ITB and knee pain in runners

Running

Our NU Moves Physio team recently debated the current beliefs surround the ITB and how it can give you lateral (or outside) knee pain which is also referred to as ITB syndrome. Here is a simple take home message from a complex discussion.

* The diagnosis of ITB syndrome can be made clinically without investigations

* The lateral meniscal cartilage of the knee needs to be considered as a possible source of pain which may require MRI imaging. A clinical assessment will predict if this is likely.

* The most common cause of the problem is an increase in the amount of running or ‘load’ on the knee. Treatment of acute ITB syndrome must include initially managing the load to help reduce inflammation.  This is usually via modifying the running program.

* The hip is the key to controlling this problem. Most importantly the strength and timing of the gluteal (buttock) muscles need to be sufficient to hold your pelvis and leg stable enough during running. Secondarily having enough flexibility in the hip flexor muscles often helps get the gluteal muscles functioning better.

* Rolling the ITB is a common form of treatment utilised if tightness is perceived as part of the problem. If rolling gives you relief of pain associated with running or any other exercise then we cannot argue with that however understanding the reason behind why it may or may not help is the challenging part. Roll it if it helps you but make sure you start your rehab at the hip.

Exercise can help osteoarthritis

water exercise

Do you know anyone who suffers from osteoarthritis? It occurs when the cartilage that lines the bones in your joints breaks down through trauma or age. It is most common in weight bearing joints such as your hips, knees and ankles. The greater the compressive forces placed through these joints – the greater the inflammatory response, pain and stiffness. Being overweight increases the compressive forces on our joints, making weight bearing challenging and exercise painful. Once you get arthritis pain it then becomes harder to exercise.

What is the best management of being overweight and having osteoarthritis?
There is a common misconception that weight loss occurs through exercise and physical activity. Recent studies looked at the effect of diet and exercise on weight, inflammation (measuring markers in the blood), joint compressive forces, pain, function, mobility and quality of life in people with osteoarthritis. The study reports that in fact a combination of diet and exercise provided the greatest loss of weight (10%) compared to exercise alone (2%). The group with combined diet and exercise management also experienced a better reduction in joint inflammation and pain, as well as improved function, mobility and quality of life compared to the exercise alone group.

What type of exercise is best?
A separate study looked at types of exercise undertaken in individuals with osteoarthritis. The study found that the best type of exercise for pain relief alone is water based exercise. The type of exercise most beneficial to improve function was a combination of strengthening and flexibility exercises alongside a low impact form of physical activity e.g. aqua aerobics or walking.

The general advice that can be provided based on these articles is valuable but everyone is different in the type of arthritis through to what exercise program will give the best results. If you or someone you know are suffering from osteoarthritis the best approach it to start with personalised research based advice on how to reduce pain, increase strength or decrease weight. Our physio’s at NU Moves are experts in exercise for arthritis.

* Uthman OA, van der Windt, et al. Exercise for lower limb Osteoarthritis: Systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347: f5555

* Messier SP, Mihalko SL, et al. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis. JAMA 2013; 310 (12):1263-1273.

Have you got persistent neck pain

Neck discomfort

The scalene muscles could be the culprit. There are 3 scalene muscles (anterior, middle and posterior) on each side of the neck. They primarily control the side tilting motion of the head but given they also attach to the first and second ribs, can assist with upper chest inspiration or shallow breathing.

At NU Moves Physio we find these muscles become overactive and painful with excess computer / screen use. If you then add stress the posterior scalene muscle in particular tightens further which has a flow on effect in how we move the neck and further increases pain. Sometimes the reported cause is sleeping awkwardly but often this is the trigger and the cause relates back to the extra muscle tension that you take to bed.

How to control it:
1. Deep tissue massage and myofascial releases combined with thoracic spine manual therapy works immediately in reducing tension and associated pain.
2. Try to diaphragm breathe – tummy breathe. Shallow breathing into the top of the chest uses the scalenes even more. Get more oxygen deeper into your lungs and give the scalenes a break.
3. Minimise the chin poked posture at the computer (too much laptop time)
4. Lastly the most common management strategy, getting active and away from the desk. Be careful if you are really tight and start with a low intensity cardio session again with a lower deeper breathing focus (e.g. go for a brisk walk). Upper body gym sessions or high intensity runs can sometimes increase the tension and discomfort when you are really tight.

If you need help with neck pain during busy times call us on 49216879. We will reduce pain and tension and help you get active.

Aerobic vs anaerobic … what type of exercise should you be doing?

Exercise types

There are plenty of research articles supporting both aerobic and anaerobic exercise. Some examples of aerobic exercise include running, walking, swimming, cycling etc. Types of anaerobic exercise include weight training, sprinting or any exercise bout lasting less than two minutes. After around two minutes your body’s demand for oxygen is exceeded by the body’s production of oxygen and therefore becomes more aerobic type exercise. Aerobic training is beneficial for cardiovascular health. It enhances the hearts function enabling it pump more blood to the body with each beat and also lowers resting heart rate. Aerobic training is beneficial for overall health, reducing the risk of cardiovascular disease, diabetes, and many other chronic diseases. Resistance training is beneficial for building strength, supporting and enhancing bone growth, and lowering blood sugar. This is especially beneficial for those people diagnosed with diabetes. Resistance training builds muscle which uses glucose for energy and increases insulin sensitivity. So which type of exercise should you be doing? A combination of aerobic and resistance training will have optimal effects. Make exercising enjoyable; try a range of exercise options until you find one you enjoy and stick with it. Try exercising with friends, with music or different classes. You are more likely to stick to a program if it is something you enjoy.

If you want to learn more about the best type of exercise for you contact us on 49216879. Our physiotherapists are skilled in exercise prescription for everyday casual exercise through to professional sports conditioning programs.

Exercise recommendations for healthy living

running and physiotherapy

The current exercise recommendations for healthy living in Australia and via the world health organisation (WHO) are worth checking. Do you accumulate 150 – 300 minutes moderate intensity exercise or 75 – 150 vigorous exercise per week? Do you do muscle strengthening 2 days per week?

Think about where you sit relative to the recommendations. And while mentioning sitting, this advice is most important if you spend most of your day at a  desk. Anything is better than nothing but maintaining the recommended level of healthy exercise will pay dividends in the short and long term.

If you want to know more about the health recommendations click here. If you need help getting started with strength based exercise program give us a call 49216879.

Managing exercise, relaxation and stress

Beach walk

Where does the time go? There are periods in life (usually the same time every year) that we don’t have time to attend to our own health in the form of relaxation and exercise. Use this as a prompt to reflect on where you are at currently. It is important to make time for both. The benefits are immense from ability to concentrate, problem solve and make better choices down to feeling better both mentally and physically.

The usual tips on getting active and managing stress at the same time are: listening to music and podcasts whilst on the gym cardio equipment, walking or jogging; exercising with a friend always helps keeps us going; playing a regularly scheduled team sports is an easy way to keep active; or starting a routine group exercise class like pilates.

I came across a different way of thinking recently which was not to focus on the time I had available as the problem but my response to being busy. It was called the 90:10 rule and challenges you to alter your mindset and increase control. 10% is what happens; 90% is how we respond. I have lots to do but I still choose what I do each day. If being busy in life is currently taking you away from routine exercise or some ‘you’ time then stop and think about the response.

Remember the exercise will make you feel better once you are in a routine. A 10 minute dose of exercise counts but 30 mins is ideal. If you find the right exercise routine you should feel more energised and relaxed rather than tired and tense. If you want to hear more about the 90:10 rule and its relevance to stress management, listen to this video from Dr Mike Evans at Evans Health Lab.

How is your bed mattress treating you?

Sleeping postureHow do you know if your bed mattress is contributing to your back pain?

If you are like most people, you will spend 6-8 hours in bed each day. If your mattress is providing insufficient support for your back, it can aggravate or cause you back pain.

Sleeping postureA mattress with poor support allows your spine to rest in an abnormal position and alters stress on the discs, joints and soft tissue in and around the spine. This can cause pain and stiffness. Identifying if the mattress is a contributing factor for a back problem is an important step in overcoming the problem.

So how do you know if your mattress is causing or aggravating you back problem? Here are some simple points to consider:

  1. If you wake up feeling stiff and sore most mornings this can point toward the mattress as a contributor
  2. Sleep in a different bed as a trial, preferably one with more support, and see if you feel less pain and stiffness

A mattress doesn’t last forever. Flipping your mattress regularly can help maintain your mattress but care is required in doing this. Having said this, sooner or later you may need to purchase a new one. If your mattress is contributing to your back pain you should look for a high quality orthopaedic mattress. Most bedding stores or bedding departments can advise you about mattress quality.

If its not the mattress then you need to see your physio and be assessed.

Get moving and keep a balance in your physical life

It’s busy again on campus and the need to get moving is greater now than ever. Musculoskeletal pain will often occur with trauma and is most common when we spend too long in one posture (sitting or standing). Similarly the amount of time spent looking at a screen (including a phone) increases the chances of neck shoulder and arm pain. The chances then increase considerably if we add stress of any type (even busy stress). You can avoid this type of muscular / soft tissue pain if you subscribe to regular activity … walk, jog, cycle, gym, yoga, Pilates, etc.

Exercise & BalanceBalance your disc with some form of daily activity. 10 mins of activity is a minimum dose, 30 mins is optimal, and 150 mins is a good target per week.

Prescribing running shoes – A guide through the fog of misinformation

Running shoes are often prescribed based on arch height, degree of pronation they show when running and the latest trends like maximum cushioning and minimalist shoes. So how do you know what advice to follow and which shoes are right for you?

1. Arch Height
It is common practice to prescribe footwear based on the height of your foot arch, such as motion control shoes for people with flat feet and a cushioned shoe for people with high or stiff arches. This has previously been common practice but does not appear to affect the likelihood of sustaining an injury while running.

2. Pronation
Although over-pronation (too much rolling in) of the foot while running is often blamed for many running injuries, there is conflicting evidence to support this. It is unclear what a normal amount of pronation is and the difference between the movement of the shoe and the movement of the foot can be up to 20% while running, which makes measuring the amount of pronation difficult even with video analysis. If you cannot accurately measure pronation then fitting a shoe based on foot type becomes trial and error.

3. Trends
Over the years many trends regarding footwear have come and gone such as minimalist, anti-pronation and extreme cushioning shoes. It is important to consider that even people with the same foot type will respond differently to the same shoe. Therefore it is clear that one type of shoe will not suit everyone and buying shoes based on the latest trends can be erroneous.

So how should you choose what shoes to wear when you run?
1. Experienced Runners
Draw from experience, know what works for you and stick with it. Don’t be tempted by the latest trends and marketing, but if you are, incorporate the new shoe slowly and as an occasional change of pace.

2. New Runners
The most important thing to consider for a new runner is comfort. Try a few pairs on in the store and see how they feel. Initially staying away from extremes such as anti-pronation or extra cushioning shoes is a good place to start.

3. Runner with recurring injuries despite a change in shoes
Remember that shoes play a small role in sustaining most injuries and it is important to consider body mechanics, movement patterns and training habits when attempting to reduce injury risk.

If you are having recurring injuries while running, have a physio assessment to work out what is the best way to get you running pain free.

This blog is a summary of a great educational video from Kevin at Running reform http://www.runningreform.com/

Watch the original video at https://vimeo.com/126720173