Shin Splints No More!

Working with runners of all kinds, I see a lot of “shin splints”.  When I was a collegiate athlete, I had my share of shin problems, to say the least!  I had multiple stress fractures, tight calves, and strained muscles.  I had to bike, swim, and strengthen like crazy just to complete long runs!

Now that I have an athletic therapy background and some experience under my belt, I understand better how this can be prevented and treated before stress fractures and muscle tears occur.

What are “shin splints”:

Shin splits is a bit of a garbage term.  It can mean: muscle tears, tendonitis, fractures, compartment syndrome, or tightness.  Most people suffer from weak tibialis posterior or tibialis anterior muscles.  Calves are usually too tight and a muscle imbalance results.

The Simple Prevention: 

Running shoes are so important for high level athletes as well as recreational runners.  Having a fresh pair of shoes that are under 8 months old is likely the easiest prevention.  Shoes that work to keep you straight is an important investment.  If you tend to over-pronate, are a heavy runner, or do a lot of mileage, you need more motion control in your shoes.  If you have a high, rigid arch and are heavy on your heels, you need a more cushioned shoe.

Training Errors:

Increasing your mileage too quickly (taking the summer easy then ramping up for an indoor track season) when you’re not strong is the best way to get shin pain.  Mileage must be increased moderately and your base fitness should be maintained all year long.  This includes volume as well as intensity of the runs.  Another training error is not allowing enough recovery time.  As you build your mileage, allow for a recovery or drop back week.  Giving your nervous system some regeneration and soft tissue a chance to repair makes your harder weeks much more effective.

Strength:

Having the strength in your lower legs will help your legs not get so fatigued resulting in microtears – leading to injury.  Ankles need to be stable and not over reactive to ground forces.  Knees need to be strong (which comes from glute strength).  Runners tend to neglect their lower legs assuming that they get enough work from running.  You need resistance with the training so the forces working on the body with running are much less. See the exercises below on how to accomplish some specific strength.

Stretching:

After each run, ensuring that you are stretching your shins, calves, and the bottom of your foot is crucial.  A good 10 minute stretch routine post run is the bare minimum for proper recovery and injury prevention.

Solution:

Here is a short routine that can be done daily to maintain or build strength in your lower legs.

1. Toe tapping 3 x 20 taps

2. Walking on your heels while brushing your teeth

3. Inversion with a band 3×12

4. Eversion with a band 3×12

5. Dorsiflexion with a band 3×12

This will help to build and prevent shin pain especially overuse injuries.  If you have been injured, seek treatment sooner rather than later.  Muscle tears are much harder to treat and will put you out of commission for 6-8 weeks.

Jen Mark BSc., CAT(C), CSCS
Athletic Therapist
www.dynamicliving.me
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Plantar Fasciitis

To start the year off right, I received a request to discuss plantar fasciitis.

Plantar Fasciitis

I think some basic anatomy will help explain how this painful injury begins and how it is treated. The plantar fascia is a tendon-like structure (fascia) that runs under the foot supporting the arch. It is an extension of the achilles tendon, which in turn is an extension of the calf tendon. Minor or major tears on this fascia is the fasciitis part of the injury.

The injury is typically caused by tight calves (most athletes experience this), or an overuse/over stretch of the arch in the foot. Improper foot wear, lack of conditioning/stretching, and overuse can be the biggest mechanisms. When I mention improper footwear, I am referring to old running shoes, unsupportive running shoes, and even dress shoes with a hard insole.

The best way to approach foot pain is to deal with it right away. Plantar fasciitis typically causes pain on the medial (inside) part of the heel, right where the arch begins. Stretching your calves can help stop small tears from growing. Checking your footwear at the first sign of pain is critical.

Plantar fasciitis can become quite painful causing difficulty walking, running, and limit activities of daily living. If your foot pain gets to this level seek medical intervention. Getting an x-ray to clear any bony abnormalities and a diagnostic ultrasound to examine the soft tissue is vital.

Therapy is needed to reduce swelling and pain, as well as promote healing to the area. The sooner you seek intervention the less damage you will cause. Some ways you can help at home include:

• Night splints (socks that keep your fascia on stretch)
• Compression socks
• Wearing running shoes in the house
• Getting out of bed into warm, supportive footwear (to reduce the shock of a cold floor and collapse of the arch)
• Foot exercises

Night Splint

Strengthening of the foot is important for healing but also as a preventative measure. Athletes take for granted the strength of their feet, which are lifelines for sport. Calf strengthening exercises include the exercises given in my last blog about ankle weakness.

 

 

 

 

 

Simple foot exercises include picking up pens with your toes and towel scrunches. In your bare feet scrunch a towel up using just your toes keeping your heel on the floor. Once the pain is manageable and you are no longer limping, the stork stance is very helpful.

Pen pick up

Towel scrunches

 

 

 

 

 

 

You can ice your foot with an old plastic water bottle. Fill the bottle with water and place it in the freezer. Once frozen, roll the bottle under your foot.

Frozen water bottle

 

If you have any questions or concerns, please contact me. Have a great 2013 and keep those feet happy!!

 

 

 

 

Jen Mark BSc., CAT(C), CSCS

www.dynamicliving.me
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Foot Pain?

I recently had a request for a blog that dealt with feet.  Unstable ankles mostly, which is actually pretty common.

I think the best place to start is with the muscles.  There are some muscles in the foot that originate and insert only in the foot.  But mostly there are tendons from muscles that originate in the lower leg that insert in the foot.  The best way to “strengthen” the foot is to strengthen the muscles in the lower leg.

Straight leg calf raises

 

 

Basic calf raises are the easiest to execute and are great for increasing functional strength in the lower leg.  Every time you take a step you execute a calf raise.  With your legs straight you are targeting your gastroc muscle (the powerful, more visible calf muscle).  You can also do this seated which would target your soleus (the endurance of the calf muscles).  Of course, while standing you are using your body weight (you can hold weights also); while seated, you need to put a weight or plate on your quads to provide resistance.

 

 

Calf raises on a step

 

 

For further challenge, stand on a step with your feet over the edge so that you can drop your heels below the step and come up from a negative position.  This can be done when you are able to accomplish the above exercises without difficulty.  The muscle fibers here begin on stretch then contract to optimal length, then to a contracted position; therefore, causing more muscle work and fatigue.

 

 

Once these exercises are simple enough, you can simply do them on 1 foot.

Stork stance

 

When ankles are unstable, it generally means the ligaments are having a difficult time keeping your position against gravity.  The stork stance is another simple exercise in theory but many people with ankle injuries have difficulty keeping their balance.  Stand on one leg, and hold for about 15-20 seconds at the beginning.  If you feel that you are losing your balance, it’s better to touch down with your other foot than to wobble around trying to regain your position. To make it more difficult, you can close your eyes (harder than it sounds!).  Past that, you can stand on an unstable surface such as a bosu ball, fit disc, or pillow (keep your eyes open).  Another great way to work your proprioception, is to toss a ball to a wall while in your stork stance.  Mix it up a little and toss to the wall in a different spot each time so that you need to adjust for the dynamic nature of the ball coming back at you.  Again, when losing your balance, touch down with the other foot instead of wobbling around.

These are simple exercises that you can try at home.  If you are having difficulty with the range of motion of your ankles or experience sharp pain with any of the above movements, you need an assessment.  Having strong/stable ankles helps with more activities of daily living than you might think.  Having a strong base will improve movement patterns in your knees, hips, and lower back.  

Let me know what you think!  If you want to request more exercises or have questions about other injuries, please leave a comment.

Jen Mark BSc., CAT(C), CSCS
Athletic Therapist
www.dynamicliving.me
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No more crunches!

Ok, we all want rock solid abs, I get it.  And having a strong core is the biggest buzz in the fitness industry – and for good reason.  So why can’t we do crunches anymore?

Remember back in the day those who were working out, were performing sit ups?  This was how fitness lovers and athletes got those abs of steel.  Then science caught up and saw evidence that doing all those sit ups were causing back injuries.  If we look close enough at the mechanics, your hip flexors (iliopsoas group) are doing most of the work and they originate in your lumber spine.  All this excessive pulling on the spine was leading to back injury.  So we all stopped doing sit ups and moved to crunches.

Now science has caught up to crunches.  There is evidence to suggest that doing a crunch can load your spine up to 150 times.  Constantly flexing the spine and overusing one muscle group will never create balance in the body.  Ask me how I feel about machines such as leg curl!!  Our spines are pretty fragile and precious, so we must find another way.  Something that science can’t debunk!

Let’s talk for a second about what your core is and what it’s role is.  Your real “core” includes your deep pelvic muscles (creating a pelvic floor), your transverse abdominis (under your 6 pack muscles), and your multifidus muscles (attaching to each vertebrae in the spine).  The job of these muscles is to stabilize your pelvis, to limit excessive movement.  If your core is strong, you will be able to lift heavier weights, run faster, jump higher etc.  All because your “base” is stable.

There are a few exercises that are needed to get  your core strong.  Keigles are one method for women and men can think about “stopping the flow” (holding in your pee).  If you want to learn about setting your core, visit my website and check out the video.  It’s easier to show that to type!

So once you can activate your core, here are some fun exercises that are commonly done incorrectly.  I typically see poor posture which is a result of a weak or unactivated core.  Most people tend to rush these exercises – remember when doing this type of training, the pelvis should be stable.

The plank on the stabilty ball is a staple exercises – focus on good posture, neutral spine, and hands under your shoulders.  When tucking your knees in, your back does not change and the movement is smooth and controlled.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When using the ab roller, the same principles apply.  Start in a modified plank position and roll forward maintaining your posture and stable pelvis.  Your body should not change position. just your arms stretch out and back in.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

One note of caution: Core work should not result in back pain.  It is acceptable to feel that your back is doing some work, but not sharp pain.  If you finish the exercise and you feel discomfort in your back, your pelvis was not stable enough and you need to decrease the difficulty of the exercise.

For questions or comments, please contact me.

Jen Mark BSc., CAT(C), CSCS
Athletic Therapist
www.dynamicliving.me

Why we all need shoulder stability

Back View – notice shoulders are set

A very common problem in the clinic is neck and shoulder pain.  Every type of athlete and avid exerciser will likely experience shoulder pain at some point in their career.  Yet so often at the gym I see shoulder exercises done incorrectly.

Most people do not know that the rotator cuff is an extremely important muscle group and what it’s purpose is.  This shows up in exercise routines as either poorly executed exercises or lack of stability exercises at all.

The rotator cuff is the primary stability for the shoulder.  The muscle group (containing four muscles) holds the humerus into the pocket of the shoulder blade.  Yes, these two bones make up your shoulder! ** side note: if your shoulder blade is winged or dysfunctional you will have shoulder weakness**  If your rotator cuff muscles are not activated, your big traps and deltoids and biceps and triceps and pecs and and and etc have to hold the joint together.  These muscles need to save their energy and strength for moving objects, turning door handles, getting out of bed, sitting in a chair or any number of upper body movements.  With a properly engaged rotator cuff, these muscles will not tire out so quickly leaving you with achy, heavy shoulders or neck pain.

Side View – notice the elbows are under the shoulders

The muscles in the rotator cuff (infraspinatus, supraspinatus, teres minor, and subscapularis) hold your posture, internally and externally rotate your shoulder, and initiate lifting your arm.  I have pictured the most popular rotator cuff exercise designed to strengthen the external rotation of the shoulder (infraspinatus and teres minor).  Since we spend so long in internal rotation (sitting at a desk or using our smart phones), it’s important to restore this movement.  When our external rotators are as strong as our overworked internal rotators, we are in balance and posture improves.

The external rotation exercise is commonly used with a resistance band.

 

Front View – notice the wrists are straight and the elbows have not moved back

The important points to remember are:

• Keep your posture
• Keep your elbows touching your sides in the rotation
• Stay away from letting your shoulders fall forward during any point of the movement
• Do not squeeze your shoulder blades together

For questions regarding this exercise or other shoulder stability exercises please contact me (jenmark@dynamicliving.me) or visit the videos on our website (video #1).

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me

Stabilize your knees

There are so many people out there that have sore knees.  We get pain in our knees because of chronic use and degeneration as well as acute, sudden injuries.  No matter the reason, the most important rehabilitation is stabilization.  You can begin stabilizing the knees once the swelling and pain is almost gone (if there was any).

Stabilization means that all the muscles that affect the knee are coordinated in working together for control, as well as the ligaments in the knee being strong enough to keep the knee still.  Think of stabilization as guide wires.  As we move about our day, or pivot and twist in a game, we have ligaments and muscles to stop the knee from over rotating or sliding too far forward.  When your knee is unstable, you are in jeopardy of this happening and causing further damage.

An important part of stabilization training is correct technique.  First, when doing any lunging or squatting, your knee needs to stay in line with your second toe (your big toe being the first).  You also must insure that your knee does not go farther than your shoe laces in a forward position.  It is, in fact, your glutes that control the position of your knee.  The bone at the top of the knee joint, the femur, is also the main bone in the hip.  So it would make sense to make sure your glutes are strong and active in order to keep good knee alignment.

Check out the following exercises for knee stability.  Check in with a certified strength coach (or personal trainer) for supervision if needed.  Email me (jenmark@dynamicliving.me)  for any questions or concerns you many have with these exercises.

2 leg squat

1 leg squat

Clam press

2 leg bridge

1 leg bridge

1 leg deadlift

stork stance

foam roll quads

foam roll glutes

foam roll IT Band

Jen Mark BSc., CSCS, CAT(C)
www.dynamicliving.me
@jenkmark
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Stuck in Traffic? Do Your Core Work!

When can sitting in traffic be wonderful? How can you keep yourself entertained?

The very basis of having a strong core is not doing crunches and planks. Those muscles are not your core muscles. Your oblique and 6 pack muscles are primary movers and it’s too awkward to be doing planks while driving.

While sitting, put your butt right to the back of your seat. Right to the back. Sit tall! You might have to adjust your mirrors. Create a space in the small of your back, big enough for your hand to fit. Your feet must be as even as possible, by which I mean your left foot isn’t outstretched as far as it will go. Now you’re in neutral.

Everytime you need to apply the breaks tighten your pelvic floor muscles! For women, these are kegel exercises. Not enough that you squeeze your glutes though. For men, we say “stop the flow”. Imagine what you would do to stop going pee.

Once your pelvic floor is activated, lighly draw your belly button in. Do this without holding your breath! You cannot drive while holding your breath! Just “draw in” enough that your tummy flattens a little.

Hold this only for a brief moment, let go, and repeat. Repeat everytime you touch the breaks or every time you turn a corner. Hold your position in your seat – might be harder than you think!

Questions? Meet with one of our athletic therapists to learn how to set your core. You can avoid or treat many back problems with learning this valuable trick.

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me
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Awkward Positions

Spring and summer are glorious for us Canadians.  Great weather finally gets (almost) everyone outside and active.  This means getting into the garden, trimming trees and shrubs, and mowing the lawn.  Some people are on the roof doing repairs, or under the cottage making adjustments from the winter.  What do all these activities have in common?

Awkward positions.

In the clinic, I see a lot of summer-time injuries.  Many people are coming in with aches and pains from being stuck in an awkward position for many minutes at a time.  Bent over in the garden causes the back to become overstretched.  Trimming trees with your arms over your head causes your shoulder and neck to be placed in an unstable position.  Mowing the lawn with a push mower, without your core activated, causes your pelvis to go out of alignment.  But what can be done?  We can’t stop taking care of our precious lawns and gardens!

Be patient, get stronger, and stretch!

Be patient: take time in between flowers to change your position.  When weeding, maintain your posture.  When doing activities with your hands over your head, bring them down often and mix in a stretch.  If you get out of posture, stop, reset, and get back into alignment.  You will last much longer and you will seriously reduce your risk of injury.

Get stronger: those that are more fit, have less gardening injuries.  Even if they do get injured, they likely recover faster and are less severely injured.

Stretch: in between activities and at the end of the day.  After you are finished with your outside chores, take some time to stretch.  Treat these activities like your workout and get down on the lawn, deck, or carpeted floor and do some stretches.

Being aware of fatiguing muscles and joints, and taking the time to maintain your alignment will help your work in the garden and around your house go so much faster and longer.  Not that I don’t like the business, but us athletic therapists don’t really want to see you getting injured doing the activities you love!

Jen Mark BSc., CAT(C), CSCS
www.dynamicliving.me

I held a brain!

Last night I found out I had the opportunity to go to a cadaver lab. I jumped at the chance. This morning I was so pumped to get through the morning so I could get into the lab and get a chance to really see the muscles, ligaments, and nerves that have been bugging my clients lately.

I got to the Canadian Memorial Chiropractic College early and got to look around their student shop. I saw lots of things that I will buy, soon. I met the group in the lobby and we went down to the anatomy labs. The smell of formaldehyde was strong, and some of the other students passed around Tiger Balm ointment to put under their noses to take away the smell. I work with hockey players so my smell senses are dead anyways, I didn’t take the ointment. Once inside the lab we put our lab coats on and began to unwrap the first body.

All the bodies we saw looked like dried out turkey. Good thing I’m vegetarian. I got to touch and see and move anything I wanted. I liked seeing the muscles and nerves in the legs the most. We saw a pelvis and scoliotic spine, which was great to see the rotation of the vertebrae at each over-curvature. We saw a spinal cord and got to touch and hold all the nerve roots that were still intact.

And then I got to hold a human brain! It took 2 hands. The over layer (that attaches to the skull – the duramater) was still intact but peeled away. The piamater (the layer right on the brain) was still present and shiny. It weighed about 5-6 pounds and was pretty firm.

We saw black, shriveled, smoker’s lungs, and I got to hold a cancerous liver. All the livers were the
size of a football! The skin that was peeled back is so thick. No wonder I have to dig deep in order to influence the muscles. There was fascia still attached to the bones that still housed blood vessels and nerves. Speaking of nerves…wow! They’re huge! I knew the sciatic nerve was fat (the width of your thumb) but the other nerves are nothing to sniff at. I got to poke and pull at the brachial plexus (the bundle of nerves just above your collar bone). You can see all the branches and roots very clearly.

It is such a great experience to impulsively get plunged into a world that you’ve never been to before. I never say no to any experience and this time it paid off. We only had an hour inside the lab, but I could have spent all day. What a fantastic learning experience! Thanks Joe!

Jen Mark BSc., CAT(C), CSCS
Dynamic Living

Listen to your mother!

We’ve all heard it: “Sit up straight!” from our mothers at one point in our life. We would sit very miliatry-like and could only hold it for a few seconds. Do you feel the same way now? What exactly is good posture and can it be for more than good looks?

Let’s start at the base, our pelvis. The spine is attached at the pelvis (Sacral Iliac Joint), and is thus very influenced by your deep core muscles and posture. You need to have a strong core in order to hold your pelvis in its neutral position. Not with your butt stuck out, and not so that your back is flat – somewhere half way in between. Once your pelvis is neutral, your lower back needs to have a small lordotic curve. This provides shock absorption for your spine. If you insist on walking around with your lower back completely flattened, you lose that valuable spring in your movements.

Your thoracic spine (where your ribs meet your vertebra) needs to have a curve also. This time, a very mild kyphotic curve. This continues the “s” shape of the spine for added absorption of movement and shock. This is the curve that can become exaggerated in seniors that is caused by osteoporosis.

Lastly, the neck should have the same curve as the lower back. A small curve oppposite to the thoracic spine. Here lies most of our problems. Many people have too much of a lordotic curve, and many have very little curve at all. If you have too much curvature, it is likely caused by an over kyphotic curve in the thoracic spine. This compensation of the neck helps to keep the eyes level for optimal vision (and we think our bodies aren’t smart!). Having either too much or no curve in the neck causes a lot of neck pain that can last a long time. This is where a therapist needs to step in and work on postural correction.

Finally, I want to touch base on shoulders. Having rounding shoulders with shoulder blades (scapula) that stick out, also causes a lot of problems. When people talk about pulling your shoulders back, it gives the wrong impression. To correct your rounded shoulders, you need to tilt your shoulder blades into your rib cage. A very small movement. Do not squeeze your shoulder blades together, this will cause more neck trouble (something we can talk about later). Having good posture through your shoulders means that your humerus is sitting in the joint in its optimal position. This allows for a greater range of motion (especially being able to lift your arm above your head), allows you to lift heavier weights, and reduces injury during sports and activities in your life.

So, straighten up! Hold your pelvis neutral, maintain a small curve in your lower back, and tilt those shoulder blades into your rib cage. It can be very fatiguing at first to hold, but keep at it. You will see a big difference over time.

For a quick demo on setting your shoulder blades and pelvis, click here. Look at the videos on shoulders and core activation.

Jen Mark BSc., CAT(C), CSCS
Dynamic Living