Wednesday, 29 June 2011
Tuesday, 28 June 2011
A detailed history, and examination by an appropriately qualified health professional, will allow a diagnosis to be made. An ultrasound or MRI scan can confirm the diagnosis.
Other causes of symptoms in the area, such as those referred from the lumbar spine and local infection, should be excluded.
Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries.
It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints.
Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy.
Footwear and training advice
I have found that, when track athletes (particularly sprinters), run over-distance repetitions (for example, 300m) as part of their training, the Achilles is subject to great forces, as the athlete tires and their heel drops further during each ground contact. This can be counteracted by purchasing a pair of middle-distance-type spike shoes that have a protective heel wedge. This reduces the strain on the tendon, as the shoe's heel offers greater protection, and is not subject to overstretching when fatigue is present. I also advocate that any running below 90% of maximum speed is performed in trainers and preferably on a stable grass surface.
Very often sports people wait until their sports footwear (trainers/boots/spike) are well beyond the state at which they provide adequate protection and support before replacing them. Then, after an injury has occurred, they are advised by a physiotherapist and/or coach to buy a new pair. Trust me, it is cheaper to buy sports footwear regularly and stay healthy, than to pay for physiotherapy treatment (and buy the necessary footwear).
ACHILLES TENDON INJURY TREATMENT
Ice therapy is an effective form of pain relief. Observe the PRICE protocol:
This can relieve the symptoms of a painful swollen Achilles tendon. Using ice packs for a period of 20 minutes every two hours can help with the swelling and pain, but pain relieving medication may also be required.
It may be necessary, in severe cases, to rest from high-impact activities for up to three months. This is because the collagen tissue, which the body produces to repair the damaged Achilles tendon tissue, can take three months to lay down.
Non-impact training, such as pool work, can maintain fitness during this period, and other body parts can be exercised with weights or other exercises. A physiotherapist may gently mobilise the soft tissue by providing controlled stress to help the tendon adapt and gain tensile strength.
Published research has suggested that recovery is promoted by using a very gradually progressed strengthening programme for the Achilles tendon and calf muscles under the supervision of a sports specialist/therapist/Physiotherapist. This strengthening programme uses eccentric muscle work, which means that the muscle is lengthening while contracting. Maximum tension is generated in the muscle and tendon during eccentric contractions.
It is important that an appropriately qualified therapist looks at the players'/athletes' overall body alignment to detect if the injury has been caused by a biomechanical problem. Over pronation can place excessive strain on the Achilles and lead to Achilles tendinopathy. An orthotic insert may be required but, in many cases, biomechanical problems are caused by stiffness in the joints. The therapist can mobilise them, which, if normal range of movement is attained and maintained, can often eradicate the problem.
What is the Achilles tendon?
The Achilles tendon is situated above the heel and forms the lower part of the calf muscles. It is a continuation of the two calf muscles, the gastrocnemius and soleus muscles, and it attaches to the heel bone.
It is the strongest tendon in the human body and must withstand great forces. Its function is to transmit the force produced by the calf muscles to lift the heel and produce the push off during walking, running and jumping. The Achilles can produce force of up to seven times body weight. This shows just how much force it has to withstand during sporting activities, such as sprinting, jumping and turning.
Understanding terms for Achilles tendon injury
Achilles tendinopathy is a common sports injury. It's caused most frequently by overuse. You might be more familiar with the term 'Achilles tendonitis'. However, in the absence of inflammation, tendinopathy is the more appropriate term.
Until medical examination determines if there is Achilles degeneration (tendonosis) or inflammation (tendonitis) the condition is referred to as tendinopathy.
Achilles tendinopathy is characterised by degeneration (tendonosis) of the tendon, often without an inflammatory response. The degeneration means that the tendon does not have the usual tensile strength and may be liable to rupture during continued sporting activity. However, before you get alarmed, this is very unlikely.
SIGNS AND SYMPTOMS
· Symptoms usually come on gradually. Depending on the severity of the injury, they can include:
· Achilles pain, which increases with specific activity, with local tenderness to touch.
· A sensation that the tendon is grating or cracking when moved.
· Swelling, heat or redness around the area.
· The affected tendon area may appear thicker in comparison to the unaffected side.
· There may be weakness when trying to push up on to the toes.
· The tendon can feel very stiff first thing in the morning (care should be taken when getting out of bed and when making the first few steps around the house).
· A distinct gap in the line of the tendon (partial tear).
The causes of Achilles tendon injuries
Overuse and changes in training
Inflammation/strain of the tendon is usually caused by overuse – for example, frequent jumping in volleyball, netball or basketball. It is often also caused by a sudden increase in certain types of training, such as hill sprinting or track running, particularly when running in spikes.
Tendinopathy can also be associated with ageing. Our ability to regenerate damaged tissue decreases as we age and the quality of the tendon deteriorates. However, the better news is that sensible training can actually strengthen all our soft tissue (tendons, ligaments and muscle).
Tight calf muscles
Tightness in the calf muscles will demand greater flexibility of the tendon, which inevitably results in overuse and injury. Biomechanically, the tightness can reduce the range of dorsiflexion (toe up position) in the ankle, which increases the amount and duration of pronation. This problem is known as overpronation.* This reduces the ability of the foot to become a rigid lever at push off and places more lateral and linear forces through the tendon. This imbalance can translate into altered rotation of the tibia (shin bone) at the knee joint and, in turn, produce compensatory rotation at the hip joint with subsequent injuries to the shin, knee and hip.
Lack of ankle stability
Lack of stability around the ankle joint can also be a contributory factor, as recurrent ankle sprains appear to be associated with a high incidence of Achilles tendonopathy.
Wearing the 'wrong' shoes
Wearing shoes that don't fit or support the foot properly can be a major contributing cause of Achilles tendon injury.
Thursday, 23 June 2011
For the frittata
2 tbsp olive oil
½ onion, finely chopped
2 handfuls baby spinach leaves
8 whole cherry tomatoes, halved
½ medium sweet potato, peeled and cut into chunks (65g)
3 medium free-range eggs, beaten
salt and freshly ground black pepper
For the salsa verde
1 handful fresh parsley
1 handful fresh basil
1 garlic clove, crushed
2 tbsp olive oil
½ lemon, zest only
3 canned anchovies, drained and chopped
1. Preheat the oven to 180C/350F/Gas 4.
2. For the frittata, heat the olive oil in an ovenproof frying pan and gently fry the onion for 2-3 minutes, or until softened. Add the spinach, cherry tomatoes and sweet potato and continue to fry for a further 3-4 minutes or until the sweet potato is just becoming tender.
3. Pour in the eggs, season well with salt and freshly ground black pepper and cook for 1-2 minutes, or until the egg starts to set around the edges. Transfer to the oven for 2-3 minutes, or until the egg is just set. Remove from the oven, slide onto a serving plate and cut into wedges. Keep warm.
4. For the salsa verde, place all of the salsa verde ingredients into a food processor and blend until smooth.
5. To serve, drizzle the salsa verde around the edges of the plate.
Monday, 20 June 2011
How did vibration training come about?
Vibration training was developed by the Soviets in response to their space programme. Specifically, to keep cosmonauts in space in as best physical condition as possible for the longest period of time. The USSR held numerous endurance records in this respect.
How does vibration training work?
Vibration training uses specially designed 'gym' machines that vibrate at frequencies normally between 30-50 Hz. The main example is 'platform-based' – although there are also vibration dumbbells, and even breathing devices (to strengthen the breathing muscles).
More specifically, it is argued that…
Vibration training can recruit nearly 100% of a muscle's/muscle groups' muscle fibres. This contrasts with the 40-60% recruitment normally associated with other resistance training activities.
How does it recruit so much muscle fibre?
Vibration training achieves these high recruitment levels by creating an almost continuous muscle contraction. Specifically, this is called a 'tonic stretch/reflex' and means that, while subject to vibration training, your muscles are automatically contracting at incredibly high frequencies. And they are also subject to considerable force – at 30Hz the body is subject to a load equivalent to 2.5 times its weight.
Increased blood flow
Vibration training also stimulates increased blood flow to the muscles. This can speed up recovery from work outs and rehabilitation from injury.
Due to vibration, balance and body awareness are believed to be enhanced.
I also found out that vibration training has developed credence within the medical world where it is used for the treatment of, for example, cerebral palsy, osteoporosis, chronic pain and back injuries.
I looked at some research to discover what the sports scientists really think of vibration training. After all, you can't believe all the hype the manufacturers might make. In trawling through the learned journals and talking to vibration experts I found out, for example, that not all machines work the same, which can make comparisons difficult and apparently alter the efficacy of the specific machines.
Whole-body vibration training
Roman researchers looked at the effects of whole-body vibration training on various measures of physical performance in female competitive athletes – whole-body vibration requires the athlete to stand on the vibration machine plate for designated time spans and/or perform reps of designated exercises, with or without added resistance (2). The athletes were split between a vibration group (13 athletes) and a control group (11 athletes). The former vibration group trained three times a week. At the end of this period they were tested on:
counter-movement jump (bend the knees, extend and jump)
leg extension strength
horizontal leg press
flexibility – sit and reach test.
Watch video of these exercises being demonstrated
The researchers found that the vibration trainers displayed a significant improvement in leg extension strength, counter-movement jump performance and flexibility. There were no significant changes in the tested abilities of the controls. The team qualified their findings by indicating that the optimal frequency, amplitude (movement of the vibration platform), and g-forces need to be identified when using vibration training in order to maximise its effects.
I then discovered that transatlantic research between the University of Aberdeen and the University of North Dakota discovered that a 30Hz protocol with 10mm amplitude (the travel of the vibration plate) for their 60 seconds on/off of vibration training exercise protocol, elicited the most significant muscle fibre recruitment in the vastus lateralis (thigh muscle) as measured by EMG (electrical activity in muscles)(1). Higher frequencies did not elicit a significantly superior response. The athletes – in this case elite female volleyball players – stood on the platform in a squat position with their knees at a 100-degree angle.
Everyday fitness and aerobic development with vibration machines…
I then wanted to find out whether vibration training could work for the fitness population. As I said at the start of this piece, many commercial gyms are installing vibration machines and many home models are entering the market.
Belgian researchers compared the effects of whole-body vibration training for fitness purposes on untrained women (3). What makes this research particularly intriguing is the fact that aerobic training was also included in the design – I'd assumed that vibration training was predominately a resistance training method. In this instance they wanted to see whether vibration work outs could reduce body fat – this is something that would normally be associated with CV training.
Forty-eight untrained young women (average age 21) were involved in the study. The whole-body vibration group (18 members) performed unloaded static and dynamic exercises on a vibration platform. The fitness group (also 18 members) followed a standard cardiovascular (15-40 minute duration) and resistance training programme. The latter included the leg press and leg extension exercises. Both groups trained three times a week. There was also a non-exercising control group (12 members). The researchers measured body composition by underwater weighing and took 12 skinfold measurements to measure body fat levels. Quadriceps strength was also tested.
The results: over the 24-week progamme, there were no significant changes in weight, in percentage body fat, nor in skinfold thickness in any of the groups. However, fat-free mass increased significantly in the whole-body vibration group only. I believe this could be explained by the fact that they'd increased their muscle mass, probably because of the vibration training's ability to target increased amounts of muscle fibre. The more muscle you have, the leaner you will tend to be due to this body tissue's high metabolic cost.
Additionally, the vibration trainers also benefited from a significant strength increase, as did the fitness group. This led the researchers to conclude that, 'The gain in strength (for the vibration training protocol) is comparable to the strength increase following a standard fitness training programme consisting of cardiovascular and resistance training.'
Interesting results, indeed, for the proponents of vibration training for fitness purposes.
It seems from the research quoted that whole-body vibration training can enhance (or at least match) performance in sport and fitness activities achieved by 'normal' training methods. Richard from Galileo did say that whole-body vibration training should be regarded as an adjunct to your normal training and not as a wonder work out.
For more information or to book a vibration training session get in touch with the fitness specialist at firstname.lastname@example.org or call 07867 535696
Tuesday, 14 June 2011
Plyometrics for better bike-run transitions
If you've ever done a triathlon, you'll know that feeling when, having completed the bike leg, you lace up your running shoes and set off for the final leg; your brain's still thinking in circles when you really want it to do is to switch into stride mode!
Previous studies have shown that at least part of the reason for these awkward bike-run transition sensations in the legs is because of changes in the neuromotor control system that occur after long periods of cycling, which take a while to reverse once running commences.
However, new Australian research suggests that a certain type of training could help minimise the discomfort of the initial running period following the bike-run transition, helping triathletes to get into their natural stride more rapidly. Fifteen triathletes were split into two groups and performed one of two training protocols:
●● Endurance-only training (as per their normal schedules);
●● Endurance training with additional plyometric training
This plyometric training consisted of three sessions of 30 minutes per week of increasing difficulty for eight weeks. Before and after the 8-week training period, the triathletes' 'neuromotor control' was determined by measuring how efficiently they used oxygen and the electrical patterns of muscle activity in their legs (lower limb electromyography) for a period of four minutes at 12kmh during a control run (no prior cycling) and during a run after 45 minutes of cycling (simulating a bike-run transition run). The results showed that after the intervention period, 100% of the triathletes in the plyometric group exhibited muscle recruitment patterns during running after cycling that closely resembled the recruitment patterns used during an isolated (control) run. In the endurance-only group however, only 40% ofthe triathletes improved their neuromotor control – a significant difference.
This was only a small study and more research isneeded. However, it does indicate that adding some plyometrics into a triathlon training routine could pay serious dividends when it comes to the bike-run transition!
Wednesday, 8 June 2011
MBTs - How effectively can MBT they be used to combat bad walking patterns and reduce injuries?
Masai Barefoot Technology trainers (MBTs) have been around for 10 years, but lately are showing signs of becoming high-fashion must-have items. The makers claim that the shoe:
· activates neglected foot muscles
· improves posture
· tones and shapes the body
· improves performance
· helps with back, hip, leg and foot problems
· helps with joint, muscle, ligament and tendon injuries
· reduces stress on the knee and hip joints
The international media hype around MBTs has even gone so far as to suggest that the shoes can help banish cellulite and promote weight loss – claims not far short of alchemy.
MBT is based on a simple concept: that the human foot is designed for barefoot walking on soft ground, yet most of us in developed countries spend our lives in supportive and restrictive footwear and walk on hard, flat surfaces. The shoe design is the brainchild of Karl Muller, a Swiss engineer, who derived his inspiration from the low injury rates of the African continent.
Leaving aside the obvious differences between the functional requirements of a Masai tribal member and the average inner-city office worker/amateur athlete, does this shoe design add up to anything more than a gimmick in terms of injury prevention?
Ordinary shoes do little to correct poor gait (walking style). Most of us prioritise comfort or fashion over our specific functional or anatomical needs, with the result that we adopt a passive gait, in which the foot, ankle and leg muscles become under-worked and develop weaknesses.
Strong intrinsic foot musculature is what allows the tissues of the foot and ankle to tolerate the stresses of instability effectively and without damage or injury. It is therefore not unreasonable to suggest that areas of weakness can also be prime sites of potential injury. There is no reliable evidence that yet proves you can strengthen specific muscles by wearing a particular type of shoe.
The MBT was designed as a medical shoe. It is a slightly unsightly, bulky shoe, with a substantial thick sole that is curved from front to back, forcing a pronounced heel-to-toe walk. The unstable rocking action is thought to simulate the natural instability of walking over undulating ground and thereby encourage beneficial muscle strengthening.
To date there appear to have been three main scientific studies on the MBT trainer and its effect on how we walk.
The first research came from the Human Performance Laboratory in Calgary, Canada. The MBT was shown to:
•increase rotational ankle movement, notably plantar flexion (where foot points downwards) and foot inversion (inward rolling)
•decrease ankle joint impulses for the knee joint, which means that the knee has to withstand fewer repetitive rotational stresses (down by 27%)
•increase the wearer's oxygen consumption by 2.5%
•increase movement of the 'centre of pressure' (COP) during standing, which allows force to be spread across a greater area of the foot. High forces going through small areas of the foot are strongly linked to an increase in injury levels with repetitive foot strikes over prolonged periods.
Based on these findings, the researchers report that the MBT strengthens the muscles of the foot and ankle complex, while reducing loading through the ankle joint. But this study had small numbers (eight people) and conducted its analysis at relatively low walking speeds, which limits its value.
The second relevant piece of research was a gait evaluation study from Sheffield Hallam University. The researchers found:
•less forward lean: MBT promotes a more upright posture, which may affect the position of the centre of mass at foot strike. The further the distance of the foot when making contact with the ground the greater the braking forces that occur on the body.
•The authors imply that the MBT reduces braking forces, which does make mechanical sense, as anything that promotes a more upright posture tends to lead to a more efficient system and reduced load through the body
•higher dorsiflexion ankle angle: The shoe's rocker system forces the foot into a greater flexed position throughout the walking cycle. This would promote a rolling of the foot, which would distribute forces evenly through the feet, allowing the body to absorb force quickly, without injury
•reduced 'transient peaks' with MBTs: momentary forces sent through the skeleton as a result of impacts during normal walking and running are a primary factor in the development of many musculoskeletal disorders
•MBTs allowed increased muscle activity in the calf, hamstring and buttock muscles, but a decrease in the small postural muscles of the spine, perhaps because of the more upright posture and production of greater propulsive forces.
A third research group, from Edinburgh, compared foot pressures during gait among 22 subjects wearing MBTs and normal trainers. For the MBTs, it found:
•reduced foot pressure in the heel (probably the result of the MBT design in which there is no cut-away on the heel section)
•reduced peak pressure in the mid foot (21% lower) and heel (11% lower)
•average pressure was greater in the toes and forefoot and less in the mid foot and heel
•a shift in the pattern of the centre of pressure, allowing force to be spread over a greater area of the foot.
People suffering with conditions such as osteoarthritis or other degenerative joint disease may benefit from the reduced joint loading of the MBT's heel-to-toe rocker. But because the rocker sole runs front to back, the shoe is primarily designed for 'single plane' activities such as walking or linear jogging. And the large and bulky sole unit may add to the shoe's unsuitability for multi-directional sports (eg, squash, tennis or team sports) where shoe feel, lightness, durability etc are important.
While there are manufacturer's claims for the MBT's efficacy in relation to jogging, there is no evidence to support them. Athletes using a more pronounced mid foot or even forefoot strike with the ground will find this kind of sole design irrelevant.
The bottom line - No single piece of technology can substitute for a well-structured and balanced conditioning programme that includes foot musculature strengthening. As things stand, it would be playing safe not to throw out all your other trainers/shoes for a life in MBTs.
Thursday, 2 June 2011
1 tbsp olive oil
4 tbsp Thai green curry paste
1 lemongrass stalk, outer
layer removed, finely chopped
2 red peppers, cut into chunky strips
450g/1lb baby new potatoes, halved
2 x 400g cans coconut milk, see tip
300ml/½pt chicken stock
5 kaffir lime leaves, torn
1 bunch spring onions, sliced
225g/8oz frozen peas
600g/1lb 5oz raw king prawns
100g bag baby spinach
2 tbsp Thai fish sauce
bunch coriander, leaves picked
juice 1 lime, plus extra wedges, to serve
Serve with 50g Jasmine or Basmati Rice (175 kcals)
Heat oil in a large frying pan or wok. Fry the curry paste and lemongrass for 1 min, until fragrant.
Tip in peppers and new potatoes, then stir them to coat in the paste. Cook for 1-2 mins.
Pour in coconut milk, stock and kaffir lime leaves, then bring to the boil. Simmer and cook for 15 mins, until potatoes are just tender.
Add remaining ingredients, but if you're freezing don't add spinach or coriander yet, and cook until the prawns turn pink, about 4 mins. Serve, with some extra lime wedges, if you like, or cool before freezing in containers.