Posts Tagged ‘joint pain’

From the Ground Up: Keeping your Ankles Strong and Stable

November 10, 2008

In my past few blogs I covered the shoulder, hip and knee joints. Moving on down the body – we now turn to the ankle joint. Your ankles have a tall task:  they must support the weight of your entire body with only the help of small ligaments and tendons.  Furthermore, whenever you walk, run or jump, your ankles have to transmit the force of impact from your feet to your legs.  No wonder the ankle is the most frequently injured joint in the human body.

Your ankle is a hinge joint formed by the articulation of your tibia and fibula (lower leg bones) and your talus (ankle bone).  Because your ankle is designed to move like a hinge around one axis, it is resistant to lateral movements. Typically an ankle sprain occurs when the foot is forced to invert, resulting in a sprain on the outside of the ankle.  Participating in activities that involve fast-paced lateral movements such as tennis, basketball or dance can leave your ankles vulnerable to injury, particularly if the muscles, tendons and ligaments surrounding your ankle are weak and/or inflexible.

Tight calf muscles can also lead to ankle injuries by making it difficult to flex your ankle. This isn’t a problem if you’re moving on even ground, but if you step in a gofer hole, your foot may come up short and twist laterally, resulting in a potential sprain or even fracture. When this happens, the ligaments surrounding the ankle often get overstretched. Because they aren’t very elastic, ligaments often don’t bounce back to their original supportiveness. Protect your ankles by shortening your stride when traversing uneven terrain. This will allow you to react more quickly to potential pitfalls in the trail. Also, practice walking heel-ball-toe.

Case Study

If you do injure your ankle, the pool is a great place to both rehab it and strengthen it to prevent future injuries. Deep water cycling, running and other ankle-specific exercises can help reduce swelling, restore range of motion (ROM), and gradually allow the return to normal activity.  “Bob” came to me after severely breaking his ankle while hiking in Telluride. The break was so bad that surgical pins were placed in his ankle to hold it together. After several months of aquatic therapy and aquatic workouts, the ROM and strength of Bob’s ankle were largely restored to his pre-accident level. Furthermore, he’s now back to running trails pain-free. For more information on aquatic rehab and training, please visit my website at www.bewellcoaching.com.

The key to preventing ankle injuries is to strengthen and stretch the muscles supporting the joint. Try the following three exercises and be sure to stretch your calf muscles after each exercise.

1. Heel Raises

Standing with your feet shoulder-width apart, rise up on the balls of your feet as far as possible and hold for five seconds, then lower your heels. Work up to 20 repetitions and then try the exercise on the edge of a step, lowering your heels below your toes and then raising them as high as possible. Next try walking on your heels around a room. Stretch your calves afterward by letting your heels hand off the edge of the step and holding for 20-30 seconds.

2. Toe Raises

Standing on your heels, lift your toes off the ground and hold for five seconds. Work up to 20 repetitions and then progress to walking around the room while keeping the toes elevated.

3. Edge of Foot Walking

Alternate walking on the inside edges of your feet and then on the outside. This strengthens and stretches the peroneal muscles above your ankles on the sides of your lower legs.

Be Well,

Carolyn

 

 

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The Hip Bone’s Connected to the…..

November 10, 2008

In my last blog I discussed the shoulder joint. Now, I want to take a closer look at the hip joint, formed by the junction of the pelvis and the femur (thighbone). Like the shoulder, the hip is a ball and socket joint. Unlike the shoulder, the hip joint is a deeper, more stable joint due to its weight bearing role. Moreover, in contrast to the shoulder joint, the hip joint is further stabilized by the resilient muscles and ligaments that surround and cross it.

 The hip joint is part of the so-called “pelvic girdle”. Because of this, the flexibility and strength of the muscles and ligaments surrounding and crossing the hip joint affect the pelvis and the entire spinal column. For example, some of the muscles crossing the hip have attachments on the spine so hip movements can have repercussive effects on the spine. Movements of the hip joint include flexion (moving the femur toward the pelvis); extension (moving the femur away from the pelvis); adduction (moving the femur toward the center of the body); abduction (moving the femur away from the center of the body); lateral and medial rotation (turning the femur outward or inward); and circumduction (moving the femur in a circular direction).

Common Hip Injuries

Typical hip injuries include trochanteric bursitis, hip adductor strains, osteoarthritis of the hip and hip fractures. An inflammation of the bursa, or fluid sac, of the trochanter bone, trochanteric bursitis presents as a pain in the side of the upper leg.  This inflammation can also affect the fascia (fibrous connective tissue) surrounding the hip joint. Trochanteric bursitis is often caused by a leg length discrepancy. A strain of the hip adductor muscles (commonly known as a groin pull) frequently results from quick lateral movements or slipping on wet pavement. Adductor strains can also be caused by imbalances in the body or when there’s not enough lateral movement of the ankle.

Osteoarthritis of the hip can sometimes be caused by repetitive trauma to the hip joint. If severe enough, it may necessitate a total or partial hip replacement. Hip fractures are usually one of two types:  a femoral neck fracture one-to-two inches from the joint, or an intertrochanteric fracture three-to four inches from the joint. Most require surgical repair with the use of either a pin or a compression screw and side plate to keep the bone in place while it heals.

Strength and Flexibility

When hip structures are weak and unstable, excess forces are transferred down the leg during impact exercise, leading to injuries of the knee, ankle and foot. The key to preventing hip injuries is to strengthen the muscles supporting the hips with exercises such as squats, leg presses or even stair climbing. For those with osteoarthritis of the hips, water exercise and stationary cycling are ideal. Flexibility of the hips is equally important and can be enhanced with regular yoga and stretching exercises. 

Case Study

“Lisa”, a competitive runner, came to me with chronic left hip pain. I discovered that Lisa had a leg-length discrepancy which was compounded by tight hip flexors and tight and weak hip extensors.  I recommended Lisa see a sports podiatrist to correct her leg-length discrepancy with an orthotic. I then prescribed a daily yoga routine for her, emphasizing hip-opening and gluteal strengthening postures. Today Lisa is training for her 5th marathon….pain-free! For more information on athletic training and rehab, please visit www.bewellcoaching.com.

“Bottom” Line

Right now you are sitting on the biggest muscle in your body – your gluteus maximus.  Keep it and your other gluteal muscles strong and flexible and your hips will be happy years from now.

Be well,

Carolyn

 

 

Keeping Your Shoulders Mobile AND Stable

November 9, 2008

Every time you reach for your seatbelt or wave goodbye, you rely on the impressive range of motion (ROM) of your shoulder. Unfortunately, for all of its mobility, the shoulder is also the least stable joint in your body, making it a prime target for injury.

The shoulder complex consists of a ball and socket joint and shoulder girdle whose combined actions result in your shoulder ROM. Covering the shoulder is the three-part deltoid, a thick, triangular muscle that stabilizes the shoulder and gives it a rounded appearance. The shoulder ball rests in a shallow cup and is held together by inherently weak ligaments. Its stability, therefore, is dependent on the muscles and tendons running across the joint. The risk of injury is high if these muscles are weak and/or tight, particularly when there is an imbalance in the strength and/or flexibility in your opposing muscle groups.

The key to preventing shoulder injuries is to both strengthen and stretch the muscles, tendons and ligaments supporting your shoulders, including a deep layer of small muscles and tendons known as the rotator cuff. Though they are small, the rotator cuff muscles have a big job to do, acting as stabilizers for the humerus (upper arm bone) in the shoulder socket. Rotator cuff injuries typically result from overusing the shoulder in sports such as tennis, golf or swimming. Furthermore, when the rotator cuff muscles are weak, the deltoids must bear the brunt of the work, leaving the shoulder vulnerable to injury. Repetitive stress on the shoulder causes micro tears and subsequent inflammation of the tendons or the rotator cuff muscles. The inflammation then causes pain which leads to a decreased ROM which leads to a decline in strength from inactivity.

One of my aquatic therapy clients, “Anne” came to me with not just a torn rotator cuff, but, according to her MRI, it was damaged beyond repair and her orthopedist wouldn’t operate. Apparently, years of competitive tennis had taken its toll. After 2 months of 2 times per week of aquatic therapy, however, Anne’s pain was greatly reduced and her strength and pain-free ROM had greatly increased. Furthermore, after 5 months of aquatic therapy Anne is virtually pain-free – except if she overdoes it by throwing a football to her grandson! Aquatic therapy can be very effective in treating both acute and chronic shoulder conditions. For more information, go to www.bewellcoaching.com and check out the aquatic therapy/training page.

Preventative Exercises to Stretch/Strengthen the Rotator Cuff Muscles

Shoulder Stretches

  Stretch the back of your shoulder by reaching your arm across your chest toward the opposite shoulder. Holding your arm either above or below the elbow, gently stretch your arm for 20-30 seconds.  Switch sides and repeat.

– Raise one arm and bend it behind your head to touch the opposite shoulder. Use your other hand to gently pull the arm downward. Hold for 20-30 seconds. Switch sides and repeat.

Strength Exercise for Rotator Cuff

Holding light dumbbells in each hand by your side, lift your slightly bent arms horizontally to shoulder height, keeping your thumbs pointed toward the floor. Slowly lower your arms and then return them to shoulder level. Repeat 8-12 times.

 Tips to Reduce Shoulder Wear and Tear

 1.  If your sport is unilateral (such as golf or tennis), try practicing your strokes or swings on your non-dominant side.

 2.  Make an effort to use your non-dominant arm as much as your dominant arm in all activities of daily life.

 3.  Keep your neck and shoulder muscles relaxed when you’re exercising other muscle groups.

4.  When performing water aerobics, avoid repeatedly reaching your arms over head, breaking the surface of the water.

Next time we’ll focus on another ball and socket joint, the hip.  Until then…

Be Well,

Carolyn

 

Healing Waters: Sports-Specific Aquatic Workouts – Part II

October 5, 2008

In my last blog I outlined the key benefits of aquatic athletic conditioning and rehab. Here, we’ll break it down sport by sport to look out how specifically to train in the pool.

SPORTS SPECIFIC WATER TRAINING

 

In addition to the healing power of water exercise as part of a rehabilitation program, water training can also help prevent future injuries by balancing the strength and flexibility of opposing muscle groups. To perform well in any sport you must train for the specific demands of that sport. Golfers must develop their swing, tennis players must strengthen their strokes and marathoners must run for miles. By taking the same training principles into the water, however, you can swing, run, jump and kick again and again – improving your skills and your sports-specific fitness and preventing potential injury. Sports-specific water training addresses every component of fitness, including strength, cardiovascular conditioning, flexibility and balance. Furthermore, the more you can duplicate specific sport skills in the water, the more you’ll be able to enhance your performance on land.

 

Golf

Golf is a sport that demands strength, power, stability and flexibility, particularly of the trunk muscles. Furthermore, because of the unilateral nature of golf, it is important to work both sides of your body in order to promote equal strength and flexibility. Take an old club into chest-deep water and slowly and smoothly swing through a full range of motion of your swing, noticing any choppy movements. Repeat ten times and then repeat ten more times in the opposite direction to balance your body.

 

Tennis

Like golf, tennis is predominantly a unilateral sport that relies on trunk stability. Bring an old racket or club into chest deep water and practice your forehand and backhand, concentrating on your form. For leg strength and speed, practice plyometric moves such as bounding and leapfrogging and perform shallow and deep water sprints across the pool, with recovery jogs in between. Wear a flotation belt for the deep water sprints. Finally, try some lateral “shuffling” in the shallow end to mimic the side-stepping movements you do when transitioning from a forehand to a backhand.

 

Running

Deep water running can be a great adjunct to the pounding of running on land and it can also provide an additional upper body workout – something land running doesn’t offer. Wearing a flotation belt, try running in the deep end. Simulate your land-running form as closely as possible by bending and extending your legs. Bend your arms and swing them by your sides in opposition to your legs, pointing your elbows straight behind you. Cup your hands for extra resistance. Try water running at a steady pace for 30 to 45 minutes or do some interval training. Make it even more challenging by deep water running without a flotation device.

 

Cycling

Cyclists can duplicate their workouts in deep water by wearing a flotation belt. Extend your arms in front of you as though you were grasping handlebars and cycle your legs, circling your lower leg forward as though pushing your pedals around a complete revolution. To improve your ankle flexibility and strength, plantarflex your foot (toes toward the pool bottom) during the downstroke; dorsiflex your foot (toes toward your head) during the upstroke. Incorporate some interval training into your workout.

 

Basketball

 

Basketball players must possess speed, power, aerobic and anaerobic capacity and a killer jump shot. Unfortunately, this high impact sport is injury prone and training on a hard court day after day can take its toll on your knees, back and feet. By bringing an old basketball and a partner into waist-high water you can practice your jump shot with only half the impact. Better yet, install a backboard next to your pool and you don’t even need a partner. If you’re injured you can practice your jump shot in the deep end by squatting on a kickboard and pushing off to a no-impact, standing jump. Volleyball players can also benefit from this type of training.

 

TRANSITIONING BACK TO LAND WORKOUTS

Water is also a great transition environment if you’re rehabilitating a sports injury. You can use the different depths of the pool to gradually transition back to land exercise; working first in the deep end with no impact and then in the shallow water with half of the impact of land training. In water up to your chest, you are only 50 percent of your body weight; up to your neck in water, your body is only about 10 percent of its land weight.

FINAL WORDS OF CAUTION

Though pool workouts don’t leave you hot and sweaty, you do perspire in the water particularly on a hot day. So pay attention to your hydration. Also, it is possible to overdo it in the water, particularly because aquatic exercise is virtually pain-free. Increase the duration and intensity of your water training gradually the way you would with your land workouts.

 

Whatever you sport, incorporating water training can be a fun and effective way of increasing your skills and your fitness and staving off injury. The only thing limiting you is your imagination.

Until next time….Be Well!

 

EQUIPMENT SUPPLIERS

 

Aquajogger/Excel Sports Science, Inc. (for flotation belts, tethers)

Phone: (800) 92209544

 

Sprint/Rothhammer International (general aquatic fitness supplier)

PO Box 3840

San Luis Obispo, CA 93403

Phone: (805) 541-5330

Healing Waters: Aquatic Workouts for Injured Athletes Part I

October 5, 2008

As we all know, sports- and fitness-related injuries are all too common. Fortunately, the water is an ideal environment for athletes to not only rehab their injuries, but also maintain or even increase their conditioning and their performance. In fact, the biggest misconception about aquatic sports training is that it’s only useful when injuries prevent land workouts, when in fact it can be a valuable, year-round cross-training tool for almost any sport or fitness activity.

My work as an aquatic therapist came directly as a result of my own success with aquatic rehab as an athlete. As a former competitive marathon runner, I discovered the performance benefits of aquatic athletic conditioning more than 20 years ago. Unable to train on land for several months because of injuries, I began deep water running. It allowed me to work out as hard as I wanted to without exacerbating my injuries and it saved my sanity in the process. Whereas most athletes give up aquatic training when their injuries heal, I continued training in the deep water with great results. In fact, I knocked 20 minutes off of my marathon PR (personal record). Furthermore, I was not only faster, but a stronger, more resilient runner.

From that point on I continued my aquatic cross training, had no serious injuries, knocked another eight minutes off of my marathon PR and qualified for the 2000 Olympic Marathon Trials where I placed 31st with a personal best time of 2:47:08. I truly believe aquatic athletic conditioning gave me an edge over my frequently-injured competitors by both improving my overall fitness and preventing injuries.

WATER WORKOUTS DEFINITELY AREN’T FOR WIMPS

Aquatic cross-training not only keeps you cool, it provides an intense, no- or low-impact, pain-free workout. It is the perfect complement to running, tennis, aerobics, basketball and other high impact activities. Famous athletes who have used aquatic training with great success when recovering from injuries include: heptathlete Jackie Joyner Kersee; baseball/football player Bo Jackson; tennis player John Lloyd; runner Mary Slaney; and basketball player Wilt Chamberlain.

Whether you choose swimming, deep water running or shallow water plyometrics, you can get both cardio and muscular endurance training in one workout. Furthermore, water enhances your flexibility so you’ll never leave the pool with tight, sore muscles. In fact, many people find they are able to stretch further in water as it promotes range of motion of joints and ligaments. Never flexible even as a child, I’m now – at age 41 – able to do the splits thanks to my aquatic exercise!

In my next blog I’ll focus on aquatic therapy workouts for specific sports.

Until then…Be Well!