Archive for the ‘Sports Injuries’ Category

Looking in the mirror is the quickest and simplest way to see if you are too fat by everyday standards, but this alone will not give you the accurate information that you need as competitive athletes. Carrying around excess weight in any sport has got to be a distinct disadvantage as it can adversely affect strength, speed and endurance. Carrying around this extra weight is not only unnecessary, but also costly in terms of energy expenditure. In endurance sports surplus fat can reduce speed and increase fatigue. It’s like carrying a shopping bag with you as you run, it’ll make it harder for you to get up speed, slow you down as cause you to tire quickly.

Muscle is stronger and more powerful than fat although I’m sure you’ll agree it‘s much harder to acquire! If two athletes weighed 100kg, but one comprised 90 kg lean (10 kg fat) mass and the other 70 kg lean (30kg fat) mass, the leaner one would obviously have the advantage. Possibly the only sport where fat could be considered an advantage is sumo wrestling!

A fat free body however would not survive. It is important to realise that a certain amount of body fat is absolutely vital. In fact, there are two components of body fat: essential fat and storage fat. Essential fat includes the fat which forms part of your cell membranes, brain tissue, nerve sheaths, bone marrow and the fat surrounding your organs (e.g. heart, liver, kidneys). Here it provides insulation, protection and cushioning against physical damage. In a healthy person this accounts for about 3% body weight. Unfortunately for the ladies there’s additional essential fat which is sex-specific and is mostly stored in the breasts and the hips. This fat accounts for a further 5-9% a women’s body weight.

The second component of body fat is storage fat and is an important energy reserve that takes the form of fat (adipose) cells under the skin and around the organs. Fat is used virtually all the time during any aerobic activity; while sleeping, sitting, walking and in most forms of exercise. The body generally uses fat from all sites and an average person has enough fat stores for three days and nights of continuous running. In practise you’d ‘blow’ way before your stores ran out!

In terms of health risks associated with fat you can use a measurement called the Body mass Index (BMI), which classifies different grades of body weight. The BMI of a person can be calculated by dividing a person’s weight (in Kg) by the square of his or her height in metres. My BMI calculation would look like:

85 / (1.87×1.87) = 24.2

BMI Less than 20 — Under Weight

BMI 20-25 — Normal Weight (Grade 0)

BMI 25-30 — Over Weight (Grade 1)

BMI 30-40 — Obese (Grade 2)

BMI Over 40 — Severely Obese (Grade 3)

Doctors use this chart to assess a persons risk of acquiring certain health related conditions, such as heart disease.

The thing here is that when you stand on the scales you weigh everything; bone, muscle, water and fat. Therefore, you don’t know how ‘fat’ you actually are. Someone with a lot of muscle and little fat could be classed as overweight and vice versa. This is where ‘body composition’ comes into play.

The body is composed of two elements; lean body tissue (muscles, organs, bones and blood) and body fat. The proportion of these two components is called body composition. This is more important than total weight.

For example, two people may weigh the same, but have different body composition. Athletes usually have a smaller percentage of body fat and a higher percentage of lean weight than those who are less physically active. Lean body tissue is functional (useful) weight, whereas fat is non-functional in terms of sports performance.

There are various methods you could use to measure your percentage body fat however the most popular methods are with skinfold callipers or bio electrical impedance.

As a personal trainer you’re taught how to measure percentage body fat using these methods however all methods come with a certain degree of inaccuracy. Skin capllipers measure the folds of fat at various measurement points throughout the body and convert to an overall figure, however this relies on a great deal or accuracy when re-evaluating clients. I tend to use bio electrical impedance testers due to the tests being much quicker to conduct. These are electrical devices that pass a mild electrical current throughout the body to measure it’s conductivity. They can be either hand-held or small boxes with wires that attach to the body via pads.

You’re local gym should be able to provide you with a body composition test should you wish find out how you fare. Again there are guidelines as to your results based on your age group. The table below will give you some idea of where you score.

MALE
AGE    EXCELLENT  GOOD     FAIR     POOR
19-24   10.8%          14.9%     19.0%   23.3%
25-29   12.8%          16.5%     20.3%   24.4%
30-34   14.5%          18.0%     21.5%   25.2%
35-39   16.1%          19.4%     22.6%   26.1%
40-44   17.5%          20.5%     23.6%   26.9%
45-49   18.6%          21.5%     24.5%   27.6%
50-54   19.8%          22.7%     25.6%   28.7%
55-59   20.2%          23.2%     26.2%   29.3%
60+      20.3%          23.5%     26.7%   29.8%

FEMALE
AGE   EXCELLENT  GOOD    FAIR     POOR
19-24    18.9%        22.1%    25.0%   29.6%
25-29    18.9%       22.0%     25.4%   29.8%
30-34    19.7%       22.7%     26.4%   30.5%
35-39    21.0%       24.0%     27.7%   31.5%
40-44    22.6%       25.6%     29.3%   32.8%
45-49    24.3%       27.3%     30.9%   34.1%
50-54    26.6%       29.7%     33.1%   36.2%
55-59    27.4%      30.7%      34.0%   37.3%
60+       27.6%       31.0%     34.4%   38.0%

With most multi-sport events (and the associated disciplines of) being endurance based you’d expect the pro’s to be in the ranges of 6-12% for males and 8-18% for females. The minimum recommended percentages for men and women is 5% and 12% respectively.

Clearly, there is no ideal body fat percentage for any particular sport. Each individual athlete has an optimal fat range at which their performance improves yet there health does not suffer. Each of us are also genetically different which has a direct impact on our body composition and ultimately performance.

Don’t get too hung up on your own percentage body fat calculations because no matter how hard you try to change how you are now, it may just be impossible due to how we’ve been built as individuals!

Happy Training!!

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The knee is basically a hinge joint, allowing backwards and forwards motion, but it is also able to rotate slightly in on itself. The bending and straightening is controlled by the hamstring and quadriceps muscles at the back and front of the thigh bone respectively, and their size and position affects the angles the legs move at, and particularly the way that the patella (kneecap) moves. Your anatomy and the patterns of your muscle use determine many of the injuries you will suffer.

Symptoms
‘Runner’s knee’, or patello-femoral pain (PFP) occurs when the patella fails to move smoothly and centrally through the femoral groove at the lower end of the thigh bones. This is sometimes due to muscle imbalance or abnormal anatomy, but it can also be the result of another injury which causes you to favour one leg in some way.
Pain will be felt beneath or on the side of the kneecap. It will probably feel more like a soreness or nagging pain. Pain is most severe after you run up or down hills. Swelling is also present. In severe cases you may feel and eventually hear grinding as the rough cartilage rubs against cartilage when the knee is flexed.

Causes
Overpronation (excessive inward rolling of the foot) can cause the kneecap to twist sideways. The quadriceps muscles, which normally aid the proper tracking of the kneecap, can prevent the kneecap from tracking smoothly when they are fatigued or weak. A muscle imbalance between weak quadriceps and tighter hamstrings can also pull the kneecap out of its groove. Hill running (especially downhill) can aggravate the condition, as can running on the same side of a cambered road, or, in general, over-training.

Self Treatment
Stop running. Ice the knee for 10-15 minutes 2-3 times a day. Use a flexible frozen gel pack that wraps around the knee. Remember not to ice directly onto skin, use a thin towel or pillow case. Once the pain and swelling has gone, do quadriceps strengthening exercises and remember to stretch the quadriceps, hamstrings and calves regularly.
Sophisticated tests aren’t normally required. A ’sunrise’ x-ray of the flexed knee will show if your patella is abnormal, roughened or displaced, and there is little need for scans. As many cases are the result of anatomical variations, having your running gait analysed may enable appropriate corrections to be made to alleviate the problem.

Medical Treatment
If runner’s knee isn’t responding to self treatment after 3-4 weeks of active recovery, seek professional medical help. They may prescribe custom-made orthotics to control over pronation. If the condition is severe you may, at a last resort, be referred to an orthopaedic surgeon to repair/remove the damaged edge of cartilage, however steroid injections and surgery aren’t often used to treat PFP. Some physiotherapists successfully tape the patella, drawing it back towards the mid-line, and can teach you how to do this yourself. Other forms of physiotherapy will ease PFP, but controlled exercises form the mainstay of treatment.

Alternative Exercises
Pool running, swimming and rowing. Anything that doesn’t put pressure on the knee.

Preventative Measures
You should stretch and strengthen your quads, hamstrings and calves. Be sure to include single leg exercises such as the ‘split squat’ to maintain muscular balance. If you over-pronate consider moving to motion control shoes with firm mid-soles. You should never run in worn out trainers. Avoid excessive downhill running and stay off cambered roads. Don’t all of a sudden ramp up you run mileage, take a gradual approach. Incorporate rest into your training schedule and don’t try and overdo it.

If you’ve suffered from ‘runner’s knee’ before, be aware that returning to training too soon could severely knock back your chances of a full recovery.

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Most of us understand the importance of ice when it comes to treating injuries and we also know how difficult it can be to get hold of, especially if you’re out training or away from home.

The ‘Ice Bandage’ is the way forward for such dilemmas as it is ideal for treating sprains and strains and will usually reduce swelling and pain within 10 minutes.

‘Ice Bandage’ can be applied on all injuries that need cooling. The bandage applies a constant and equal pressure which prevents blood flow from gathering and reduces the swelling at the site of the injury. It contains no harmful ingredients and is ideal for treating sprains and strains to the ankle, wrist, elbow, hand, knee and back. The cooling effect can be expected to last up to two hours.

Using the bandage to ensure RICE (Rest, ice, compression & elevation) can speed up the healing process. Cooling an injury reduces the sensation of pain through the counter-irritant effect and can slow down the metabolism within the damaged tissue, which reduces muscle spasm and inflammation. This reduction in pain, swelling, heat and redness effectively aids recovery.

Ice bandage is small and light and can provide on the spot relief to injuries which occur when either training or racing. Without the need for refrigeration, the bandage is a convenient alternative to conventional ice in an emergency situation and can even be reused as a regular crepe bandage once the cooling properties have ended and the bandage is dry.

The ice bandage is available from independent pharmacies nationwide from around £3.90.

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You can’t beat a sports massage for injury prevention that you can ‘feel’. Whilst not as pleasurable as your typical ‘spa massage’, a good sports massage certainly has it’s moments and it will leave you feeling revived and ready to go again. For this reason, almost every elite endurance athlete now includes regular massage as part of their recovery and from my own experience a growing number of you guys are following suit.

Sports massage enhances recovery and helps prevent injuries in several ways. The most important effect of massage with respect to recovery is that it substantially increases blood circulation to the muscles and keeps it elevated for as long as an hour afterwards. This extra blood flow flushes metabolic wastes from the muscles, hurries in nutrients that repair muscle damage, and controls inflammation and the pain associated with it.

Massage also alleviates muscular trigger points (areas of sensitivity), mobilizes adhesions and breaks up scar tissue in the muscles, restoring normal function.

Yet another use for massage is identifying incipient injuries before they become painful during exercise, as well as muscle imbalances that could lead to injury and are probably compromising your technique, efficiency and end result. For this you should search for a massage therapist with an interest in endurance sports and even better, with experience of working with multi-sport athletes!

Sports massage may cost you anything between £25-£50+ depending on the therapists practice as well as their own experience. If money’s no object and you’re serious about performance (or you have a friend who works as a sports massage therapist), schedule one session per week during the build and peak phases of your training cycles as this is where the higher intensity sessions may start to play havoc with your bodies muscles. Some therapists may do half hour sessions, which will not cost you as much but would still allow a competent therapist to target specific muscles groups within your allotted time.

There are various other self massage techniques that you could and should practice, which you can learn from a whole host of various books and videos on the subject. If used properly, devices like the foam rollers used by physical therapists can yield some of the same benefits as sports massage, however in my own opinion you cannot beat a hands on sports massage from a therapist to fully enhance the benefits from the points mentioned above.

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Post run and cycle stretching is something we all mean to do when we ‘remember’ and ‘have the time’. The trouble is, many of us only find the time once every few months.

There are three very good reasons why you should stretch, and they are;

1. Tight muscles, tendons and ligaments restrict motion, particularly in the ankle and hip. This will shorten your run stride and restrict the full pedal revolution range of movement when cycling so that you use more energy when overcoming the stiffness to maintain a given speed. Regular stretching will counter act that improving running efficiency and cadence technique.

2. It’s quite obvious that regular post exercise stretching can be linked to a reduced chance of injury, particularly in the knees, hips and ankles.

3. Research indicates that stretching stimulates the passage of amino acids into muscles and speeds up repair. So stretching after training will help your muscles repair themselves quicker.

In recent years one particular type of stretching has been hailed as very effective, yet it’s one many people have never heard of . Proprioceptive neuromuscular facilitation (PNF) has been shown to improve flexibility by 10-15% more than normal stretching and despite its complex name, PNF stretching is simple to do. In fact, PNF stretching is made even easier to do because its best done with a partner.

Your four step guide to performing a PNF stretch
1. Relax and let you partner gently push you into a stretch as far as is comfortable.
2. Stay in this position for 10-20 seconds – don’t bounce or tense up.
3. Push back gently (approx 10-15% effort) against the pressure of your partners weight for 10 seconds.
4. Relax again and let you partner re-apply the stretch for 30 seconds (and increase it if you feel comfortable).

An example PNF stretch on the Hamstrings.
Stretcher – Lie on your back with your arms by your sides. Lift one leg off the floor as far as you can, keeping the knee as is comfortable.

Partner – Kneel behind your partners raised leg with the back of their calf against your shoulder. Place one hand on the thigh, above the knee. Gently lean forward so your weight increases the stretch on the hamstring. Perform the PNF sequence as above, then repeat on the other leg. Try to complete three full rounds of the stretch.

How not to stretch.
1. Don’t stretch cold muscles. Stretching before a run has been shown to increase the risk of injury. Perform a few functional movements such as gentle ‘walking lunges’ or ease into every run with about 5-10 minutes of walking/jogging.
2. Don’t over-stretch. Extreme flexibility is no real use to triathletes, so there’s no need to force a stretch. Over doing a stretch to the point of pain, shaking or extreme tension can cause injury just as easily as twisting your ankle.
3. Don’t bounce. It might be what you see certain professional footballers do, but trust me, it’s a sure route to damaged muscles.
4. Don’t just stretch. If you hurt yourself whilst out training, stretching will not make a bad muscle good. It’s a preventative measure not a quick cure.

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So what do you do if, despite doing everything right, you still get injured? Perhaps these are a common thoughts of yours and believe you me, it happens, even to the best of us.

Distance athletes injuries are typically overuse injuries, meaning that the body does not have the ability or time to repair the tissue breaking down during the activity. For some injuries you may be able to continue to train. For others you should take a week or more off from running.

To work out how much (if any) downtime you need, you first need to determine the severity of your injury.

Type 1: Pain after activity only.
Type 2: Pain during and after activity, but not severe enough to make you cut short a workout.
Type 3: Pain during activity so severe that you give up early.
Type 4: Chronic, unremitting pain that makes you want to surgically remove a part of your body.

You can continue to run with Type 1 or 2 pain, as long as you understand and address what’s causing the symptoms (e.g. tight calves causing posterior leg pain) and as long as your pain does not intensify. Listen to your body. Don’t wait until you have Type 3 or 4 pains to adjust or get help. Waiting may result in time off from training or end your competing career altogether.

Seek professional medical help if you have Type 2, 3 or 4 pain or any type of pain that does not go away after four days of active or complete rest. Consult running or athletic professionals , as they will be open to guiding you back on course. Doctors who don’t run often will simply only tell you not to run, so seek out a podiatrist, physiotherapist, sports therapist or orthopaedic specialist who runs. One of the members at your local running or triathlon club should be able to recommend a good specialist.

Over the years I’ve learnt the hard way when it comes to rehabilitating an injury, but through experience I have come to understand the value of professional assistance.

In order to keep competing, training and enjoying sport you must listen to your body and be more aware of ‘those little niggles’. Don’t wait until it’s too late!!

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Iliotibial band syndrome (ITB) is defined as an inflammatory condition of the iliotibial band. The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. This tendon runs down the side of the thigh and connects to the outside edge of the tibia (upper shinbone), below the middle of the knee joint. The iliotibial band provides stability to the knee and hip and prevents dislocation of those joints.

Signs and symptoms
Iliotibial Band Syndrome symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur.

The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground.Pain might persist after activity.

Pain may also be present below the knee, where the ITB actually attaches to the tibia.

Causes
Iliotibial Band Syndrome can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:
Training habits:
Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur.
Inadequate warm-up or cool-down.
Increasing distance too quickly or excessive downhill running .
Abnormalities in leg/feet anatomy:
High or low arches.
Overpronation of the foot.
The force at the knee when the foot strikes.
Uneven leg length.
Bowlegs or tightness about the iliotibial band. Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.
Muscle Imbalance:
Weak hip abductor muscles.

Treatment
Reduce training load and intensity so running remains ‘pain free’. Apply ice to the knee (10mins approx every 2-3 hours). Wrap the ice pack in a damp cloth.
Use non-steroidal anti-inflammatory drugs (eg. Ibuprofen) regularly for 5-7 days. Consult your pharmacist or General Practitioner for the recommended dose.
Take massage therapy to decrease tightness of the iliotibial band. You can also try using a rolling band to self-treat.
Gentle stretching of the iliotibial band approx 3 times daily, holding stretches for 30 seconds.

Prevention
Ensure appropriate footwear. You may require motion control shoes or orthotics to control over pronation. Gait analysis can be used to determine this.
Avoid excessive downhill running or running on cambered surfaces.
If running on a track alternate between running clockwise and anti-clockwise.
On full recovery from iliotibial band syndrome decrease the risk of reoccurrence by the following preventative measures:
Gradually increase training intensity.
Continue iliotibial band stretches regularly.
Ensure footwear remains correct.
Ensure adequate strengthening of the gluteals, quadriceps, hamstrings and calfs within your training program.
Avoid excessive downhill running or running on cambered surfaces.
Ensure adequate rest within your training programme.

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Plantar Fasciitis is a common foot condition that causes heel pain and pain in the sole of the foot. Plantar Fasciitis is inflammation of the Plantar Fascia, a fibrous sheath that runs most of the length of the sole of the foot. It attaches between the heel bone and the bones at the base of the toes, covering the small muscles in the sole of the foot. During walking and running, as you ‘toe-off’, the Plantar Fascia becomes taut and helps the foot act as a lever to push off with force. It is one of the primary stabilising structures of the arch on the inner side of the foot.

Inflammation of the Plantar Fascia usually occurs at the point where it attaches to the heel bone.Plantar Fasciitis is reasonably common in older individuals, where the movement in the joints of the foot has become restricted and strain on the Plantar Fascia is increased.

It may also occur in individuals who do a lot of standing, walking or sporting activities, usually as a result of overuse. It tends to be more common in females and in people who are overweight.

Signs and symptoms
Plantar Fasciitis produces foot pain over the inside of the heel and this usually radiates down the inside of the sole of the foot. This foot pain usually occurs with activity and is also typically present in the morning when taking the first steps of the day.

Plantar Fasciitis can be diagnosed by a doctor or physiotherapist, if pain is present on touching the affected area, and/or on stretching the Plantar Fascia (by pulling the toes up). The diagnosis of Plantar Fasciitis can be confirmed on an Ultrasound scan, when the fascia has a thickened appearance. In a small number of cases of heel pain, that fails to respond to normal treatment, it may be necessary to get an x-ray to rule out other conditions such as a bony spur on the heel bone or a fracture of the heel bone

Causes
There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage.

Treatments
Physiotherapy is the main treatment for this condition.

Stretching is an important treatment. If the pain is bad in the morning the foot can be stretched up by putting a towel under the forefoot and pulling up with the hands. Standing calf stretches and a night splint to hold the foot up in a partly stretched position can also be useful.

Deep massage along the plantar fascia may be useful and can be done by the sufferer once shown how by a therapist.

Ice can reduce both pain and inflammation, used from 10 to 20 minutes as an ice pack. Use care with ice and ensure your skin is protected. Do not put a freezing pack directly on your skin as this can cause frost-bite like damage.

Taping can be used by a therapist or trainer to attempt to route some of the forces through the sole along a different line.

Advice on activity modification is important as the condition may not completely resolve. Patients may need to consider alternative methods of keeping up their aerobic fitness and strength if weight-bearing activity is too painful.

Shock absorbing heel pads can be useful and should be tried as soon as the condition presents. Silicone gel pads are commonly used and are relatively cheap.

Arch supports may also be useful to restore more normal foot mechanics in cases where this has been disturbed.

Prevention
Inadequate footwear is often implicated in Plantar Fasciitis. Shoes should provide adequate support for the foot. Unsuitable footwear can increase strain of the Plantar Fascia and lead to the development of inflammation.

Insoles that support the arch on the inner side of the foot can be helpful for limiting excessive pronation and relieving stress on the Plantar Fascia and Achilles tendon.

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The Achilles tendon, named after the seemingly indestructible mythological Greek warrior, is the largest and strongest tendon in the human body. Your Achilles tendon is the large band of tissues connecting the muscles in the back of your calf to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump, or push up on your toes.

Achilles tendonitis is present when your Achilles tendon becomes inflamed or irritated.Often, Achilles tendonitis results from sports that place a lot of stress on your calf muscles and Achilles tendon. Achilles tendonitis also is often associated with a sudden increase in the intensity or frequency of exercise, hence why so many endurance based athletes suffer from the condition.When treated promptly, Achilles tendonitis is often short-lived. Left untreated, Achilles tendonitis could cause persistent pain or potentially cause your tendon to tear through lack of treatment and rehab exercises. If so, you may need surgery to correct the damage.

Fortunately, rest and over-the-counter medications to reduce your pain and inflammation may be all the treatment you need for Achilles tendonitis.

Signs and symptoms
The signs and symptoms of Achilles tendonitis often develop gradually. They include:

 - Dull ache or pain when pushing off your foot during walking or when rising on your toes

 - Tenderness over your Achilles tendon

 - Stiffness that lessens as your tendon warms up

 - Mild swelling or a “bump” on your tendon

 - A crackling or creaking sound when you touch or move your Achilles tendon

You may notice that the affected tendon is sore when you get up in the morning or after you’ve rested, improves slightly once you start moving around, and then worsens again when you increase your activity level.

If you have sudden pain and swelling near your heel and are unable to bend your foot downward or walk normally, you may have ruptured your Achilles tendon. If you’ve ruptured the tendon completely, you won’t be able to rise on your toes on the injured leg. You may feel as if you’ve been kicked in the back of your ankle. See your doctor immediately if you suspect you have an Achilles tendon rupture.

Causes
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. A sudden increase in a repetitive activity that involves the Achilles tendon can be to blame. A number of other factors can cause Achilles tendonitis, including:

Improper conditioning
Achilles tendonitis is most common among athletes whose bodies aren’t properly conditioned for their sport or activity. Inadequate flexibility and strength of the calf muscles can contribute to overload of the tendon. Frequent stops and starts during the activity, as well as activities that require repeated jumping can also increase your risk of Achilles tendonitis.

Too much, too soon
Achilles tendonitis resulting from overuse can occur when you begin a new exercise regimen. If you’re just beginning a new exercise program, be sure to stretch after exercising, and start slowly, increasing your activity over time. Don’t push yourself too quickly. Excessive hill running can also contribute to Achilles tendonitis.

Flattened arch
Flattening of the arch of your foot (excessive pronation) can place you at increased risk of developing Achilles tendonitis. This is because of the extra stress placed on you Achilles tendon when walking. If you have excessive pronation, be sure to wear shoes with appropriate support to avoid further aggravating your Achilles tendon.

Trauma or infection
In some cases, inflammation of the Achilles tendon is due to trauma or infection near the tendon.

Complications
Achilles tendonitis can progress to a degenerative condition called Achilles tendinosis, in which the tendon begins to lose its organized structure, making the tendon weaker and more fibrous. Continued stress to your Achilles tendon could cause it to tear (rupture), which may require surgery to correct the damage.

Treatments
If you’ve tried self-care measures, such as rest, ice and over-the-counter pain relievers, and they aren’t working for you, your doctor may suggest other Achilles tendonitis treatments:

Orthotic devices
A temporary foot insert (orthotic device) that elevates your heel within your shoe may relieve strain on the stretched tendon. Your doctor also might prescribe special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night that will keep the Achilles tendon stretched while you sleep.

Boot and crutches
In severe cases, your doctor may suggest a walking boot or have you use crutches to enable the tendon to heal.

Surgery
Nonsurgical treatments, including physical therapy and perhaps a change in your exercise program, should allow the tendon to heal and repair itself over a period of weeks. If these treatments aren’t effective, surgery to remove the inflamed tissue from around the tendon may be necessary; however, this is usually a last resort.
If left untreated and if the tendon continues to sustain small tears through exercise and repeated movement, the tendon can rupture under excessive stress.

Sports Massage/Physiotherapy
A sports therapist or physiotherapist will aid you to a quicker recovery be performing massage techniques and/or ultrasound on the injured Achilles tendon in order to break up scar tissue, promote healing, and increase blood flow to the injured area. Whenever I have an injury and feel rest and stretching isn’t working I always pay a visit to my local physiotherapist. The recovery rate using a private sports physiotherapist is much quicker than going through a doctor. You may have to pay for the treatment yourself if you wish to get back to full fitness as quickly as possible, however in my opinion the benefits of such services outweigh the costs.

Prevention
While it may not be possible to prevent Achilles tendonitis, you can take measures to reduce your risk:
Increase your activity level gradually. If you’re just beginning training, don’t feel like you have to be Ironman-ready in record time. Starting slowly will help you determine your limits and follow a sensible training program.

Take it easy.
If you can, avoid other activities away from your multi-sport training that place excessive stress on your tendons, especially for prolonged periods. If you can’t avoid this, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.

Choose your shoes carefully
The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes.

Stretch daily
Take the time to stretch your calf muscles and Achilles tendon in the morning very gently and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendonitis. Use steady exercise as warmups prior to your main training session.

Strengthen your calf muscles
Performing exercises such as toe raises, especially with a slow return to the ground after each toe raise, trains the muscle-tendon unit to withstand more loading force.
Cross-train. Alternate impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

Finally, if you are unsure of the extent of you injury, don’t hesitate to visit the doctor or a sports physiotherapist. With the limited time us muli-sport athletes have, you wouldn’t want to be out of action any longer than necessary would you!

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During a 10k road race earlier in the year I stumbled over what was maybe half an inch of paving stone and fell to the ground holding my ankle. For me this is quite a regular occurrence. Often when I’m competing or training, and not necessarily on uneven ground, I quite regularly experience the feeling of the ankle joint wishing to ‘give way’. In the past I have ignored the issue to a certain degree, rested for a short while and then returned to training a couple of weeks later. Following the last sprain in April I received a more intense range of therapy from my local physio involving friction massage and ultrasound, and also performed additional rehab strengthening exercise using a wobble board as well as other stability aids. So far so good, as the extra rehab seems to have done the job.

The information below will hopefully provide you with more of an understanding into the common ankle sprain and hopefully get you back to full fitness a little quicker than normal.

An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. Ankle sprains can range from mild, to moderate, and severe. Type 1 ankle sprain is a mild sprain. It occurs when the ligaments have been stretched or torn minimally. Type II ankle sprain is a moderate level of sprain. It occurs when some of the fibers of the ligaments are torn completely. Type III ankle sprain is the most severe ankle sprain. It occurs when the entire ligament is torn and there is great instability of the ankle joint.

What part of the ankle is involved?

Ligaments are tough bands of tissue that help connect bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. They are the ‘anterior talofibular ligament’ (ATFL), the ‘calcaneofibular ligament’ (CFL), and the ‘posterior talofibular ligamen’t (PTFL). The common inversion injury to the ankle usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side.

Why do I have this problem?

A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain.
The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.

A severe form of ankle sprain, called an ankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called a high ankle sprain because it involves the ligaments above the ankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting the tibia and fibula bones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.

What does an ankle sprain feel like?

Initially the ankle is swollen, painful, and may turn bruised. The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.

People who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is called ankle instability. Athletes who have ankle instability lose confidence in their ankle to support them, especially on uneven ground. They often have swelling around the ankle that doesn’t go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way, meaning it may have a tendency to twist again very easily.

People who have had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle. The ligaments that were sprained may become irritated and thickened, causing them to get pinched near the edge of the ankle joint.

What can be done for the problem?

Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability.
Ankle Sprain

The best results after an ankle sprain come when treatment is started right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the word RICE. These stand for rest, ice, compression, and elevation.

Rest: The injured tissues in the ankle need time to heal. Crutches will prevent too much weight from being placed on the ankle.
Ice: Applying ice can help ease pain and may reduce swelling.
Compression: Gentle compression pushes extra swelling away from the ankle. This is usually accomplished by using an elastic wrap.
Elevation: Supporting your ankle above the level of your heart helps control swelling.

Your doctor may also prescribe medications. Mild pain relievers help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner after an ankle sprain. These medications include common over-the-counter drugs such as ibuprofen.
As treatment progresses, it is helpful to gradually begin putting weight through the joint.
Healing of the ligaments usually takes about six weeks, but swelling may be present for several months. Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion, improve balance, and maximize strength.

Ankle Instability.

If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain.

Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation called position sense. For example, nerve sensors in your arm and hand give you the ability to touch your nose when your eyes are closed. The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint.

Many people who have ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called the peroneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability.

What will it take to make my ankle healthy again?

If you don’t need surgery you still may need to follow a program of rehabilitation and exercise. Doctors recommend that their patients work with a physical therapist for two to four weeks. Your therapist can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.

Swelling and pain are treated with ice and electrical stimulation. If swelling in the ankle is severe, therapists may also apply massage strokes from the ankle toward the knee with your leg kept in an elevated position. This helps get the swelling moving out of the ankle and back into circulation. Your therapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg.

An effective treatment for ankle sprains is disc training, which uses a circular platform with a small sphere under it. Patients place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions. This form of exercise strengthens the muscles around the ankle, and it improves joint sense (mentioned earlier).

When you get full ankle movement, your ankle isn’t swelling, and your strength is improving, you’ll be able to gradually get back to your work and sport activities. An ankle brace may be issued for athletes who intend to return quickly to their sport.

The physical therapist’s goal is to help you keep your pain under control, improve range of motion, and maximize strength and control in your ankle. When you are well under way, regular visits to the therapist’s office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program. 

Don’t just think rest itself will repair any ankle ligament injury. It is very important to seek medical advice from a physio or sports therapist as soon as possible, in order to make the quickest possible recovery and prevent any further occurances.

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