Poor Glute Activation and running pain

I've mentioned glute activation before:  here

Here is an interesting study - women with knee pain are poor at activating their glutes during running.

Gluteal muscle activation during running in females with and without patellofemoral pain syndrome.

Time for some of these:

Knee Pain

Check out Colin's latest post on knee pain. 

dealing with knee pain is often not simply an issue of dealing with the knee and its surrounding tissues.  Making sure you get rid of your knee pain can, and more often will, mean not just work on making sure the knee flexes and extends but that the tibia/femur glide properly over one another  that there is no restriction in dorsi and plantar flexion and that the hip flexes and extends fully. So, in other words, a knee pain could  be considered not to be just a knee problem but a leg problem.

Some interesting ideas.  He has been realy developing his practice recently through the work of Art Riggs. He stresses that massage is really working the fascia

A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together like plastic sandwich wraps.[2]

This ties back to the Anatomy Trains approach that I've mentioned before.

Here is a video of Art working on a client's ITB.



Interesting stuff.

Knee injuries....

I have had posts previously about knee injuries, especially anterior cruciate ligament tears.

Those posts noted that:

• injuries might be prevented through balance or proprioception training;
• women's knees are more prone to injury (also here);
• stretches should be avoided prior to exercise;
  
• the inflammation associated with problem knees interferes with healing and
  
• stretching can actually promote knee stability;

I was reminded of all these posts earlier today when I read a story from the New York Times as it came through my RSS reader: Big-Time Injury Strikes Little Players

In the article the journalist notes the incresing incidence of ACL injuries in children and the difficulties in treating them in those whose bones are still growing:

The standard and effective treatment for such an injury in adults is surgery. But the operation poses a greater risk for children and adolescents who have not finished growing because it involves drilling into a growth plate, an area of still-developing tissue at the end of the leg bone.

Although there are no complete or official numbers, orthopedists at leading medical centers estimate that several thousand children and young adolescents are getting A.C.L. tears each year, with the number being diagnosed soaring recently. Some centers that used to see only a few such cases a year are now seeing several each week.

It is not an overuse injury from playing one sport too intensively, like shoulder injuries in young pitchers. Instead, doctors say, the injury occurs simply from twisting the knee, and diagnoses are on the rise partly because it can now be easily detected and partly because the very nature of youth sports has changed.

These are serious injuries that can ruin a kid's sporting life, fitness and future health and the article emphasised to me the need to keep health and function at the forefront of your concerns when training. Whatever else are training should be doing, it should be making us more resilient not more fragile. So that means balance training and stretching, plus - as Lou Schuler has pointed out - strength training.

Vern Gambetta has written an excellent article about this:

On Guard: Multiple-plane, multiple-joint workouts are the key to an effective defense against ACL injuries.

The emphasis on ACL prevention needs to be on multiple-plane, multiple-joint work that puts a premium on balance and proprioception in functional, sport-specific positions. Instead of focusing on the knee alone, we need to address the entire kinetic chain to better reduce force on the joint. We must shift our thinking away from traditional exercises and training methods that emphasize force production to a more balanced program involving force reduction and proprioception. The emphasis needs to be on training integrated movements, not isolated muscles.

An important but often ignored fact is that 70 percent of knee injuries, regardless of gender, are non-contact. The typical mechanisms of these non-contact injuries are planting and cutting, straight-knee landing (no flexion on landing), hard one-step stops with the knee hyperextended, pivoting, and rapid deceleration. These are all movements that occur with high force and at high speed, and though they usually happen very quickly, athletes can be trained to make them more efficiently as part of a comprehensive prevention program.

Gambetta suggests some programmes, but his conclusions are worth restating:

All of the successful ACL-prevention programs share a few key components: mechanics of movement, proprioception, plyometrics, and strength training. They can be translated into the following five modules:

• strength/power, including basic strength, core strength, elastic/reactive strength (plyometrics)
• balance/proprioception
• agility, including body awareness, footwork, and change of direction
• dynamic flexibility
• sport-specific conditioning.

I've said before that such training doesn't have to be complicated - build it into your day. For example stand on one leg when putting your socks on, or when combing your hair.

Just to finish off the post, here is a quick video of some balance/proprioception training. I am really interested in balance at the moment, so if you spot any interesting balance videos or resources, please let me know.

Knee injuries - what is dangerous, what is more dangerous

I've had posts up here before about knee injuries, especially ACL tears. We noted that women are more prone to these injuries and that balance (proprioception) training can help.

The study below has just been published and is interesting in terms of what activities it says are dangerous for the knees:

A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.

PURPOSE: The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training.
METHODS: A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training.
RESULTS: Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball.
CONCLUSIONS: Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.

stretching with no other exercise improves performance

This is an interesting article. We have talked before about the benefits of stretching and also about how research has shown that stretching immediately before exercise can diminish performance.

This study however showed that in the absence of any other exercise, simply stretching the muscles had a training effect. The trainees got faster, stronger and more flexible.

The article suggests that a stretching routine might be a good introduction to training for those who are not yet fit enough to train with other exercises or modalities.....

It is possible that persons who are unable to participate in traditional strength training activities may be able to experience gains through stretching, which would allow them to transition into a more traditional exercise regimen.

Chronic Static Stretching Improves Exercise Performance.


Abstract:
Purpose: This study investigated the influence of static stretching exercises on specific exercise performances.

Methods: Thirty-eight volunteers participated in this study. The stretching group (STR) consisted of 8 males and 11 females whose activity was limited to a 10-wk, 40-min, 3-d[middle dot]wk-1 static stretching routine designed to stretch all the major muscle groups in the lower extremity. The control group (CON) consisted of 8 males and 11 females who did not participate in any kind of regular exercise routine during the study. Each subject was measured before and after for flexibility, power (20-m sprint, standing long jump, vertical jump), strength (knee flexion and knee extension one-repetition maximum (1RM)), and strength endurance (number of repetitions at 60% of 1RM for both knee flexion and knee extension).

Results: STR had significant average improvements (P < 0.05) for flexibility (18.1%), standing long jump (2.3%), vertical jump (6.7%), 20-m sprint (1.3%), knee flexion 1RM (15.3%), knee extension 1RM (32.4%), knee flexion endurance (30.4%) and knee extension endurance (28.5%). The control group showed no improvement.

Conclusion: This study suggests that chronic static stretching exercises by themselves can improve specific exercise performances. It is possible that persons who are unable to participate in traditional strength training activities may be able to experience gains through stretching, which would allow them to transition into a more traditional exercise regimen.

On your knees!

shock news! exercise is good for your joints!!!


Somehow I seem to be posting a lot on knees! It is just that I keep coming across articles on knee health that I think are useful; plus I know a few people - especially older hill walkers - whose knees give them trouble.

I've noted previously how balance training can help prevent ACL injuries and how appropriate stretching may also be beneficial.

This article explains that exercise itself is beneficial to the joints.

Among the notable findings, both baseline and current vigorous physical activity— exercise that gets the heart pumping and the body sweating—were associated with an increase in tibial cartilage volume, free from cartilage defects. What’s more, tibial cartilage volume increased with frequency and duration of vigorous activity. Recent weight-bearing exercise was also linked to increased tibial cartilage volume and reduced cartilage defects. Finally, moderate physical activity, including regular walking, was associated with a lower incidence of bone marrow lesions.

The article is also referred to here.


I was thinking about this and how it fits in with a sort of template that I have been considering. I sort of filter all this stuff through a lens of thinking "is this what we were designed for?" I suppose it is a bit like DeVany's Evolutionary Fitness or Sisson's Primal Health. If you have a paradigm within which to work I think it helps you pull diverse ideas together. So I apply this question to think about diet - what to eat and how often - exercise, stress, social pressures, spirituality....

Well, I think we were designed to be active, to move. In that context, of course regular exercise is good for you, of course there will be benefits for your joints. Move, walk, sprint....It is what you were designed for.

Knee injuries - serious implications

In previous posts we have noted the way in which women are more prone to knee injuries but also the way in which balance training and stretching can help to prevent such problems.

This study identifies some of the serious implications of an ACL injury in women. It can seriously affect the health of the leg bones. Strong bones are essential as we age. To keep healthy it is essential that you maintain the health of your knees. So :

- do some balance training; and
- stretch!



Unilateral chronic insufficiency of anterior cruciate ligament decreases bone mineral content and lean mass of the injured lower extremity


Abstract: We studied the effects of unilateral chronic anterior cruciate ligament (ACL) injury on bone size, bone mineral content (BMC), bone mineral density (BMD), soft tissue composition and muscle strength of the injured lower extremity in Japanese 21 men and 12 women aged 15 to 39 years. Bone area, BMD, BMC, lean mass and fat mass of lower extremity were measured using dual energy X-ray absorptiometry. The isometric and isokinetic muscle strength was assessed by an isokinetic machine.
BMC, lean mass, circumference of the thigh and circumference of the lower leg of the injured lower extremity were significantly smaller than those of the intact lower extremity (p=0.0002, p<0.0001, p<0.0001, p=0.0131). In cotrast, fat mass and %Fat of the injured lower extremity was significantly greater than that of the intact lower extremity (p=0.0301, p<0.0001). Bone area and BMD did not produce significant difference. These findings suggest that chronic insufficiency of ACL decreases BMC and lean mass of the injured lower extremity. J. Med. Invest. 54: 316-321, August, 2007

Stretching for healthier knees

In previous posts we have looked at the way in which knee injuries might be prevented through balance or proprioception training, at how women's knees are prone to injury and also how stretches should be avoided prior to exercise.

This study below is useful in that it indicates how appropriate stretching might also contribute to healthier knees.

If you have bad knees you might want to consider adopting a regular stretching routine of the muscles mentioned in this article - quads, hamstrings and adductors. If they are tight they might be throwing out the positioning of the knee. Stetching should be about stretching the tight muscles to restore balance and function to the body.

Effect of static stretching of muscles surrounding the knee on knee joint position sense


Background: Muscle stretching is widely used in sport training and in rehabilitation. Considering the important contribution of joint position sense (JPS) to knee joint stability and function, it is legitimate to question if stretching might alter the knee JPS.

Objective: To evaluate if a stretch regimen consisting of three 30 s stretches alters the knee JPS.

Design and setting: A blinded, randomised design with a washout time of 24 h was used.

Subjects: 39 healthy students (21 women, 18 men) volunteered to participate in this study.

Methods and main outcome measures: JPS was estimated by the ability to reproduce the two target positions (20° and 45° of flexion) in the dominant knee. The absolute angular error (AAE) was defined as the absolute difference between the target angle and the subject perceived angle of knee flexion. AAE values were measured before and immediately after the static stretch. Measurements were repeated three times. The static stretch comprised a 30 s stretch followed by a 30 s pause, three times for each muscle.

Results: The AAE decreased significantly after the stretching protocols for quadriceps (3.5 (1.3) vs 0.7 (2.4); p<0.001), hamstring (3.6 (2.2) vs 1.6 (3.1); p = 0.016) and adductors (3.7 (2.8) vs 1.7 (2.4); p = 0.016) in 45° of flexion, but no differences were found for values of the gastrocnemius and popliteus muscles in this angle and for the values of all muscles in 20° of flexion (p>0.05).

Conclusion: The accuracy of the knee JPS in 45° of flexion is improved subsequent to a static stretch regimen of quadriceps, hamstring and adductors in healthy subjects.

Knee injuries again

Moving on from the balance stuff and making some connections.....

The last few posts have thought about how balance training can help to prevent injuries, particularly ankle injuries, but such training can also be a strategy to prevent knee injuries, as explained here.

There is a study on this here too, explaining how a neuromuscular and proprioceptive performance program was effective in decreasing the incidence of anterior cruciate ligament injuries in female football players.

On the subject of knees, there was some news released this week about knee injuries following an experiment in pigs. It found that the sort of swelling that occurs when a joint is damaged by injury or degeneration is normally essential to the healing process, but when it comes to the knee, that inflammation can actually interfere with healing. Researchers identified two immune system proteins -- interleuken-1 and tumor necrosis factor -- produced by the body during swelling that blocked the healing of a damaged pig meniscus. Almost 15 percent of all athletic injuries to the knee involve the meniscus.

The researchers say that there are drugs in existence and in development that could block these two proteins and so promote healing.

However, it was interesting to me that this came back again to TNF. This protein keeps popping up in things I'm reading at the moment. For example remember the post from a few days ago about the way in which high intensity training attenuates (reduces) TNF in humans? Or this one?

I wonder if there is a connection here? Maybe you could promote healing through appropriate training that would minimise these inflammatory proteins?

Inflammation is interesting. Necessary as an immune system activity in some cases but potentially damaging too. Incidentally in the wikipedia entry about inflammation it says that it is linked to obesity:

High levels of several inflammation-related markers such as IL-6, IL-8, and TNF-α are associated with obesity.[3][4] During clinical studies, inflammatory-related molecule levels were reduced and increased levels of anti-inflammatory molecules were seen within four weeks after patients began a very low calorie diet.[5] The association of systemic inflammation with insulin resistance and atherosclerosis is the subject of intense research.

TNF again?

Women and problem knees

(image from Medline Plus)



Apparently female athletes have a really high incidence of knee injuries - particularly to the anterior cruciate ligament (ACL). That is a real footballer's injury. I'm showing my age and nationality now, but I always remember that as the injury that Paul (Gazza) Gascoigne suffered in the FA cup final in 1991.

Mike Boyle in a provocative article says that most women shouldn't run: wider hips mean narrower knees which leads to more injuries for the average female runner. Incidentally there is an interesting response to Boyle here.

Eric Cressey prescribes "increasing glute and hamstrings strength and optimizing frontal plane stability is crucial for resisting knock-knee tendencies and preventing ACL tears".

While I am sure that strengthening these muscles and structures will help, an article has just been published that indicates that the issue is about more than simple biomechanics. There is a problem here in terms of pathology - it is about the very nature of women's tendon strength. Perhaps while training can help, women are always going to suffer more soft tissue injuries than men.

The adaptability of tendon to loading differs in men and women.
Peter Magnusson S, Hansen M, Langberg H, Miller B, Haraldsson B, Kjoeller Westh E, Koskinen S, Aagaard P, Kjær M.

Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.

The reason why women sustain more soft tissue injury than men during physical activity is unknown. Connective tissue properties and extracellular matrix adaptability in human tendon were investigated in models that addressed biochemical, physiological and biomechanical aspects of tendon connective tissue in response to mechanical loading. Habitual training resulted in a larger patellar tendon in men but not in women. Following an acute bout of exercise, men had an elevated tendon collagen synthesis rate and this effect was less pronounced or absent in women. Moreover, levels of circulating oestrogen affected the acute exercise-related increase in collagen synthesis. Finally, the mechanical strength of isolated tendon collagen fascicles in men surpassed that of women. Thus, compared to men, women have (i) an attenuated tendon hypertrophy response to habitual training; (ii) a lower tendon collagen synthesis rate following acute exercise; (iii) a rate of tendon collagen synthesis which is further attenuated with elevated estradiol levels; and (iv) a lower mechanical strength of their tendons. These data indicate that tendons in women have a lower rate of new connective tissue formation, respond less to mechanical loading, and have a lower mechanical strength, which may leave the tissue more susceptible to injury.