The Right Run- Common Injuries


Running is a great way to stay in shape. But it can take a toll on your muscles and joints. To avoid running injuries, it’s important to take precautions before you set out.

Most running injuries happen when you push yourself too hard. Adding distance or speed to your running routine, running up hills, and interval training are just some of the reasons running injuries occur. Body mechanics — the way your body is designed — also play a role. The hips, knees, legs, and feet are the most vulnerable to injury.Untitled.001

Runner’s Knee

Type of Injury: Overuse injury

Causes: Several. But it’s commonly due to the kneecap being out of alignment.

What to Look Out For: Vigorous activity leads to pain around the kneecap, particularly when:

  • going up or down stairs
  • squatting
  • sitting with the knee bent for a long time

Stress Fracture

Causes: This is a small crack in a bone that causes pain and discomfort. It typically affects runners in the shin and feet. Often due to going too hard before your body gets used to a new activity.

What to Look Out For: Pain gets worse with activity and improves with rest. Rest is important, as continued stress on the bone can lead to more serious injury.

Shin splint

Causes: Commonly occur after a change in activity, such as running longer distances or increasing the number of days you run too quickly.

What to Look Out For: A pain that occurs in the front or inside of the lower leg along the shin bone (tibia). People with flat feet are more likely to develop shin splints.

Achilles Tendinitis

Causes: This is inflammation of the Achilles tendon.

What to Look Out For: Achilles tendinitis causes pain and stiffness in the area of the tendon, especially in the morning and with activity. It is usually caused by repetitive stress to the tendon, often due to increasing running distance too quickly. Tight calf muscles may also play a part.

Muscle Pull

Causes: A small tear in your muscle, also called a muscle strain, often caused by overstretching of a muscle.

What to Look Out For: If you suffer a pulled muscle, you may feel a popping sensation when the muscle tears.

Muscle pull commonly affects these muscles:

  • hamstrings
  • quadriceps
  • calf
  • groin

Ankle Sprain

Causes: This is the stretching or tearing of ligaments surrounding the ankle. It often occurs when the foot twists or rolls inward.

What to Look Out For: Pain in & around the ankle.

Untitled.001Plantar Fasciitis

Causes: 

An inflammation of the plantar fascia. That’s the thick band of tissue in the bottom of the foot that extends from the heel to the toes. People with tight calf muscles and a high arch are more prone to plantar fasciitis. Although it may be linked to an increase in activity, plantar fasciitis may occur without any identifiable reason.

What to Look Out For: Pain in the arches in weight bearing activities.

Iliotibial band syndrome (ITBS)

The iliotibial band is a ligament that runs along the outside of the thigh, from the top of the hip to the outside of the knee.

Causes: ITBS occurs when this ligament thickens and rubs the knee bone, causing inflammation. Long-distance runners are more likely to develop ITBS.

What to Look Out For: This syndrome causes pain on the outside of the knee.

Blisters

Causes: These are fluid-filled sacks on the surface of the skin. They are caused by friction between your shoes/socks and skin.

What You Can Do: To help prevent blisters:

  • start using new shoes gradually
  • wear socks with a double layer
  • apply petroleum jelly on areas prone to blisters

Temperature-related Injuries

These include:

  • sunburn
  • heat exhaustion
  • frostbite
  • hypothermia

These can be prevented by dressing appropriately, staying hydrated, and using sunscreen.

Visit Us This Tuesday to Know More on Injury Prevention & Treatment!

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Psoas: ‘The’ Core Muscle


This mighty muscle, lying at the very core of your physical body, has a profound influence upon our well-being.

The psoas is the most important muscle in the body for 3 reasons:

  1. It brought us up to stand. The lumbar curve was created when we came to stand upright by the psoas.
  2. The walking muscle.  It is the muscle responsible for propelling you forward.  There are a lot of muscles helping it, but essentially walking is falling, and falling is all about your psoas. A healthy psoas provides a suspension bridge between trunk and legs. The psoas responds to every movement of the spine. Ideally the psoas guides rather than bears the transfer of weight from the one (trunk) into the two (legs).
  3. It’s a muscle of trauma.  This is the muscle in your body wherein you’re storing your emotions. When feeling threatened it is your psoas muscle that propels you into fleeing or fighting or curls you into a protective ball.

Everything from the chairs we sit in to the shoes we wear can curtail the natural movement of the psoas. Having a constricted psoas might be traced back to your first shoe. Wearing a shoe that shapes the foot, stops bones from rolling, limits ankle mobility, drops the heel behind or shifts the weight onto the toes can and does affect skeletal balance. It can stifle the vitality of your psoas.

Premature standing and walking (before the bones are fully formed and weight bearing) teaches a child to rely on their psoas muscle for structural support. Playpens and walkers encourage early standing and limits crawling, which is so important for kinaesthetic maturation. Plastic baby holders restrain and limit natural movement, rhythm and the protective give and take of a mother’s supple body.

The Effects/Symptoms of a Shortened Psoas

  • Pain with prolonged standing, or standing while leaning forward (doing dishes), pain on rising to stand after sitting, especially when you are leaning forward (computer use or bleacher sitting), and lying flat on your back with the legs flat
  • Constricted organs
  • Impinged nerves
  • Impaired diaphragmatic breathing
  • Putting pressure on the uterus, a tense or short psoas can cause cramping
  • Pushing the oesophagus forwards, a tight upper psoas can cause digestive problems
  • A short psoas can interfere with the diaphragm fully descending through the abdominal core

Psoas as ‘The’ Core Muscle

psoas

See the Psoas as a support.  It is the length and vitality of the psoas that helps to maintain volume in the core. Providing a diagonal muscular shelf, the psoas moves through the core supporting the abdominal organs. A major ganglion of nerves is located on top, around and imbedded through the psoas. Together with the diaphragm, the action of the psoas works like a hydraulic pump to massage the organs and viscera while stimulating the flow of fluids throughout the body.

The keystone of skeletal alignment, it is the balanced pelvis that provides a base of support for the spine, ribcage, neck and head. It is the aligned pelvis that transfers weight down through the hip sockets, legs, knees and feet. If the bones do not support and transfer weight properly, it is the psoas muscle that is called upon to provide structural support, making it tight & weak.

In addition to the psoas being tight, it is also typically weak at the same time. This creates dysfunction in the muscle. Our brain has trouble controlling the muscle because it has been in a shortened position for so long, thinking the psoas always needs to be flexed.

True core strength then, depends upon core integrity. Unlike other muscles, the Psoas does not need strengthening, but rather nourishing. The ‘weak’ Psoas muscle is really a dry, exhausted, Psoas; abused, over-used and too often misused.

Test your Psoas

  • constructive-rest-positionConstructive Rest is an easy position for releasing tension in your psoas muscle. After work and before your evening meal take 10 – 20 minutes to rest in constructive rest and feel the benefits.  Begin by resting on your back. Knees bent and feet placed parallel to each other, the width apart of the front of your hip sockets. Place your heels approximately 12-16 inches away from your buttocks. Keep the trunk and head parallel with the floor. If not parallel place a folded, flat towel under your head. DO NOT push your lower back to the floor or tuck your pelvis under in an attempt to flatten the spine. For best results keep the arms below the shoulder height letting them rest over the ribcage, to the sides of your body or on your belly. There is nothing to do; constructive rest is a BEING position. In this simple position gravity releases the psoas and you’ll feel more at peace with your self and the world.
  • Psoas Strength Test  hip-flexor-strength-test-226x300
    (Modified Sahrmann’s Test (3))
    Here is a general way to determine if your psoas is weak:

    1. Standing, grab and pull your knee to your chest as high as you can without leaning backward. You will need to get your thigh well past 90° (in relation to your supporting leg).
    2. Once your knee is close to your chest, release your hands and attempt to keep your leg above 90 degrees for 15 seconds.
    3. Start timing when you release your hands and stop when your thigh drops below 90° (make sure to use a clock on the wall).

    If you fail before 15 seconds then you have a weak psoas muscle. Any major body shifts, leans, cramping, or loss of control in the allotted time also results in a failed test.  Failure far before 15 seconds shows further weakness. For best accuracy have a fitness professional conduct your test.

For more on Psoas muscle & its conditioning, check out:

Thus working with the Psoas challenges the standard precept of core strength. To really achieve core strength you must first regain a supple, responsive and fluid core so that rich bio-intelligent messages from the central nervous system can foster healthy neuromuscular and skeletal relationships.

 

Total Hip Replacement – Precautions


Total Hip Replacement(T.H.R) is a surgical procedure of removing the diseased hip joint and replacing it with an artificial one.

Usually the patients considered for T.H.R are

  1. Young patient
  2. Osteoarthritis of hip joint
  3. Rheumatoid Arthritis
  4. Avascular Necrosis
  5. Septicemia

There is a progressive increase in chronic pain and difficulty in walking, stair climbing and rising froma chair.

Usually there are two types of prosthesis which are commonly used for the surgery: Cemented and Uncemented Prosthesis.

Difference of cemented and uncemented prosthesis:

Cemented prosthesis is usually used in older patients who are less active and have less bone moneral density.

Uncemented Prosthesis is used in younger and more active individuals.

The primary disadvantage of uncemented rposthesis is the extended recovery periof. Because it takes long time for natural bone to grow and attach to prosthesis, hence the person has to limit his activitties for upto 3 months to protect hip.

Your hospital stay my last for a week. If you go home you will need help for several weeks.

The following steps can make your home coming easier:

  • In kitchen as well as other rooms, place items of daily use within reach so you dont have to reach up or bend down.
  • Rearrange furniture you can walk easily with walker or stick.
  • Get a good chair that is firm and higher than average seat.
  • Remove rugs or area rugs that could make you slip.
  • Securely fasten electrical cords around perimeter of the room
  • Install a shower chair grab bar and raised toilet.
  • Use assistive devices such as long handle sponge and grabbing tool or reacher to avoid bending too far.

Once you get home, stay active.The key is not to overdo it while you expect some good and some bad days, you should notice gradual improvement over time.

WEIGHT BEARINGDiscuss with your physical therapist regarding the weight bearing of operated leg as the rehabilitation protocol will be different for cemented and uncemented prosthesis.

STANDING: Move your operated leg first and pushoff the armrest of chair to stand up.

SLEEPING POSITIONS: Sleep on your back with legs slightly apart on your side with abduction pillow.Be sure to use the pillow atleast 6 weeks or untill your doctor tells you to use. Sleeping on stomach is alright.

SITTING: For atleast 3 months donot cross your legs at knees. Make sure the seat height is good so as to avoid bending of hip beyond 90 degreesGet up and move around possibly every 1 hour.

SEX: Some sex positions can be safely resumed 4-6 weeks after surgery. Ask your doctor regarding the same.

CLIMBING: Stair climbing should be limited if possible untill the wound is healed.

Following pattern of stair climbing should be followed.

GOING UP :

  • the unaffected leg should step up first
  • then bring affected leg to same step
  • then bring the cane

GOING DOWN:

  •  put the cane first
  • next bring the affected leg down the step
  • finally step down with unaffected leg.

DRIVING: You can begin driving an automatic car 4 to 8 weeks after consulting your doctor and symptoms after surgery.

SITTING INTO CAR: Be sure the passenger seat is pushed all the back.Recline the seat as far as possible.with the walker in front of you slowly back up the car seat.Swing your legs into the car.Lean back if you need to avoid the hip more than 90 degrees.

GETTING OUT OF THE CAR: Push the seat all the way back.recline the seat and lift your legs out.lean back if you need to.place walker up in front of you and stand up on unaffected leg.

RETURN TO WORK: Depending on the type of activities you eprform it may take as long as 3 months to 6 months to return to work.

OTHER ACTIVITIES: Walk as much as you like once doctor gives you permission, but remember donot substitute walking to exercise.Swimming is recommended once suture are removed and wound is healed.Acceptable activities are dancing, golfing with spike less shoes and cart,bicycling on level road.Avoid activities that involve impact or stress on joints such as tennis, badminton or contact sports like baseball, football,squash, jumping or jogging, Lifting weights is not a problem but carrying heavy and awkward objects that cause to stagger is not advised especially if you must go up and down stairs or slopes.

Do’s and Dont’s

The do’s and dont’s vary depending on orthopaedic surgeons apporach.Your doctor and Physical therapist will provide you with a list of the same to remember with your new hip.The precautions will help you to prevent the new joint from dislocation and ensure proper healing.

 The Dont’s

  • Donot cross legs at knee for atleast 8 weeks
  • donot bring knee up higher han your hip
  • donot lean forward while sitting or as you sit down
  • donot try to pick up something on the floor while ou are sitting
  • donot turn your feet excessively inwards or outwards
  • donot reach down to pull your blanket when lying down
  • donot bend at waist beyond 90 degrees
  • donot use pain as a only guide for what you may or may not do

The Do’s

  • Keep skin dry and clean
  • Notify doctor if wound drains
  • Swelling is normal for first 3-6 months. Elevate leg slightly <30 degrees on pillow and put ice packs for 15-20 min
  • If you get calf pain , chest pain and shortness of breath notify doctor immediately
  • Do exercises prescribed daily.
  • A balanced diet is very important.
  • Maintain an active lifestyle after surgery.

DISCLAIMER: Kindly refer your doctor and Physical therapist for the instructions depending on your surgery procedure.

Scoliosis- Contraindications in Exercise


In continuation of our discussion on Scoliosis..

Your doctor can give you a more specific recommendation based on your specific condition, but there are a few things that people with scoliosis should avoid, or at least be wary of.

  • Poor Form: It is important to learn proper form as it allows you to keep an upright posture. Poor form can lead to unbalanced muscles, nerve damage, & can increase your back pain. When you work out work in front of a mirror & strive to maintain level shoulders & hips. Keep your head in line with your neck, & always look straight ahead.
  • High Impact: High impact exercise isn’t good for anyone’s joints. Opt for low- or no-impact exercises like swimming or cycling instead of running or plyometrics.
  • Collision Sports: Collision sports like football, boxing & wrestling can cause damage to your spine. Scoliosis means your spine is already curved — severe impact from any angle can cause tremendous pressure on your vertebrae. It won’t make the curve worse, but it can cause tiny fractures that can weaken the spine over time.
  • Torque Sports: Torque sports involve spinal twisting. It’s a tricky situation, because a gentle spinal rotation that stops within your pain threshold, like a yoga seated spinal stretch, can actually be a good way to relieve back pain. But sports like gymnastics & martial arts that require fast, high-powered spinal rotation can easily force you beyond your comfort zone & end up causing you more pain in the long run. It won’t make your scoliosis worse, but there’s very seldom an opportunity to stop when it hurts or favor a particular side — the rotation is usually part of the mechanics of the stunt, and failing to rotate properly can cause an unsafe landing that definitely could damage your spine.

Scoliosis- An Overview


Scoliosis is not a disease, but rather it is a deformity in the spine that causes an abnormal C-shaped (one curve) or S-shaped curvature (two curves). Depending on when it develops, there are 3 types of scoliosis:

  • Infantile– Birth-3 years of age
  • Juvenile- 4-9 years of age
  • Adolescent 10 years-when growth is complete

Adults can have residuals of childhood scoliosis.

Causes:

A specific cause of scoliosis is unknown or idiopathic. This Scoliosis most typically occurs in individuals 10 to 18 years old (Adolescent). It tends to run in families & is more common in girls than boys. Often it develops in middle or late childhood during a rapid growth spurt.

Scoliosis can also be present at birth or may develop as a result of another neurological condition such as cerebral palsyspina bifida, or spinal muscular atrophy.

Any part of the spine can be affected-cervical, thoracic, or lumbar vertebrae. Most often the thoracic & lumbar spines are affected. At first, a C-shaped curve may develop causing the shoulders and hips to tilt down on one side. In an effort to keep the head in the middle, the spine may compensate by curving the lower part of the spine in the other direction, hence forming an S-curve.

This article focuses on the most common form of scoliosis-idiopathic scoliosis.

What does Scoliosis feel like?

Scoliosis is a painless condition. You may not feel any change in the spine but instead notice that your clothes don’t fit quite right. The shoulders & hips may be uneven, causing one shirtsleeve or pant leg to seem shorter than the other. Often there is rotation of the vertebrae causing an uneven waist so that a pair of pants or skirt twists to one side.

The most common signs of scoliosis are-

  • Visible curvature of the spine to one side/ Leaning to one side
  • Uneven shoulders
  • Prominent or winging shoulder blades
  • Uneven breasts (girls) or nipples (boys)
  • Uneven hips
  • Leg-length difference
  • Abnormal gait
  • Bump or rib hump on one side of the spine, most noticeable when bending forward at the waist.
  • Hemlines or trouser lengths uneven
  • Clothing does not fit correctly

The presence of one or more of these signs suggests a need for a medical exam by your medical professional.

It is important to note that idiopathic scoliosis results in spinal deformity, but is not a cause of back pain.

 Treatment:

The optimal treatment depends on the degree or severity of the scoliosis.

There are several ways to treat scoliosis in children:

Examination & x-rays taken over a period of time will help show if the scoliosis is staying the same or progressing (getting worse).

Selecting treatment options for the child with scoliosis involves several factors-

  • Age of the child
  • Degree of the spinal curve
  • Skeletal maturity of the spine
  • Preferences of the patient & family

Treatment may be nothing more than observation especially if the curve is 30-degrees or less in a child who is no longer growing. If the curve is progressing & the child is growing rapidly, the child is referred for exercise and/or bracing.

Preventing severe curvature is important for the physical appearance & health of the patient. The deformity can cause marked psychological distress & physical disability, especially among adolescent patients. A high degree of curvature may also put the patient at risk for cardiopulmonary compromise as the curve in the spine rotates the chest & can cause pressure on the heart, lungs (i.e. shortness of breath), liver, & other internal organs.

Early diagnosis & treatment are important to help prevent curve progression & stabilize the spine while the child grows & also prevent problems with breathing & cardiovascular function.

Important Note: That idiopathic scoliosis is not caused by activity such as exercise, sports or carrying heavy object; nor does it come from sleeping position, posture or minor differences in leg length.

Total Hip Replacement


Total Hip replacement is a surgical procedure of removing the diseased the femur head and neck and replacing it with an artificial prosthesis.

Usually the patients considered for the total hip replacements are:

  • Young patient
  • Osteoarthritis of hip joint
  • Rheumatoid arthritis
  • Avascular necrosis
  • Septicemia
There is a progressive increase in chronic pain and difficulty in walking, stair climbing & even rising from a chair.
Difference in Cemented & Uncemented prosthesis:
Cemented prosthesis is usually used in older patients who are less active  and have less bone density.
Whereas uncemented can be used in younger andactive individuals.

The primary disadvantage of uncemented prosthesis is the extended recovery period.
Because it takes a long time for the natural bone to grow and attach to prosthesis, hence the person has to limit his activitites for upto 3 months to protect hip.

Your hospital stay may last for a week, if you go straight home you will need help for several weeks. The following steps can make you homecoming easier:

  1. In kitchen as well as other rooms, place items you use frequently within reach so you dont have to reach up or bend down.
  2. Rearrange furniture so you can walk easuily with walker or stick.
  3. Get a good chair: the one that is firm and higher than average sear
  4. Remove any throw rugs or area rugs that could make u slip.
  5. Securely fasten electrical cords around perimeter of the room.
  6. Install a shower chair, grab bar and raised toilet.
  7. Use assistive devices such as long andle sponge and a grabbing tool or reacher to avoid bending too far.
  8. Wear big pocket shirts or soft shoulder bag for carrying things.

Activities at Home:

  • Keep skin dry and clean,
  • Notify doctor if your wound drains.
  • Swelling is normal for first 3-6 months. elevate leg slightly <30 degrees on pillow and put ice pack for 15 20 min.
  • If u have calf pain, chest pain and shortness of breath notify immediately.

Resuming Activities at Home:
Once you get home, stay active. The KEY is not to overdo it, while you expect some good days and some bad days, you should notice gradual improvement over time.

Weight Bearing
Discuss with you physical therapist regarding the weight bearing of the operated leg as the rehabilitation protocol will be different for cemented and uncemented.

Driving
You can begin driving an automatic car in 4 to 8 weeks after consulting your doctor and your symptoms post surgery.

Sex
Some form of sex positions can be safely resumed 4-6 weeks after surgery. Ask you doctor regarding the same.

Sleeping positions

  • Sleep on you back with legs slightly apart on your side with abduction pillow.
  • Be sure to use pillow atleast 6 weeks ot untill doctor says not to use,Sleeping on stomach is alright,
Sitting
  • For atleast 3 months sit only on chairs that have arms.
  • Do not sit on low chair, reclining chairs.Donot cross your legs at knees.
  • Get up and move around possibly every 1 hour.

Climbing

  • Stair climbing should be limited if possible untill healing is far enough.
  • If you must go up stairs- The unaffected leg should step up first, then bring affected leg up to same step, then bring your cane.
  • To go down- Put cane first, next bring affected leg down to that step, finally step down with unaffected leg

Return to work:
Depending on the type of activiies you perform it may take as long as 3 months or 6 months to return to work.

Other activities:

  • Walk as much as you like once doctor given you go ahead, but remember don’t substitute walking for your prescribed exercise.
  • Swimming is recommended once sutures are removed and wound is healed, apporox 6-8 weeks after surgery,
  • Acceptable activities are dancing, golfing with spikeless shoes and cart , bicycling on level surfaces.
  • Avoid activites that involve impact or stress on joints such as tennis, badminton, contact sports such as baseball, football, squash, jumping or jogging
  • Lifting weight is not problem but carrying heavy awkward object thatr cause you to stagger is not advised esp if you must go up or down stairs or slopes

DOS AND DONTS:
The dos and donts vary depending on orthopaedic surgeon’s approach.
Your doctor and physical therapist will provide you with a list of do’s and dont’s to remember with your new hip.
The precautions will help you to prevent the new joint from dislocation and ensure proper healing.

  • Do not cross your legg at the knees for atleast 8 weeks
  • Do not bring your knee up higher than your hip
  • Do not lean forward while sitting or as you sit down
  • Do not try to pick something onfloor while you are sitting
  • Do not turn your feet excessively inward or outward when you bend down
  • Do not reach down to pull your blankets when lying in bed
  • Do not bend at waist beyond 90 degree
  • Do not stand pigeon toed
  • Do not kneel on knees on un operated leg
  • Do not use pain as a guide for what you may or may not do.
DO cut back on your exercise if your muscle aches but dont stop doing exercise.