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The Triathlon Hub

The Triathlon Hub & Sports Therapy NW

Why do I need to read about Sports Therapy now?  I’m not injured….

We’ve got a few questions for you:
1.     Have you had a good season?
2.    
Have you had an injury free season?
3.    
Are you looking to improve for next season?
4.    
Do you know if your body is performing at its best?

We appreciate this isn’t an X-Factor audition, but hopefully you’ve got 4 “yes’s”!  However, most people may have 3 “yes’s” and possibly a “no”?  Some 2 of each and let’s hope no body falls into just answering “yes” to question 3.

We’ve bought into the philosophy of The Triathlon Hub and are here to offer you Sports Therapy advice with hands-on treatment should you require it.  We know that the science behind performing better can be complex and sometimes hard to make work, so we believe that if you do the simple things right, i.e. look after your body, then everything else will fall into place. 

If you answered “no” to questions 2 & 4, then please take a moment to consider whether you could benefit from having the equivalent of an MOT so that you can enter an intense training regime with your body primed and prepared to take the exercise you are going to give it. 

Some of the unseen benefits of Sports Massage Therapy are often the most important, such as restoring muscular condition, balance and elasticity; unfortunately what no one can promise is that you won’t get injured, but by trusting your body to someone who can gauge, assess and feedback to you what your current state is, as well as being able to offer you advice on how to make improvements on your current condition, then you’re doing all you can to realise your goals for next year.

We have experience of working with athletes from many disciplines, but in particular, we know and understand the particular mental and mechanical stresses that Triathlon and multi-sport events place on your body.  What we also know is that you have to work 5 days a week (for some anyway), so whilst we’d all like to be professional athletes with access to daily treatments and siesta’s at 2pm, the reality is that we’re not and we have to train when tired mentally, train when tired physically, train when cold and train when stressed.  These conditions can lead to injury, so our philosophy is to give individual advice and treatment before injuries occur.

Hopefully you see a Therapist already to keep you in good order, so please feel free to share information on injuries you may have had and what worked best for you – often it’s the tell-tale signs of an injury in the making that are the most important signals to act upon, so please tell us what you’ve experienced and we’ll also be here to give you relevant information on what to look for.  We work closely with Paul to give him feedback on what we find so he can monitor you and help you in more ways than one…

Here’s to a brilliant season of training for 2014!

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Montane Lakeland 100 & 50, July 2013

Well, that was something a bit special I think you’d all agree!  What an event!!  The weather was fantastic, the atmosphere was a bit special and then the rain arrived at 10pm – bit of a shame and it changed the atmosphere a bit; the focus changed from dehydration to dehydration and hypothermia which was a shame and the crowd moved inside, but the vibe was still there and each and every competitor received a rapturous welcome as soon as they were in the building!

We were kept really busy trying to loosen off some extremely tired muscles, so we adapted ourselves to soothe the aching limbs and bring people back round to planet earth.  We were overwhelmed by the effort all the competitors had put in and it was a real pleasure to see everyone leave our tent feeling better and able to shuffle to their showers/beds a little more easily than when they’d fallen onto our treatment couches.  Some of the tales of pushing on through extremely traumatised injuries were almost beyond comprehension, but fortunately all will be recoverable with the right post-race rehab.  Concerns were raised at people with stress fractures who were unsure about what to do, so we did have to have a few sterner words with those guys to make sure they did the right thing for themselves – you know who you are!  Please get yourselves repaired…

We wanted to get more pictures taken, but as we were rushed off our feet, the camera got put away unfortunately.  Anyway, here are a few from behind the scenes and it was great working with Gary Wilkinson and John Warburton to the very small hours – who says you can’t pull a 19 hour Sports Therapy shift…?

We look forward to seeing you out at the remaining events, so we hope your training goes well and get in touch with us if you need advice on injury management – better to nip any problems in the bud wouldn’t you agree?!?!

Proximal Hamstring Tendinopathy ” A pain in the backside”

To the vast majority of the population, the image of a hamstring tear will be a Sprinter pulling up in a race looking like they’ve been shot. To me, a common hamstring condition is an endurance athlete, runner, cyclist or triathlete, saying to me that they’ve got “a pain right in my ar*e” and “I’m struggling to increase my speeds as I know it’s going to go”.

It’s really important to run a full diagnostic with the evidence presented and pinpoint the cause, but invariably, the description given will lead you right to the spot, basically proximal hamstring and often right at the Ischial Tuberosity (your seat bone).

To understand what’s where, there are 3 hamstring muscles of the posterior thigh: Semitendinosus (ST), Semimembranosus (SM) and Biceps Femoris (BF) with it’s long and short heads. Proximally, while the short head of BF attaches to the femur, all the other hamstring muscles share a common point of origin on the ischial tuberosity (seat bones) of the pelvis, all covered by the gluteal muscles.  Distally, ST and SM both attach to the medial tibia while BF attaches distally close to the fibular head, lateral to the knee.

hamstrings

However, the hamstrings, being a two-joint muscle group (crossing hip and knee), when we run there are other considerations to take into account, especially during stance phase. During this phase the foot is anchored to the ground by our body weight creating what’s called a “closed chain environment”. As the hamstrings contract with Glute Max to create hip extension propelling us forwards, they also create an extension moment at the knee… rather than just knee flexion.

The Injury Itself!
The common origin point of the hamstring muscles at the ischial tuberosity of the pelvis is basically the site of injury when diagnosing Proximal Hamstring Tendinopathy. The injury is classified as a tendinopathy rather than a tendonitis, as it has a more degenerative nature rather than being an inflammatory condition.

Sufferers will complain of pain local to the ischial tuberosity when running, especially when accelerating and sustained faster paced running as mentioned before. The pain will most likely be an intense ache in nature, rather than sharp or stabbing. Due to the anatomical proximity to the common hamstring origin, the sciatic nerve can sometimes be affected (Therapist will check Glute Med and Piriformis), which can cause referred pain into the posterior thigh. Once aggravated, sitting on solid surfaces can also be uncomfortable, as can direct palpation and pressing onto the ischial tuberosity manually.

Differential diagnoses for similar symptoms can include piriformis syndrome, pelvic stress fractures and low back injuries. Thus, a proper assessment from a musculoskeletal physiotherapist or similar sports injury professional is important. Often an MRI scan will be used to support diagnosis once and for all, but this can be avoided with accurate diagnosis – depends entirely on the choice of the individual!

Treatment and Rehab:
Soft Tissue Treatment, Manual Therapy & Stretching:
Hands-on treatments providing soft tissue mobilisations to break up scar tissue and adhesions can be useful, as can transverse frictions to the affected tendon. Care should however be taken not to apply direct pressure to the ischial tuberosity itself. This sort of soft tissue work is complementary to a gradual introduction to regular hamstring stretching.

If upon assessment, pelvic malalignment (anterior innominate rotation in particular) is identified, manual manipulation to restore alignment of the pelvic bones is often useful in restoring proper hamstring function. The question of course must always be asked – where does the imbalance come from that caused the pelvic malalignment…?

Specific Hamstring Strengthening
It is suggested that the progression of targeted hamstring exercises should go as follows:
Double leg, non-weight-baring isometric exercises:
Bridge Holds
Single leg isometric (closed chain) and isotonic (open chain) exercises:
Single Leg Bridge Holds
Single Leg Hamstring Catch
Eccentric hamstring loading exercises:
Swiss Ball Hamsring Curls
Single Leg Swiss Ball Hamstring Curls

It goes without saying that these progressions depend on the pain free completion of each stage.

(“Finally, you might say”) Core Strength & Pelvic Posture Correction!

Hands-on treatments, stretching and progressive strengthening are all important parts of the any good rehabilitation plan for Proximal Hamstring Tendinopathy. However, in my experience, I find the following core strengthening element to be the key to a successful outcome.

In my experience of working with triathletes/athletes/runners who suffer from proximal hamstring tendinopathy, or recurrent hamstring strains, almost all were displaying poor ability to control their pelvic position throughout the performance of functional movements for their sport.

In virtually all cases, it seems that the recurring theme is that they fall into an anterior pelvic tilt/innominate rotation during exercise; this will put the hamstring in a position where they are chronically held under tension, or put a different way, the soft tissue is now technically inelastic and unable to contract and extend from a neutral (and stable) position.

Re-educating proper pelvic position throughout movement, and working to correct imbalances which predispose an athlete to poor pelvic posture should be treated with equal importance, because if not, increased precedence over elements of the rehab programme such as eccentric hamstring strengthening protocols are potentially exacerbating the problem. It’s absolutely vital to check for quad flexibility or a dominance (unwilling to release), and tight hip flexors.

It’s very simple to prescribe a raft of general exercises that will help build stability, but equally as important, you have to treat and deal with the individual in front of you so that the balance between anterior and posterior muscle groups must be achieved first so that all you are strengthening on a “stable” platform rather than over-exerting already (technically) weakened muscles.

Get in touch with us if you want to talk further and we’d also like to hear about the topics that interest you that you’d like us to put on the website!

Train well and look forward to seeing you soon (preferrably uninjured!)

The STNW team.

Sports Therapy, Science Testing and Bike Fitting clinic now OPEN!

It’s been an incredibly busy few months what with getting everything ready at the Endurance Store in Appley Bridge and also supporting the Epic Events in the sun-kissed Lake District, but we’re now incredibly happy to announce that we’ve got our dedicated facility OPEN!

Before we go on, about us being OPEN 6 days a week, Monday to Saturday, how about we make you an introductory offer of £20 for your first Sports Massage treatment?  The only proviso being that you’ll need to bring a stick to bite down on once Jacqui (who works in the Store) gets a hold of your legs!  Richard’s a bit nicer…he brings his own sticks.

We don’t want to be boring here, but we’ve now got a great team of Sports Therapists, Performance Analysists and Coaches who have been brought together with the sole purpose of understanding how you currently train, compete and perform so that we can help you look for and find the ways that will help you maximise your performance on your efforts.  If it makes it easier, we’ve broken down our Services into the following:

Sports Therapy – Injury Rehab, Soft Tissue Improvement, Sports Massage, Postural Analysis, Personal Training and Event Support

Science Testing – Metabolic Testing, Nutrition Analysis, Performance Feedback, Coaching, Training Plans

Performance – Bike Fitting, Personalised Coaching, Training Schedules, Core Fitness, Winter Spin Classes

We are always present in support of Epic Events at the weekend’s, so feel free to come along and have a chat, discuss whether you’d like to know more about our services (a bike fitting session could be the answer to many an issue), and it’s also our intention to give you a free rub down (BYO bite stick)!  We will also usually be present at the Tuesday evening Duathlon and Open Water Wednesday’s at the 3 Sister’s Lake (email us if you can’t make it and have a question).  In all seriousness though, we understand the rigours, stresses and strains that a tri event (or double or single for that matter), place on the human body, so we are here to get to the cause of the problems and give you accurate feedback as to what’s happening and then help you out.

All our details are in the “Contact” section, so even if you’re not injured, why not take up the £20 offer and see if we can get you feeling in top shape by ironing some well used soft tissue fibre’s from your heavy training schedules, especially now the business end of the season is here.

We look forward to seeing you all soon!  Train hard, train smart and it will be a pleasure to sort your body’s out.

The Sports Therapy North West Team

p.s. Don’t forget your bite-stick…

Runners, don’t lengthen your stride.. just fly a little further and faster..

“How do you run quickly when you’re such a short arse?”

My reaction to this was twofold, one part of my brain started to analyse stride rate, stride length and how they combine to influence run performance. The other part of my brain was hung up on the fact that ‘short arse’ was indeed a little harsh considering I’m 5’9 on a good day, 6′ in my HOKA’s.

It is a question that I’ve been asked many times, surely if you are short with proportionally little legs, you have to take far more strides than a taller runner with his irritating, lanky, ‘look at me I’m over 6′ tall’ frame. The answer is dictated by your definition of key terms, let’s explain further!

Stride Length V Stride Rate

Stride length is simply how far you stride. My old running coach used to tell me to stride out and reach a little further. If I could increase my stride length by an inch each time, those inches would add up to a mile by the end of a marathon! The problem with ‘increasing your stride length’ as we have discussed many times is that it tends to lead to heel striking, whereas taking shorter strides promotes the preferred mid/forefoot landing. I’m not going to discuss the benefits of shorter strides and forefoot striking as we’ve done that lots of times already on this blog, check older posts if your interested.

Stride rate is how quickly you stride, generally measured as strides per minute. An average runner may take 170 strides each minute (most people only count on one leg, e.g. 85 right foot strikes per minute). If a runner completes a training run, with a stride length of 1.5m and a stride rate of 170, then in one minute they would travel 255m (1.5m per stride x 170 strides). This equates to 6 mins 18 secs per mile and if they want to go faster this can be achieved by increasing stride rate, stride length or both simultaneously. This sounds simple right? We haven’t even got started yet and this is where it gets good..

In your head, how would you describe stride rate?

In my head, I would describe it as the furthest distance between my right and left foot when I am in mid flight, in simple terms, how far apart do my feet separate. If you are a short runner with little legs, it’s likely that your feet will not separate as much as those taller runners with their longer legs. It won’t be the case all of the time, but as an average, it’s fair to presume that longer legs will naturally result in a longer stride length.

Look at the picture below, if you could take a tape measure and measure the distance between their right and left feet when they are at maximum distance apart, that would give you stride length. If all of the runners below were using the same stride rate (180 strides per minute) then the runner with the longest stride would win.. right? In fact this isn’t the case at all, stride length isn’t actually that critical, it’s flight distance and flight time which really decide who wins.

Flight Distance

This simply refers to the distance you cover between your left foot leaving the ground and your right foot hitting the ground (or vice versa). When running quickly, after your left foot leaves the ground, you then fly through the air (not being in contact with the floor) until your right foot hits the ground. The further you fly through the air and the greater the distance you cover before landing again, the greater your flight distance.

What’s the difference between stride length and flight distance?

Stand with your feet together and jump as far as you can, landing with your feet together (commonly called a standing long jump). measure how far you traveled from take off to landing, that’s your flight distance. I already know your stride length, it’s zero, your feet didn’t separate, they stayed together at all times during take off, flight and landing. I told you this was going to get good..

Imagine you’ve got little legs and your stride length isn’t very big (your feet don’t get that far apart). Now imagine your little legs are so powerful that when you take off, you fly 2.5 metres before you land on the other foot. By contrast, imagine a tall runner with long legs and a big ‘stride rate’. Unfortunately this tall runner isn’t powerful at push off and almost as soon as he’s got airborne, he’s landing again on the other foot, with a total flight distance of 2 metres.

What’s the relationship between stride length and flight distance?

Something worth considering is that forefoot landing (easier when running with shorter strides) allows runners to generate more ‘plyometric’ energy return, using natural bounce in the foot and knee. This greater plyometric return / bounce will lead to greater flight distance. By contrast, heel striking reduces plyometric return, thereby potentially reducing flight distance. In simple terms, trying to increase your stride length, may well decrease your flight distance. I’d bet that most people trying to increase stride length, do so because they are in fact trying to increase flight distance.

Can you handle one more thing? OK.. let’s quickly mention flight time

Without making this whole article too confusing we do have to mention flight time, the easiest way is to give another running example. If a runner has a stride rate of 180 strides per minute and a flight distance of 2 metres per stride, he’d travel 360m per minute (2m X 180), this is slight quicker that 4 minutes, 30 seconds per mile (dream on..). One of the key problems which may prevent people achieving this is how long they spend in the air, now bear with me on this part. If our super fast runner completes 180 strides per minute, that equates to 3 strides per second and each of those strides covers a 2m flight distance!! Do the maths, as the foot takes off, the runner flies 2m through the air and has to touch down in less that 0.3 of a second. If he doesn’t fly quickly enough, he’d never manage to complete 3 strides per second!!

Try this.. bound from one foot to the other and try to travel as far as you can each stride, maximise your flight distance. I’ll bet that some of you can easily bound 2 metres per stride but you’ll hang in the air with a ‘pause’ in your running style, land, bound, hang and pause, land, bound, hang and pause. So, you’ve managed to travel 2 metres, but your stride rate (strides per minute) is now incredibly slow. You need to travel 2 metres, but couple it with a 180 strides per minute stride rate.. sorry to bring you that news.

What’s the conclusion to this article?

The main driver behind this article was my dislike at being called a short arse, but it has now ‘grown legs’ (like what I did there) and developed into a more structured discussion. The main points I would take from this are:

1. Do not to confuse stride length with flight distance, they are different things (in my head at least)
2. Be aware that by trying to increase stride length, the subsequent changes in technique (heel striking) may reduce flight distance
3. Flight distance and flight time are generally governed by force production, largely plyometric energy return
4. Never pick on little people.. we will crush you.

If you like this article or found it useful, please do the right thing and share ;)

Regards
Marc Laithwaite
The Endurance Store

Flexibility for athletes..

Don’t worry, I’m not about to tell you that you should stretch before and after every session and attempt to make you feel guilty.. I’ll take it for granted that you probably don’t stretch enough and I’ll add myself to that category. This article is focused more upon the type of stretching you should complete and understand the theory which supports it.

Static V Dynamic

Static stretching involves you holding a position for a specific count to stretch the muscle, dynamic stretching involves some kind of continuous movement to gain the stretch. As a simple example, touching your toes and holding the position for a count of 10 seconds would be a static stretch for your hamstrings. Standing tall and swinging your leg backwards and forwards in a ‘high kick’ manner without stopping would be a dynamic stretch. Both types of stretching have different benefits and both are useful in their own way.

Tight muscles or damaged muscles?

It’s really important to understand what causes tight muscles following a hard training session. Your muscles are surrounded by a sheath of connective tissue and the fibres within the connective tissue can become short and tight, released by stretching relatively easily. If you feel ‘tight’ or ‘stiff’ and stretching removes the problem immediately, then its likely that the connective tissues were the problem. If your muscles feel tender and despite stretching the ‘tenderness’ doesn’t go away, then this is more likely to be muscle fibre damage caused by training, as opposed to connective tissue tightness. The day after a marathon, the pain in your legs will not go away, however much you stretch and that’s because you have severe muscle damage. Whatever the cause of your discomfort, I can safely say it has nothing to do with ‘lactic acid’ in the muscles, this is a myth which has existed for many years. The day following any hard exercise, there is no remaining lactic acid causing discomfort.

Why do my legs hurt the day after a long run?

One of the key things is muscle fibre damage which leads to bleeding and inflammation. Running road marathons creates a huge amount of damage, but due to the DOMS effect (delayed onset of muscle soreness), you don’t actually feel it until the morning after, or worse still, the morning after that! Stretching will not help to resolve this and in many cases you should not stretched when your muscles are severely damaged. Running downhill is known to make this problem worse as the braking effect exaggerates muscle fibre damage.

There are several ways of reducing the damage caused by impact and the main ones are simply running more mileage and running downhill more frequently. Aside from the obvious options, cushioned shoes and better run technique to avoid excessive impact can also help. The final option is to try compression clothing during exercise which can help to prevent muscle damage.

Why do my legs hurt after a faster training session?

Your muscles have built in sensors called ‘stretch receptors’ which monitor the amount of stretch and the speed of the stretch, this information is fed back to your brain. I’m sure at some point when walking along the street you’ve stepped on an uneven surface and ‘turned your ankle’. If you were lucky enough, within a fraction of a second, you managed to make the muscles on the outside of your lower leg contract and pull the foot back into alignment, saving a torn ligament. This is usually followed by you hobbling for a few metres whilst asking the question ‘is it twisted? is it twisted?’ followed by relief as you continue to run and the pain subsides. You survived.. this time!

What happened during that scenario is your stretch receptors on the outside of your lower leg realised that the muscles were being stretched too far and too quickly. In response to this, they trigger a muscle contraction to try and prevent the twisted ankle. There was no conscious thought process, you didn’t make the decision, it just happened automatically within a fraction of a second and saved you a few weeks off training!

What does this mean for faster training sessions?

If you are a slower runner who spends a lot of time travelling at a slow pace, with slow movements, the stretch receptors can lead to problems when you attempt to run fast. If you run 100m as fast as possible, each time you stride out, your hamstrings are stretched beyond their normal range and at a speed which they are not used to. The stretch receptors unnerved by this change in length and fast speed make the hamstring contract as a protection mechanism, this is an attempt to reduce both the stretch and speed of stretch. In such situations, your muscles is trying to lengthen, whilst also trying to shorten at the same time! Pulling in both directions leads to muscle fibre damage and in some cases the tug of war is so powerful that the hamstring may tear!

Avoiding the stretch receptor reaction..

The purpose of dynamic stretching is to accustom the muscles to stretching quickly, without triggering the stretch receptor response. The example hamstring stretch mentioned earlier in this article is a simple example of how this can be achieved. Following a warm up period, stand tall and begin by swinging your leg gently backwards and forwards gently. Gradually increase the height of the swing and the speed of the swing over a period of 30 seconds, never stretching to the point of discomfort. This action allows the stretch receptors to become accustomed to changes in both length and speed of working muscles. Another simple way to progressively and dynamically stretch the running muscles is to complete acceleration strides. Start jogging and over a 50 distance build to 75% of maximum speed, complete twice. Progress to 85%, complete twice and finish by building to 95%, complete twice. Total = 6x50m with 30 seconds between each. The key is starting slow and gradually building, too fast will trigger the stretch receptor response!

Lower limb injuries part 2..

In part 1 we discussed common lower limb injuries sustained by long distance runners and also highlighted the fact that pronation is often blamed for these injuries. As a consequence, shoes are specifically marketed as anti-pronation and inserts are often encouraged. In part 2, we ask whether pronation is really such a bad thing?

The Benefits of Pronation

One of the simple benefits of pronation is shock absorbancy. As your foot strikes the ground, the inwards rolling on the foot allows the dispersion of energy, thereby reducing the shock. Aside from shock absorbancy, pronation can also assist performance by storing energy and using it to generate propulsion.

In the last blog we discussed the muscles which ‘control pronation’, these muscles can also be used in a propulsive manner, using stored energy in an elastic manner. Look at the video clip below and watch the foot movement as it strikes the ground. What you are seeing largely is ‘ankle eversion’ as opposed to pronation. Pronation is the rolling forwards from heel to big toe, ankle eversion refers to the inward collapse of the ankle which can be clearly seen in the last 2 frames..


Elastic / Plyometric Energy

Hopefully you saw clearly the inward collapse of the ankle under weight.. it looks almost uncomfortable and it looks like bad technique. However, it didn’t seem to do Samuel Wanjiru any harm as he broke the world half marathon record aged only 18 and went on to claim gold at Bejing Olympics in the marathon.

The muscles which control the pronation/eversion movement (discussed in part 1) are stretched as the foot collapses inwards and are able to store elastic energy. That stored energy can then be used to provide propulsion as the muscles ‘spring back’ to their original shape. The ability to store and generate energy in such a way is governed by individual tendon structure and it deteriorates with age as tendons lose elasticity.

Pronation the Performance Enhancer

I’ll stick my neck on the line here and state that Samuel Wanjiru would not have broken the half marathon record if we had inserted an orthotic into his shoe which prevented the pronation / eversion movement you saw in the video. The movement created the elastic energy needed to propel him at such speeds and without it, performances would have suffered.

Go Forwards and Pronate??

That’s not quite what I’m saying.. but the point I am making is that pronation is not necessarily a bad thing. Some running shops and podiatrists  conducting gait analysis, upon identifying that a runner pronates, make the snap judgement that the runner requires an ‘anti-pronation shoe’.  It would be wrong to make such assumptions and will have a potentially negative impact upon performance.

Some Things to Consider

1. If a runner has no injury history (in particular lower limb) and they visit a shop to be told that they pronate and should therefore wear anti-pronation shoes, that should be seriously questioned!

2. Based on age and tendon structure (varies each individual), some runners will be capable of pronating excessively and rarely suffer injury as a consequence.

3. If you have an injury which is caused by pronation / eversion, your first port of call should be rehab and conditioning so the tissues can handle the movement, store elastic energy and provide propulsion. Don’t instantly take the easy option and purchase inserts. If your injury is chronic, there will be cases where inserts are necessary as this is your only option to continue enjoying running.

4. The video plays extremely slowly, in real time the pronation / eversion movement is ‘super quick’. The stretch and energy return occurs within hundredths of a second as the foot ‘bounces’ on the ground. When you are doing rehab you should consider this, calf raises or lowering are all well and good, but the movement is slow and controlled, unlike reality. You need to include plyometric exercises in the rehab before you return to running.

5. As part of your regular running routine you should include simple plyometric exercises which strengthen all the tissues of the lower limb and encourage energy storage and return.