The Achilles Tendon, my nemesis. If you're a runner I bet you've experienced that familiar sharp pinch directly below the calf before...I wish Costco sold new achilles in bulk! That would have been extremely handy these last couple months as I've been rehabing and coming back from an left Achilles injury that came on my first week back training after my break. This seems to be an especially vulnerable time for any runner, particularly if there are other life stressors going on in addition which aren't factored into the "weekly training plan". (Such as, shall we say, moving? Which I happened to also be doing that week...hindsight truly is 20/20...) As I've been coming back I have had plenty of time to think about common patterns which I've seen in my career both when an injury first occurs and while coming back into training after weeks or months on the sidelines. One thing that continues to come up year after year is proper hip alignment and muscle firing patterns. The body is an amazing compensator! I've found that at times of injury, such as now, my muscles revert back into bad compensation patterns to protect injured areas and making sure my hips are aligned and all muscles are firing "correctly" is crucial on my first runs and workouts back. This last week I was fortunate to see the one and only Brad Ott from Rebound Physical Therapy, who I worked with in high school in my home state of Colorado. He is great at explaining concepts with easy to understand analogies, and these are some great excerpts from the Rebound blog:
Overuse Injuries- Detecting the Cause:
Overuse injuries are the result of repetitive micro-trauma to tissues such as muscles, tendons, ligaments and even bone. Common diagnoses include tendinitis, bursitis, stress fractures and chronic muscle pain (myositis). Sometimes this is simply the result of doing too much training, but in many cases there are underlying factors that if not dealt with can make a recovery difficult or very prolonged.
Every sport has unique biomechanical demands on the body, and our muscular system can be thought of as having “primary muscles” and “secondary muscles” for each sport. Primary muscles should do the bulk of the work while the secondary ones serve more in a back-up role. Our nervous system calls on secondary muscles once the primary ones become fatigued, but also when there is a muscle or joint imbalance.
A good example is in running where our larger gluteus maximus muscles have the primary role of propelling us down the road. When the gluteus maximus is weaker, or inhibited (think lazy), the body may compensate by over-recruiting the calf muscle on that same side to assist with push off. As this becomes habitual the athlete often suffers from Achilles tendinitis, a common running injury.
Another common cause for an overuse injury is altered joint alignment such as the hips and pelvis. Similar to a car frame, our bodies can fall out of neutral alignment. In a car with bad alignment, there may be no symptoms if it is just driven a few short miles a day for work commute; however that same car, driven 75 miles a day, will much more quickly develop a balding tire. Endurance sports are no different, they expose the imbalances. This is why a runner who has stayed healthy to run 5k and 10k races suddenly falls apart when they increase their training for a half or full marathon. The increased training distances simply exposed an imbalance that may have been there all along.
When considering muscle and joint imbalances the key is isolate the problem areas, and also to understand that nearly all of these compensating patterns can be fixed through corrective exercises.
Who needs to Rebound?
A common approach with many injuries is simply to rest and allow the body to conduct its natural healing process. Our bodies have a truly amazing ability to adapt and heal, but along the way there can also be a very important undesired occurrence, and that is called compensation. Compensation begins with our nervous system recognizing pain and altering the way that we move and posture our bodies for even the simplest of daily activities. In basic terms it is a hard-wired protection mechanism.
Immediately following an injury, compensation can be a good thing to help the body protect from pain and create a healing environment. The nervous system does this by changing what muscles it uses and how it moves our various joints. This strategy used by our bodies is called “inhibition.”
The problem with muscle inhibition is that many times the body does not let go of this compensating strategy even once injured tissues have healed. Thus a return to sports and activities can begin with significant biomechanical imbalances that make re-injury or a new problem likely. For example, many patients who have injured a foot or ankle will report after being in a cast or boot that their original pain is gone, but as they increase activities again they experience a new pain in their knee or hip.
Ideally following an injury, whether to a joint, bone, muscle, ligament or tendon, a physical therapist can check your biomechanics to make sure range of motion has been restored and that key muscles have turned back “on.” Turning muscles back on and improving muscle recruitment patterns is called “activation,” and it is absolutely critical to stay pain-free and enjoy your recreation and sports activities.
Last May Flotrack featured some of these symmetry tests and injury prevention exercises from Rebound, here are the pictures and links again:
SYMMETRY TESTS: The goal is that both legs will have equal range of motion.
Bent leg fall-in: let legs fall in naturally one at a time and see if there is any feeling of impingement keeping them from falling in equally.
Everted leg fall out: let legs fall out naturally and see if they fall out the same amount on each side or if one is higher than the other.
Single leg raise: keep leg straight and raise upwards to test range of motion on both sides, it might be helpful to have someone else watch this one.
ACTIVATION EXERCISES: The goal in these exercises is to feel the targeted muscle group, thus isolating it and "waking it up" or "activating" it (and not other muscles which may be "cheating" by wanting to take over the targeted muscle group's role).
Oblique leg lift: contract obliques to lift legs off the ground
Outer hip leg slide: slide leg out and feel the outer hip engage.
Full butt leg lift: contract the glutes, THEN raise one leg off the ground at a time using the glute.
Leg Cross Groin Pull: provide resistance with hand, feel a contraction deep within the groin.
Adductor Resistance: pull knee towards the ground, feel adductor muscle contracting (feels like the inside portion of quad).
Click the links to go straight to the video clips on FloTrack:
Katie Follett, Olympic Trials 1500m finalist, of the Brooks Beast team in Seattle shows Flotrack her daily activation analysis and exercises with Beast coach Danny Mackey. This analysis and exercise series is a very simple and easy way to get the body firing properly before you go out for runs, workouts or simply to start your day. Simply check your body with the three Activation Analysis tests, then go through the 5 simple exercises to get your bodying firing. Its a 5-10 minute series that could really help you to start becoming proactive with injury prevention rather than reactive!
Katie's Activation Analysis/Exercise Series
Activation Analysis Tests:
Part 1 - Bent Leg Fallen
Part 2 - Everted Leg Fall Out
Part 3 - Single Leg Raise
Part 1 - Oblique Leg Lift
Part 2 - Outer Hip Leg Slide
Part 3 - Full Butt Leg Lift
Part 4 - Aductor Resistance
Part 5 - Leg Cross Groin Pull
Coach Danny Mackey explains importance of activation
Katie Follett's favorite achilles tendon stretch
Katie's full injury prevention routine