sportsclinic
sportsclinic
Stretching point
BODY WORKS Q&A
You run to get fit, but are you fit to run? Chartered Physiotherapist Jenny Branigan
looks at the finer points of stretching for runners
Runner’s Achilles heel
Injuries are the bane of the runner’s life,
leading to frustration and sometimes an
early end to a New Year’s fitness programme
or a promising career.
Injuries, though, rarely occur out of the blue.
Most are caused by overuse, and develop
slowly over weeks or even months. The gradual
tightening or weakening of a structure usually
happens unnoticed until suddenly it reaches a
critical point and pain starts to disrupt a training
regime. Your body is letting you down,
struggling to keep up with training intensity
levels you are not fit to maintain, let alone
increase.
A vital part of getting fit is realising the body’s
limitations and developing awareness about the
joints and soft tissues that can break down in
THIGH WONDERS
the quest for fitness. We run to get fit. But are
we fit to run and what can we do to get fit for
running?
A good start is learning how to stretch
properly and then building basic stretches (like
the one illustrated below) into your routine.
How to stretch and when to stretch is the
subject of much debate in the scientific
literature. There are different stretching techniques recommended depending on whether
you are warming up (dynamic) or cooling down
(static) or just stretching to improve overall
flexibility levels.
Static stretches involve assuming the stretch
position slowly and holding it for 15-30
seconds. As the position is held, muscle
relaxation is triggered which then allows you to
stretch a little further. If during either stage of
the stretch discomfort is felt, you are
overstretching and this may cause injury.
Dynamic stretching uses speed of movement,
momentum and active muscular effort to bring
about a stretch. It involves multiple contractions
to replicate the complicated movements of
running or your specific sport. It features movement of the arms and legs in activity specific
patterns to stretch to the end of range, such as
kicking heels to buttocks to stretch the quadriceps muscle. The end position is not held.
The quadriceps (thighs) are a good place to
start a stretching routine and the photos and
text below explains some of the common
mistakes people make with this exercise and
how to correct them.
STRETCHING DOS AND DON’TS:
• Make sure that you are feeling the stretch in the
muscle you are trying to stretch
• Stretching should never be painful. Stretching
into pain means you are overstretching and
results in microscopic muscle tears that increase
the risk of injury
• For short-term changes, hold the stretch for 15
to 30 seconds and for maximum effect repeat
five times
• For long-term changes, hold the stretch for 30
seconds and repeat 5 times. Long term changes
will plateau after approximately six weeks
• Remember: a progressive, specific stretching
programme can decrease rehabilitation time
PHOTOS: STEPHEN MCCARTHY - SPORTSFILE.COM • ATHLETE: DAVID CAMPBELL
Quadriceps (thigh muscles) flexibility is a fundamental
requirement for running and is commonly overlooked,
resulting in significant knee injury. One of the four
muscles that makes up the quadriceps muscle group
crosses the hip and knee joints and has the
potential to cause problems in those two joints
if the fibres are tight. For that extra bit of
suppleness, try massaging your
quadriceps two/three times per week,
using your forearm and elbow for
that extra physio depth.
Alternatively, invest in a foam
roller to do it for you – making
sure to roll from hip to knee
CORRECT
…OR TRY IT LIKE THIS
We all think we know
how to stretch the quadriceps but not
many athletes actually do it correctly.
Many struggle to keep the knees and
hips in the correct position, not to
mention the balance element of the
position. You will see many runners
casually stretching as in this photo,
blissfully unaware that their
technique is all wrong
Stand and bend the knee fully on
the side to be stretched. Grasp
the top of your ankle or foot to
hold the position. Keep your
knees together and push your
hips forward to feel the front of
the thigh stretching. If you are
wobbling all over the place on
one foot, hold onto a wall, a
nearby tree or your running
buddy for support.
For a deeper and more stable stretch,
kneel onto the knee on the side to be
stretched. Bend the knee fully and grasp
the top of your ankle or foot. Then place
your other foot onto the ground as
shown to keep your balance. Try to keep
your torso upright without bending the
spine backwards. This excellent stretch is
very effective for quadriceps flexibility,
particularly the lateral fibres of the
muscle and for the illiotibial band.
– 2011 YEARBOOK
What is Achilles Tendinopathy?
Achilles Tendinopathy is a common,
degenerative, overuse tendon condition.
It manifests as pain at the back of the heel,
either at the point where the tendon inserts
on the heel bone or approx 4cm above that
point. There may be a palpable grinding,
localised swelling and the formation of a
nodule in the tendon.
The most significant pain and stiffness is
usually felt after periods of inactivity, i.e.
when first walking in the morning or getting
up after sitting for long periods. The pain
will ease as the tendon warms up only to
recur several hours later. Pain will also be
experienced while participating in activities
such as running and most significantly when
pushing off the foot or jumping.
What causes Achilles Tendinopathy?
The main factors in Achilles Tendinopathy
are:
• Wear and tear after years of running
• Sudden increase in activity levels, such
as speed, hills or mileage
• Insufficient rest periods between
training sessions
• Change in footwear
• Biomechanical problems such as
excessive pronation which overloads
the calf muscles and Achilles tendon
• Inadequate strength in the calf
muscles
• Restricted flexibility in the ankle
• Tight calf muscles
INCORRECT
18
Achilles tendon injuries are most common
among recreational runners, typically aged
between 30-50 years. Chartered Physiotherapist Jenny Branigan looks at the
causes, prevention and treatment.
2
Why is Achilles Tendinopathy such
a problem for people increasing
their mileage?
Achilles Tendinopathy is a degenerative,
rather than acute inflammatory condition;
there is usually a slower than normal
healing response in this tendon due to an
area of reduced blood flow.
It is poorly diagnosed as runners often
think they have an acute tendonitis that will
settle quickly with anti-inflammatory
medication and a few stretches. In the early
stages, there is usually a recognisable cycle
of pain aggravation by inactivity, easing of
pain as the tendon warms up, then more
pain again on cessation of that activity. This
is why many people continue to run
through this injury in the early stages, as
there is usually no pain after a few minutes
of running. This is very damaging to the
tendon and the longer this cycle continues,
the more rehabilitation will be needed.
Achilles Tendinopathy healing requires
time for collagen turnover and remodelling
of that injured tissue. This results in the
condition taking months rather than weeks
to resolve.
How can I treat Achilles Tendinopathy?
This injury will not settle down by itself, so
do not ignore it and hope for the best. Even
with prompt treatment, full resolution of
Achilles Tendinopathy may take at least
three months. A longstanding injury may
take up to six months of intense
rehabilitation.
RICE – Rest, Ice, Compression and
Elevation – can prevent further damage of
the collagen fibres. A heel raise in your shoe
will help to offload the tendon in the acute
phase. Correcting any predisposing factors
such as muscle tightness or biomechanical
issues is very important in the early stages.
Eccentric strengthening is the most vital
component in building up the tendon again
to pre-injury levels and beyond.
How can I strengthen my Achilles tendon
and what is eccentric strength work?
Eccentric calf drop training is the most
effective treatment for Achilles
Tendinopathy. The most effective way to do
this is to stand at the edge of a step and let
your heel drop down. This lengthens the
tendon while supporting your bodyweight
and is known as eccentric action. It must be
done with the knee flexed as well as
extended so both components of the
tendon get built up. It will take at least three
months to build up strength in the tendon
this way. There are no short cuts.
2011 YEARBOOK –
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