

THIGH AREA

Static quadriceps stretch

·                                This can be performed in either standing, or laying on your front.

·                                Pull the foot of the injured leg towards your buttock until you can feel a gentle stretch on the front of the thigh.

·                                To increase the stretch, tilt your hips backwards.

·                                Hold for 20-30 seconds and repeat 3 times. Do this at least 3 times a day.

Internal Rotation (Hamstrings)

·                                 Sit with one leg bent and the other straight out in front.

·                                 Rotate the straight leg inwards and lean forward at the hips to feel a stretch under           the thigh (image 1).

·                                 Hold stretch for 30 seconds.

·                                 Repeat the stretch throughout the day at least 5 times.

External Rotation (Hamstrings)

·                                 Sit with one leg bent and the other straight out in front.

·                                 Rotate the straight leg outwards and lean forward at the hips to feel a stretch under        the thigh (image 2).

·                                 Hold stretch for 30 seconds.

·                                 Repeat the stretch throughout the day at least 5 times.

Hip flexor stretch

·                                 This stretch will focus on the Rectus femoris and Iliopsoas muscles.

·                                 Kneel with one knee on the floor and the other foot out in front with the knee bent.

·                                 Push your hips forwards and keep the back upright

·                                 You should feel a stretch at the front of the hip and top of the thigh.

·                                 Hold for 20-30 seconds, repeat 3 times, at least 3 times a day.

Short adductor stretch

·                    This will stretch the short adductor muscles that attach to the thigh (above the knee).

·                    Assume the position as shown. Gently press down with the elbows onto the knees to increase the stretch.

·                    If it is painful then stop. You should feel a gentle stretching in the inner thigh.

·                    Hold for 30 seconds, repeat 5 times a day.

Long adductor stretch

·                    This will stretch the long adductor muscles that attach below the knee.

·                    Stand with your feet wide apart as shown, and lean away from the side you are stretching.

·                    Hold for 30 seconds and repeat 5 times a day.

HIP STRETCH

Outer hip stretch

·                    To stretch the muscles that rotate the hip outwards.

·                    Lie on your back and bend the knee of the leg to be stretched.

·                    Use the opposite hand to pull the knee over to the side as shown opposite.

·                    You should feel this in the hip and buttocks.

·                    Hold stretch for 30 seconds, repeat 3-5 times and stretch 3 times a day.

Piriformis stretch  90/90

·                    Sit on the floor with both your front and back legs bent to 90-degrees.

·                    The angle of your groin should also be 90-degrees.

·                    Place your hand on the ground next to your hip.

·                    Tip your pelvis as though it was a bowl and you were trying to pour the contents out over your belt. Imagine sticking your but back like Donald duck.

·                    You should have an increased curvature of your lower back. Keep the curve in your low back and your chest and head up as you move forward over front leg.

·                    When you feel a comfortable stretch in your outer thigh and hip ,inhale and press the front knee and ankle firmly into ground for 5 seconds. Exhale and move farther into stretch.

BACK STRETCHES

Lower Back Stretch

·                    Lie on your back.

·                    Pull  knees up to chest as far as they will go.

·                    Hold for 10 + seconds repeat 5 times

This exercise stretches the muscles around the lumbar vertebrae

Cat Stretch:

·                                 Start on your hands and knees.

·                                 Arch your back upwards, like an angry cat, hold for a couple of seconds and then         arch the back downwards, like a happy cat.

·                                 Repeat this exercise 10 to 20 times

Knee Rolling:

·                                 Lie on your back as above with the knees bent.

·                                 Slowly lower both knees to the left whilst turning the head to the right.

·                                 Bring the knees up again and to the right whilst looking left.

·                                 Repeat this movement 10 times

Side stretch(quadratus lumborum)

·                                 Standing upright, lift one arm above your head.

·                                 Lean over to one side as far as is comfortable.

·                                 Hold for 10-20 seconds.

Pulling knee up(Back)

·                                 Lie on your back with both legs out straight.

·                                 Raise one knee gently up to the chest and bring the head up to meet it.

·                                 Lower the knee back down and repeat with the other leg.

·                                 Repeat the exercise 10 times on each leg.

SHOULDER

Front of shoulder stretch (pecs)

·                                 Place the arm to be stretched against a wall and gently turn away.

·                                 Hold for 20 to 30 seconds and repeat 5 times.

·                                 Stretch at least every day.

·                                 If any pain is felt then discontinue and rest.

·                                 A gentle stretch at the front of the shoulder should be felt but no pain.

Front of Shoulder against a wall (pecs):

·                                 Place one forearm against a fixed point (such as a doorway), with the elbow and            shoulder at 90 degrees.

·                                 Gently turn your body away to stretch the front of the shoulder and chest.

·                                 Again, hold the position for 20 seconds and repeat 3 times.

·                                 The athlete should feel a gentle stretch in the front of the shoulder but not pain.

Doorway Stretch

·                    The arm is placed behind the top of a doorway or similar and the athlete moves forwards whilst maintaining contact with the top of the doorway.

·                    A stretch should be felt in the front of the shoulder.

·                    Hold for 20 to 30 seconds, repeat 5 times.

Back of Shoulder (rotator cuff):

·                                 Place one arm across your chest and pull it in tight with the other.

·                                 The athlete should feel a gentle stretch at the back of the shoulder.

·                                 Again, hold the position for 20 seconds and repeat 3 times.

·                                 The athlete should feel a gentle stretch in the back of the shoulder but not pain

Extension stretch (biceps)

·                    The arm is placed  from the side, as far backwards as it will go while keeping the palm of the hand facing downwards

·                    This position is then increased to stretch the front of the shoulder

·                    This can be done either with a partner assisting by passively pulling the arm backwards and upwards or by placing the hand on a table behind and lowering the body to increase the stretch

Supraspinatus stretch

·                    Place one hand on your lower back and pull the elbow forwards using the other hand.

·                    Hold for 20 to 30 seconds and repeat 5 times assuming there is no pain. If it is painful then discontinue.

·                    The athlete should feel a gentle stretch in the shoulder, but not pain.


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