Thursday, March 11, 2010

A little training and finally: A LITERATURE REVIEW

Ok this one is going to be somewhat long. I haven't felt passionate about something to research until my buddy Karl posted on his blog his biggest pet peeve. People who think that running elicits arthritis. If that topic interests you his blog is very informative. You see him and I are on the same crusade. We have dedicated our life to health and wellness. One patient at a time educating them on the benefits of exercise and a more physical life. I often tell them that an injury usually is a wake-up call to the lifestyle they live. This post is NOT geared towards anyone in particular nor is it bash on any other professions. The goal of this post is to educate.

In my experience with endurance athletes I have found something very unorthodox. They seem to be drawn to the strangest things, to me anyway. They seem to believe that pain is normal. That training in pain is normal. The faster and the longer the event the more pain you should endure. WRONG. If the body is capable of doing the activity, the body will not hurt. Do not change the activity, CHANGE THE BODY. If you have pain on the body and it is attached to a brain that is capable of pushing beyond limits, it doesn't stop you. For the sedentary patient, they will not make the decision to do more. I give them permission to push into it and it goes away. Athletes are the opposite. We do things like foam roll, massage (various myofascial release protocols), and stretching. They learn how to maintain it. Symptom maintenance. This is my pet peeve. What would it be like to train without pain? Obviously soreness after a 20 miler or 100 mile bike you will have some pain some acute and some DOMS. I am talking about nagging injury pain. I decided to get onto PUBMED the place where all respectable literature goes to sit and wait for interested readers. I pulled up abstracts on the first articles that discuss myofacial release/foam rolling/massage. For some of you this will be a paradigm shift for you. Here is what I found (the blue is how I interpret that):

....the belief that massage has benefits for athletes, the effects of different types of massage (e.g. petrissage, effleurage, friction) or the appropriate timing of massage (pre-exercise vs post-exercise) on performance, recovery from injury, or as an injury prevention method are not clear. - Sports medicine, 2005. CANNOT PROVE IT HELPS
.....No measurable physiological effects of leg massage compared with passive recovery were observed on recovery from high intensity exercise- "British journal of sports medicine."2004 MASSAGE IS JUST AS GOOD AS LAYING THERE THE SAME TIME YOU WERE GETTING MASSAGED
.....Massage (myofascial release) may induce a transient loss of muscle strength or a change in the muscle fiber tension-length relationship, influenced by alterations of muscle function and a psychological state of relaxation.- "Journal of alternative and complementary medicine." 2008 THOSE TECHNIQUES ACTUALLY CONTRIBUTE TO LOSS OF STRENGTH
...Tradition foam roll does not produce the same force as the isolated hand held massager (the one with the little rolly things). FOAM ROLL CANNOT CHANGE TISSUE LENGTH

SO then I directed my attention to common problems we these kinds of treatment for:

IT BAND (ITB) SYNDROME. First of all did you know that the ITB is made of the kind of connective tissue that can tolerate the force of tying one end to 1 car and the other end to another car and allow for the second car to be towed. REALLY? you think you can stretch that with the weight of your body? A CAR CANT STRETCH IT! Here is some literature:

...Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners. It is an overuse injury that results from repetitive friction of the iliotibial band (ITB) over the lateral femoral epicondyle, with biomechanics studies demonstrating a maximal zone of impingement at approximately 30 degrees of knee flexion. Training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage and downhill running. Studies have also demonstrated that weakness or inhibition of the lateral gluteal muscles is a causative factor in this injury. When these muscles do not fire properly throughout the support phase of the running cycle, there is a decreased ability to stabilize the pelvis and eccentrically control femoral abduction. As a result, other muscles must compensate, often leading to excessive soft tissue tightness and myofascial restrictions. Initial treatment should focus on activity modification, therapeutic modalities to decrease local inflammation, non-steroidal anti-inflammatory medication, and in severe cases, a corticosteroid injection. Stretching exercises can be started once acute inflammation is under control. Identifying and eliminating myofascial restrictions complement the therapy programme and should precede strengthening and muscle re-education. Strengthening exercises should emphasise eccentric muscle contractions, triplanar motions and integrated movement patterns. With this comprehensive treatment approach, most patients will fully recover by 6 weeks. Interestingly, biomechanics studies have shown that faster-paced running is less likely to aggravate ITBS and faster strides are initially recommended over a slower jogging pace. Over time, gradual increases in distance and frequency are permitted. In the rare refractory case, surgery may be required. The most common procedure is releasing or lengthening the posterior aspect of the ITB at the location of peak tension over the lateral femoral condyle.-- "Sports medicine." 2005 SOME MAY USE MYOFACIAL TECHNIQUES IN THE BEGINNING AS THIS POINTS OUT BUT I DO NOT. I FIND THAT IF YOU HAVING A MECHANICAL ISSUE RESULTING IN THIS PAIN, IF WE COUNTERACT THAT PROBLEM THE PAIN STOPS. BIOMECHANICS INFLUENCE EVERYTHING. WHY WOULD SHOES CAUSE A NEW PAIN? YOU CHANGE THE BIOMECHANICS.

...A long-term successful outcome and prevention of re-injury are more likely if the focus of rehabilitation is on the restoration of the functional kinetic chain, rather than on a specific injured tissue. For example, the typical treatment of "iliotibial band syndrome" is a stretching protocol that frequently is unsuccessful in the long-term improvement of symptoms. A functional biomechanics approach might identify that the injured runner has lack of calcanea eversion and a structurally rigid supinated foot. These functional biomechanics deficits would lead to inadequate internal rotation of the tibia and femur and result in inhibition or decreased recruitment of the gluteal muscles, in particular the gluteus medius. Restoring pronation throughout the lower extremity would require joint play techniques or functional joint mobilizations for the foot and ankle..................STRETCHING DOESNT WORK, STRENGTH AND STABILITY DO.........(same article)...........Exercises that integrate foot and hip function, including balance reaches, lunges and step-downs, are prescribed to stimulate the gluteus medius and other gluteals in positions that simulate running. Activities that are done in this manner activate the entire functional kinetic chain of muscles and joints. The non-operative sports medicine specialist, in particular the physiatrist and physical therapist, are in an excellent position to integrate treatment of the entire functional kinetic chain through a thorough biomechanics evaluation and comprehensive rehabilitation of the injured runner........USE STABILITY WORK TO GET THE WHOLE LEG TO DO THE JOB IN FRONT OF IT, RUN! Did you know that running requires your body to tolerate 3-5 times your body weight. So why would I do something that takes away from strength? I NEED FORCE. Strength and stability allow for injury free training AND make you faster!!!
....Our view is that ITB syndrome is related to impaired function of the hip musculature and that its resolution can only be properly achieved when the biomechanics of hip muscle function are properly addressed. SINCE THE PROPERTIES OF THE CONNECTIVE WILL NOT ALLOW IT TO STRETCH IS IT EVEN FRICTION THAT CAUSES IT? no....HIP STRENGTH AND STABILITY.

That is only ITB too. If you have heard of a common "running injury" there is a body of evidence to support biomechanics training. That training is about teaching the body to tolerate force. Build stability. If you have a chronic problem you HAVE NOT identified its mechanical problem. If you get to someone to help you with a chronic problem , if they do not address the biomechanics, it will persist. When you reach out for help. You are in the driver seat. Informed consumers get what are looking for. Show up at the clinic you have been referred to. Ask them questions. If you have a running problem, they should say we watch you run and teach you how to fix it! We have a saying in our clinic: All that palliative stuff is just as good as rubbing chicken bones over your head to fix it! LOL.

Performs syndrome. Now I didn't look at any articles but I do have some experience with this problem. ITS ALWAYS BACK PAIN. I have never delegated a performs stretch. When you feel pain in that area it is almost always referred pain from the lumbar spine. MOVE THE BACK and the pain stops. Then you never have to stretch the muscle! IT IS ALWAYS JOINT PROBLEMS NOT MUSCLE PROBLEMS. If the muscle cannot overcome the stiffness in the joint then the muscle will be in dysfunction and spasm. JOINT STRETCH GOOD, muscle stretch=CHICKEN BONES!

Even this month running times has an article on static stretching. IT HINDERS PERFORMANCE WHILE MAKING YOU PRONE TO INJURY. Stretching can be a whole other post. Tendon "priming" (or dynamic stretching) is better than static stretching. Now I would never take something away that a person 'Needs.' But every single one of them gets education and what they decide to do with it, is up to them!

Wednesday-5 mile run. My legs still don't belong to me.
Tonight-3 mile run. Felt very good.

Was his helpful? QUOTE:

“If you don't create change, change will create you”

please don't let that change be to quit. Its not the activity, its the body. Lets fix the body.


KC (my 140 point 6 mile journey) said...

thanks for pointing out that pain from injury IS NOT a normal part of training and that it is not ok to just manage it. there are reasons behind why our bodies get injured and finding the reason and correcting it is the key, not medicating it or quitting. Great post!

Jeff - DangleTheCarrot said...

Very informative post! +2 on what KC said ... very well thought out post ..thanks

Pete32 said...

Great read! It makes a lot of sense, and I agree with everything that was said here. Thanks for the great post, and information! I few things I take from this that I will be working on - dynamic stretching & stability work (balance strength training).

Amanda said...

Actually, piriformis (if that's what you meant by "Performs") syndrome doesn't ALWAYS cause pain in the back. I've had issues with it as well. And it caused pain deep in the hip/buttock. And the ONLY thing that alleviated the pain for me was deep tissue massage and ART.

Also, have you tried a foam roller?