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The Best Approach to Effectively Treat Running Injuries

Caleb Uncategorized Leave a comment   , , , , , , , , , , , , , ,

As discussed in the previous entry, “Why Are Running Injuries So Prevalent?,” the majority of running injuries develop as a result of cumulative trauma and repetitive stress.   This recurrent micro-trauma facilitates the formation of scar tissue, which leaves the soft tissues short, weak, and painful.

So how do we treat quickly and effectively treat these injuries?  Some of the most common approaches include rest, ice, electrical muscle stimulation (e-stem), ultrasound (US), stretching, exercises, injections, and surgery.  Unfortunately, most of these treatments only provide temporary relief and are often slow to take effect.
running injuryThe reason these treatments are ineffective is because they fail to address the underlying cause of the symptoms.  It is the scar tissue adhesions that bind down the tissues, reduce blood flow, restrict normal muscle motion, and alter the movements in the kinetic chain.

Passive approaches like rest, ice, e-stem, and injections simply treat the symptoms without addressing the dysfunctional component of the tissues.  More active approaches like stretching and strengthening are important in the recovery of injuries yet fail to address the scar tissue that has caused the muscle to be tight and weak in the first place.

Scar tissue must be addressed to effectively treat and prevent further injuries from occurring.  Active Release Technique® (A.R.T.) is the gold standard for soft tissue injuries and is specifically designed to locate and treat scar tissue that entraps nerves and accumulates in muscles, tendons, ligaments, and fascia.  By locating the scar tissue adhesions, the practitioner is able to break up the adhesions, restoring proper muscle movement, length, strength, and blood flow. The end result is increased functionality, improved range of motion, better stability, and most importantly, the elimination of pain.

Call Ridgway Chiropractic to see if ART® can help with your running injuries. For more information on ART®, check out activerelease.com

-Dr. Caleb Ridgway DC, ART

 


Plantar Fasciitis: A Big Pain in the Heel!

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Do you ever experience pain in the heel or the bottom of the foot after prolonged periods of standing, walking, or running? Do you ever experience foot pain when first getting out of bed in the morning?

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If so, you are not alone and may be suffering from the very common and very debilitating condition known as plantar fasciitis. Unfortunately, this condition often causes months to years of discomfort and when not addressed properly, can lead to a lifetime of frustration. You may have tried one or more of the traditional treatment methods before with little relief. Ice, heat, NSAIDS, electrical muscle stimulation (e-stim), and ultrasound (US) have been regularly prescribed for the treatment of plantar fasciitis yet merely focus on the symptoms rather than the underlying cause. This achieves the very short-term goal of temporary pain relief but does nothing to eradicate the cause. Other treatment options like stretching and exercise are essential components of the recovery process but again fail to address the underlying issue. What is the issue you ask? The answer is scar tissue.

So how does this scar tissue get there in the first place? To answer this, we must examine the anatomy of the foot and the role of the plantar fascia. The foot is an intricate network of muscles and ligaments, which support and stabilize the 26 bones and 33 joints of the foot. The plantar fascia is a dense connective tissue that runs from the heel to the toes and helps support the arch and stabilize the joints of the foot. Together, the muscles and plantar fascia work together to allow the foot and ankle to work properly. However, any breakdown or compromise in the integrity of the support system will result in very painful consequences.

Throughout the day, we put a tremendous amount of stress on our feet. Running, walking, and standing stress the muscles and fascia of the foot. Overtime, the tissues become fatigued and more susceptible to micro-trauma, or microscopic tears, that develop as a result of overuse. The body responds to this injury by laying down scar tissue. Over time, this scar tissue builds up leaving the muscles short, tight, weak, and unable to properly support the foot and ankle. As the muscles become tight, the tension increases at the attachment on the heel and is often the first symptom of plantar fasciitis. As you can see, pain is typically the last stage of dysfunction. What started out as a mild ache or tight muscle becomes a debilitating and frustrating condition over weeks, months, and years of repetitive insult.

So what do we do about the scar tissue that has left the bottom of our feet feeling like a bed of hot coals? Fortunately, a new technique known as Active Release Technique® (ART®) has proven to be very effective at resolving plantar fascia pain. Active Release Technique® is specifically designed to treat short, tight, and damaged muscles, tendons, ligaments, nerves, and fascia by targeting scar tissue. The ability to quickly and effectively treat scar tissue separates ART® from the rest of the available treatment options, restoring proper muscle movement, length, strength, and blood flow. The end result is increased functionality, improved range of motion, better stability, and most importantly, the elimination of pain.

Call Ridgway Chiropractic to see if ART® can help with your foot pain. For more information on ART®, check out activerelease.com

-Dr. Caleb Ridgway DC, ART

 


Why Are Running Injuries So Prevalent?

Caleb Uncategorized Leave a comment   , , ,

There is nothing more frustrating than being kept from training or competing due to an injury. Unfortunately for runners, this realization is particularly common as running injuries are some of the most common in sports. Plantar fasciitis, shin splints, IT band syndrome, piriformis syndrome, low back pain, etc. are all injuries that many of us have had to deal with at one time or another. Not only are these injuries common, but they can be debilitating, recurrent, and often very slow to respond to traditional treatment. And often times, significant rest does nothing to solve the problem and a runner experiences the same complaint that sidelined them when they return after a several week or even several month layoff. Many fail to understand why significant rest does nothing to solve the problem.

U.S. Track and Field Olympic Trials - Day SevenBefore we talk about treatment options, it is important for us to address the pathophysiology of running injuries. Let’s start at the most basic level, injuries in general. There are two basic types of injuries: Those that are acute, and those from repetitive insult. An acute injury is a sudden trauma, like an impact or sudden tearing which results in sudden inflammation and eventually scar tissue formation. A repetitive injury is a far more common injury in runners and is the type of injury we will focus on today.

The typical runner will take somewhere in the neighborhood of 800-1000 strides per mile. So to put this in perspective, if you were to go on a nice two-mile jog, each heel would strike the ground approximately 2000 times. A five-mile run would result in each heel striking the ground approximately 5000 times and a ten-mile run would result in each heel striking the ground approximately 10,000 times. Not only is this a tremendous amount of repetitions, but the amount of force generated from each heel strike is equally astounding. Studies vary, but on average, a heel striker will generate a force 2-3 times their bodyweight per heel strike. So let’s take a 150lb individual. Each heel strike then generates between 300lbs and 450lbs of pressure. Multiply that by the 2000 heel strikes from a 2-mile jog or the 10,000 strikes from a 10-mile run and I think you guys see the point. Running results in a tremendous amount of cumulative micro-trauma that is translated from the foot to the ankle to the knee to the hip to the back, etc.

Now, the body is designed to handle these stresses, albeit there must be sufficient strength, endurance, mobility, and muscle balance to absorb and translate the forces in the appropriate manner. An imbalance here or a weakness there results in inappropriate stresses on joints and tissue that are not designed or intended to take those stresses. This is why running injuries are so prevalent. A minor problem can cause a whole host of problems when the repetition is high and the forces are great.

When we talk about running, it is important to remember that the foot, ankle, knee, hip, back, etc. are all connected and the proper function of each is necessary to achieve optimal performance and injury prevention. One dysfunctional muscle can cause a problem not only in the affected area, but anywhere in the entire kinetic chain, resulting in compensation and inefficient movement.

In running, we call this “stride compensation.” As the body compensates for problematic areas, forces are translated to areas not designed or accustomed to take the increased stresses causing minor problems to be amplified over the course of a series of repetitions. In this case, a minor issue can become a very painful, chronic issue.

So what causes these minor issues? What causes muscle tightness, weakness? And how does cumulative trauma culminate into a serious and chronic injury?

Let’s talk about micro trauma. As runners subject themselves to continuous and repetitive forces, micro trauma develops. The body then lays down scar tissue to repair the damaged area. This is a normal process and is not a problem. However, as runners continue to train, the amount of scar tissue compounds as the same muscles are strained and repaired over and over again. Scar tissue begins to build up resulting in scar tissue adhesions.scar-tissue

Normal muscle consists of hundreds to thousands of parallel fibers running in a specific direction. As the body repairs micro trauma, it lays down new tissue with little attention paid to the parallel nature of the surrounding musculature. The result is a thick, stiff, matted, and non-contractile matrix within the muscle tissue.

The result is a shortened muscle that is unable to effectively and efficiently contract. The shortened muscle now requires more power output to move, increasing energy expenditure, leading to premature fatigue, and causing the recruitment of other muscles to compensate. The repetitive injury cycle has been initiated.

As this cycle repeats itself, the integrity of the muscles involved continue to be compromised. Eventually, the muscle gives way and a more serious injury is the result.

Many runners have difficulty explaining how the injury occurred, as they did nothing differently in training. When questioned more, most runners describe a slight pain or experience some muscle tightness that has been building up over time. The “injury” that brought them in the front door was merely the match in the powder barrel.

So, now that we have established how and why running injuries occur, the best approach to treatment will make total sense. Read about running injury treatment in the upcoming blog post, “The Best Approach to Effectively Treat Running Injuries.”

-Dr. Caleb Ridgway DC, ART


IT Band Syndrome: To Foam Roll or Not to Foam Roll?

Caleb Uncategorized 3 Comments , , , , ,

Iliotibial-band-syndromeIn practice, I often encounter patients looking for at home techniques to enhance treatment results and minimize injuries. Patients inquire about specific stretches, exercises, foam rolling, and trigger point balls, all of which can be very beneficial when done correctly.

As a runner myself, I have dealt with many of the common injuries runners seem to incur. Plantar fasciitis, piriformis syndrome, shin splints, and IT band syndrome are extremely common running injuries that are debilitating, recurrent, and often slow to respond to treatment. But this article isn’t about the treatment or prevention of these injuries per se, but is more of a look at the effectiveness of foam rolling the IT band specifically.

In this ever-changing landscape of sports medicine, new ideas and theories are constantly being postulated. Which brings us to the question, to foam roll or not to foam roll?

Before we get into that, I think it is important to briefly describe the anatomy of the IT band. The IT band is a thick, dense, band of fascia traveling down the lateral aspect of the leg from the level of the pelvis to the knee. It works with surrounding muscles to assist in flexion and stabilization of the knee as well as assisting in movement of the hip.

Because the IT band is not muscle, but rather a thick, dense band of fascia, it is very resistant to being stretched. In addition, it lies on top of other thigh muscles, which need to move and slide with movements of the legs. Dysfunction of these muscles may be imitating or aggravating IT band symptoms.

As I mentioned earlier, muscles need to properly slide and glide against each other as we use them. With that in mind, compression of the IT band through use of the foam roller actually pins the IT band up against the muscles of the quad (vastus lateralis) and the muscles of the hamstring (biceps femoris). This compression facilitates the formation of adhesions between the two layers of tissue and prohibits the proper glide and slide that must occur between these muscles to facilitate proper muscle firing and biomechanics. These adhesions become a source of pain as they put pressure on nerve receptors and increase muscular tension.

quad-foam-rollerSo what to do about IT band issues? First, it is important to address the muscles that connect to the IT band. The IT band is actually a continuation of a muscle at the lateral aspect of the pelvis called the tensor fascia latae (TFL). Tightness in the TFL increases tension in the IT band and can be an important muscle to address with foam rolling. The gluteus maximus also has fascial connections to the IT band and can influence the tension, similarly to the TFL. I recommend searching foam-rolling techniques for the TFL and glutes.

Secondly, one should address the muscles that lie under and beside the IT band, the muscles of the quad and the hamstrings. Unlike the IT band, these muscles are not resistant to change and can be lengthened and stretched fairly easily with a foam roller. However, one must pay special attention to the placement of the foam roller. As I mentioned earlier, stay off the IT band. Concentrate of contacting the lateral aspect of the quad and the hamstring, without moving onto the thick, dense tissue of the IT band.

To reiterate, I am not condemning the use of foam rollers. I am a firm believer in their effectiveness but realize that they are not a fix-all modality. One must consider the tissue and anatomy of the injured body part when attempting to rehab it. So give these other muscles a good foam rolling, and leave the IT band alone.

-Dr. Caleb Ridgway DC, ART