ATLETA Fitness

Sports Injury Occurrence and Rehabilitation – Part 2 of 3

Running is one of the most popular exercise pursuits Australia-wide. Australia plays host to the largest Fun-run in the world, the City 2 Surf, as well as hosting a mass of other fun runs, half marathons, marathons and ultra-marathons (over 50km and past 160km long in some cases!) Australia also has a large participation in team and individual sports. When we consider that a Rugby front-row player will amass an average 4km distance throughout a game, through to an AFL winger averaging over 13km in a game, it’s no wonder that we must love and enjoy running!

Optimized-Group_runningFollowing on from part 1 of our sports injury blog series, we will pick up where we left off, and look at further detail on the remodelling stage of injury repair. Then, we will consider some common running injuries and common causes of these, and how we can utilise strength and conditioning expertise to rehabilitate and return the injured site to full function. Part 3 of this blog series will follow on from this, and examine in greater detail the incidence of acute running injuries, and the difficulties we face in rehabilitating these injuries.

Remodelling Phase of Injury Repair

Part one of this three part blog explored the three phases of injury repair and recovery, from the inflammatory phase (~72 hours post injury) through the reparative phase (from 72 hours until 1- 4 weeks post injury) to the final stage of recovery, the remodelling phase (1-4 weeks post injury until 6 weeks or even 6 months or more post injury). The remodelling stage of injury repair takes place after the injured site has reduced, or removed inflammation, and scar tissue has reconnected the injured site across the tear or rupture. The severity of the injury (Grade I, II or III) can determine how much scar tissue was laid down, and how long it has taken to reach the remodelling phase. A GI hamstring tear might only take 1 week to reach remodelling phase, and return to sport achieved in less than 2 weeks; where a knee GIII MCL sprain could well take months to fully restore fibre connections, and return the joint to full loading and function. Effectively, what we are aiming to do during the remodelling phase is restore strength, flexibility (range of motion or ROM) and proprioception to the same, if not a better, point of function when compared to your pre-injury ability. We use a range of strength, power, plyometric and flexibility training methods to break down and remove scar tissue, improve neural messaging and feedback (proprioception) and improve the strength and size of the muscle fibres (either of the affected muscle, or the surrounding musculature of the joint). How do we do this specifically? Read on to find out about strength and conditioning, rehabilitation and pre-hab training for common running specific injury problems.Optimized-running skeleton

CORE AND LOWER LIMB INSTABILITY AND THE EFFECT ON RUNNING

The muscles of our core are generally not the first muscles that come to mind when considering running technique, however, these muscles are some of the most important for technique and injury prevention. Core instability can lead to poor running technique, excessive spinal loading and excessive hip movement during running stride. All of these result in hip pain, lower back pain and poor running technique. How can we fix this?

1. Technique:

The first important step is to identify what motion of the running technique has resulted in this pain. The most common problem is excessive hip motion, resulting from weak glute muscle, poor hip control and an underactive core. Once this is identified, we can modify and correct this aspect of technique, to decrease the negative effects of poor technique. The info-graphic below sums up correct running technique nice and concisely.Optimized-running technique

2. Flexibility:

We need to avoid incurring muscular imbalances associated with core weakness and instability, and if they’re already present we need to rectify these imbalances. Hip flexors, glutes, adductors, quadriceps and hamstrings can all change in strength and flexibility following running with poor technique. Not only is this bad for core stability and the affected muscles, but a change in one of these muscles may influence a poor change in another. For example, over-tight hip flexors might result in under-strength hamstrings and a weakened core. Before we can strengthen any of the under-active muscles, we must stretch out the over-active muscles. If we stretch these out regularly, we can reduce the risk of side to side or front thigh to back thigh
imbalances, and the consequential over-tight muscles this could promote. Furthermore, strength exercises will be more effective if the associated area is in a more stable and balanced site, and we avoid exacerbating existing problems (which we’ve hopefully fixed to some degree by this stage).

3. Stability:

Keeping Hips level, and in line with Knee and Ankle

Keeping Hips level, and in line with Knee and Ankle

We need to stabilise the core, and associated musculature, through a variety of dynamic hip and glute control exercises. Skater hops are a great way to dynamically load the glutes and promote the employment of hip stability in response to heavy hip loading. Similarly, we need to promote central core stability and strength, with a variety of core loading exercises. A range of dynamic movements (mountain climbers, jack knives, crunches, leg raises) and static movements (transverse abdominal holds, pelvic floor activation) can be used in strengthening the core, among a host of other core and full body associated strengthening exercises. Stability exercises are the first step into strength training, and provide a great foundation off of which to build.

4. Strength:

Bosu Squats can build strength, while stressing the core effectively

Bosu Squats can build strength, while stressing the core effectively

After we have rectified running technique, flexibility, muscle imbalance and stability, we can start to strengthen the core and lower limb. Simple glute activation exercises, such as clam and glute isolation holds, can improve the muscle’s strength functional ability. Similarly, we need to determine if the glutes or the hamstrings are the predominant muscle during hip extension. Poor running technique and weak glutes are often associated with over-active hamstrings. We need to focus on glute activation, and hamstring flexibility (as the hamstrings may have tightened up in response to excessive use).

Employing the help of a qualified exercise professional in guiding you through this remodelling stage can ensure the best quality and fastest recovery, with the best long-term outcomes for you. Part three of our three part blog series will look more in depth at acute, or sudden onset, running injuries and both how to prevent recurrence and rehabilitate the site. Get in contact today to book in with one of our experienced, degree qualified trainers. With a wealth of prior experience and great depth of knowledge, it’s hard to beat the level of service we offer here at ATLETA. Don’t forget to sign up for our annual City 2 Surf Classes, Which started on Tuesday (June 2nd).

Written by Johann Ruys

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