Month: December 2009

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Injuries – Ankle Sprain Rehabilitation

I sprained my ankle doing the 2008 Port St Francis Summer Series Tri, and it has remained a weakness ever since. Now again I tweaked it with the first Summer Series Tri on 16 December whilst running over the rocky beach, so have started this rehab program to sort it out properly. Mike

Phase 1

1. Band resistance work

Push against a resistance band, and you should feel this strengthening the calf muscles and achilles tendon. Start with 3 sets of 10 once a day.

2. Small foot circles

Move foot around in circles against the resistance band. You should feel medial and lateral ankle ligaments lengthening.

Phase 2

3. Seated calf raise.

You should do this exercise seated to build up strength slowly. 3 sets of 10 should be performed.

Progressions

3b. Seated calf raise with barbell

Add barbell onto knees while doing calf raise

3c. Seated lateral calf raise with barbell

Add barbell onto knees while doing calf raises in a lateral direction to strengthen both lateral and medial ligaments.

4. Calf raise on stable swiss ball with base

5.Wobble board ankle ligament exercise

6. Single leg calf raises on swiss ball with base

Phase 3

7. Heel drop on box with both legs

Ensure you do not over-do this exercise and only do as many as is comfortable to start with, paying careful attention to the achilles tendon

8. Heel drop single leg

Again ensure that you do not over-do this exercise. Do not do as many as the two footed heel drop.

9. Walking calf raises.

Walk pushing yourself up on to your toes on each step. Start doing 20 steps and progress each day until you can do 100

6. Calf raises on a box

The ball of your foot must be all the way on the box. Raise yourself up then back down. There is no need to drop heels on this one.

7b. Calf raises with bar bell.

Phase 4

7. Ladder work

8. Step ups

9. Squat jumps

You must use a mat or spring floor for this exercise. You must use explosive power that comes from the quads and knees. You must not squat too low and must also not pause between jumps to keep the plyometric effect going. Focus on a fixed point otherwise you will migrate across the gym floor.

This article was taken from the Peak Performance newsletter, the number one source of sports science, training and research. Click here to access these articles as soon as they are released to maximise your performance

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Triathlon Training – 3-Part Periodization Plan for Running

Periodization can be quite a complex subject, but this article helped me to at least understand the basics. Although written specifically for running, I dare say the same principles could be applied to all three triathlon disciplines. Mike

With all the workouts you try to fit in—long runs, tempo miles, track intervals, hill repeats, strength training—sometimes it seems that in order to run well, you’d have to quit your day job to train 20 hours a week. Fortunately, you don’t have to give up your paycheck or your running. You just need to “periodize” your training.

Periodization divides a training cycle of, say, 16 to 20 weeks into phases, each with a specific goal, so you don’t have to do every type of workout all the time. In fact, you shouldn’t. The phases allow you to combine the benefits of different workouts that collectively add up to peak conditioning. And they build variety into your training, which limits your chances of hitting a plateau or suffering from fatigue or injury.

“Periodization helps you reach a higher level of performance,” says George Dallam, a professor of exercise science at Colorado State University-Pueblo and an elite triathlon coach. “It encourages you to plan your running. You’re always more successful when you plan.”

Nearly every elite runner uses periodization. The number, type, and length of phases can vary, but programs typically include a base, a preparation, and a peak period that lasts four to eight weeks, with each phase building on the previous one.

The base phase develops endurance, the foundation of any distance-running plan. Phase two, preparation, adds a layer of speed by introducing tempo runs and long repeats. “These workouts strengthen the muscles, ligaments, and connective tissues, which prepares the body for the demands of fast running,” says running coach Greg McMillan of Flagstaff, Arizona. The peak phase is characterized by short, fast workouts that simulate racing. These workouts fine-tune the speed you began in phase two by further recruiting fast-twitch muscle fibers, improving running economy (how efficiently your body uses oxygen), and strengthening muscles and connective tissue.

To peak for key races, mark your event (or events) on a calendar and use the guide below, along with your favorite training programs, to map out your base, preparation, and peak phases. Each should be four to eight weeks long (you can extend the base or preparation phase beyond eight, but not the peak, to avoid burnout). Every fourth week, recover by reducing your miles by 10 to 50 percent and easing up on strength training. And after your peak, you can start again with base training—whenever you’re ready—and work your way through the phases over and over again.

Phase 1: BASE

10 percent Speedwork
15 percent Strength
This phase emphasizes easy miles, but don’t confuse base training with fitness running. You are building a base by increasing miles and adding some speed and strength work.

Key Workouts

Endurance: The long run. “Long runs teach your body to run more efficiently,” says McMillan. Build to five to 10 miles, depending on your goals.

Pace: Easy enough that you can talk comfortably.

Speedwork: Strides, mini-tempo. Do eight to 10 x 20- to 30-second bursts of speed at the end of one or two of your easy runs. In the last few weeks of the phase, add 10 to 15 minutes of faster running (no faster than half-marathon pace) into one of your runs. “The idea is to push yourself a little, so it’s not a shock when you go faster in the next phase,” says Kristen Dieffenbach, Ph.D., a professor of athletic coaching education at West Virginia University in Morgantown.

Strength: Running-specific exercises. Do a weight workout two or three times a week, emphasizing exercises that strengthen the key running muscles — hamstrings, quadriceps, calves, and glutes.

Phase 2: PREPARATION

60 percent Endurance
15 percent Speedwork
25 percent Strength
Preparation means strengthening the body for the fast running to come, says McMillan. You continue to build endurance through long runs, but a few of your easy days become tempo miles or hill repeats.

Key Workouts

Endurance: The long run. Continue to build or maintain endurance by upping your long runs to 6 to 15 (or more) miles, depending on race distance.

Pace: Half-marathon race pace or slightly faster, or a seven or eight on a 10-point perceived-exertion scale. You can alternate your tempo runs with long repeats (miles, 1200 meters) run at 10K pace to help prepare your body for faster running.

Speedwork: Tempo runs or long repeats. Tempo running trains your system to utilize lactate instead of letting it shut you down, and also develops muscular endurance and strengthens connective tissues.

Strength: Hill running. Hills are by far the best strength training for runners, says McMillan, because they’re specific to the sport and they put the same demand on your muscles as weight training. Run them at a hard, but not all-out effort. Reduce your gym workout to once a week or upper body only.

Phase 3: PEAK

40 percent Endurance
50 percent Speedwork
10 percent Strength
You have one goal this period: speed. Gradually increase the intensity of your workouts, and as you do so, drop the overall volume (miles/hours) by about 10 percent.

Key Workouts

Endurance: The long run. Maintain endurance with long runs slightly shorter than those in Phase 2, depending on your race goals. For example, if you topped out at 14 miles in the prep phase, run 10 in this one. Shorten them further as race day approaches.

Speedwork: Two speed sessions a week dominate this phase, as well as the option to run tune-up events—shorter races to help you prepare for your main event. Focus one session on short, fast repeats, such as 400s or 800s at 5K pace. Do a tempo run or long repeats (1200s for example) for your second speed session.

Strength: Replace one speed session every third week with a hill workout to retain strength and power. You can continue your strength training once a week, maintaining the same weights and reps; or put weight-training on hold until after your race.

Author:  Christie Aschwanden  (11 Dec 2009)

http://www.active.com/running/Articles/Your_3-part_Training_Plan.htm

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Injuries – Iliotibial band friction syndrome in triathletes

Iliotibial BandA very informative article on the causes, prevention and treatment of ITB issues. Mike

What it is

The ITB is the connective tissue band that runs down the lateral side of the thigh and attaches on the lateral surface of the tibial condyle (Gerdy’s Tubercle). The ITB originates from the Tensor Fascia Latae (TFL) muscle that originates on the outer third of the antero-lateral iliac crest.

ITBFS is an overuse injury that produces pain on the lateral knee during running and, occasionally, cycling. Pain is generally caused by an unusually tight ITB, the undersurface of which frictions over the lateral femoral condyle. This occurs during knee flexion and extension at approximately 30 degrees knee flexion when running and cycling, when the ITB flicks over the lateral femoral condyle. This process leads to friction, microtrauma, inflammation – and hence pain develops.

What causes it

The two most common predisposing factors that lead to ITBFS in triathletes are anterior hip inflexibility and poor rotational control of the lower limb. First, one of the reasons that this pattern of inflexibility is frequently observed in triathletes is because of the length of time spent cycling with the hip flexed in the aero/time trial position. This prolonged activity in hip flexion can lead to muscle sarcomere shortening – and hence iliopsoas/TFL muscle tightness develops over time. This increased tension in the TFL that is transferred to the ITB can cause increased friction and pathology.

This same flexed positioning during cycling can also lead to the development of reduced rotational control in the lower limb. This can occur if the TFL muscle becomes overactive in the shortened hip-flexed position described above. The TFL internally rotates the hip and is also a synergistic hip abductor with the Gluteus Medius muscle during stance phase, preventing lateral pelvic tilt. Therefore, if the TFL develops overactivity, the Gluteus Medius can potentially become inhibited. This can lead to the lower limb being forced into internal rotation and uncontrolled pronation through the stance phase via the action of the TFL. ITB friction can then increase over the lateral femoral condyle due to this movement.

Prevention

One strategy essential for preventing this pattern from developing and potentially causing injury is regular hip flexor and quadriceps stretching. Whichever position you prefer to stretch your quadriceps muscle group (standing, kneeling, sidelying etc), keep your knees together and your gluteal muscles contracted to ensure an ideal pelvic and spinal position. The muscle groups should be stretched daily and before and after activity (especially after cycling) to optimally prevent the development of ITB symptoms. As with all stretches, they should be held for approximately 30 seconds without bouncing, performed gently and slowly to the point of tension but never pain.

Self-massage to the outer side of the thigh between the knee and the hip can also assist in reducing tightness in the ITB. Icing the distal ITB is essential after running and cycling for 20 minutes.

Lower-limb stability, strength and balance exercises are crucial in rectifying ITBFS predisposing factors. Single leg squats and lunges can remarkably improve lower-limb control if performed in front of a mirror with good alignment where the knee flexes over the middle toe. This ensures that the Gluteus Medius activates effectively and that the TFL remains underactive.

Assessing biomechanics

Another strategy used in the prevention and assessment of ITB friction syndrome is to assess the triathlete’s running and cycling biomechanics. The biomechanics of the Australian triathlon squad members are routinely assessed by their respective State Institutes of Sport and/or their individual coaches. They are performed via video analysis where coaches, physiotherapists and biomechanists can assess running and cycling technique and prescribe various drills and strategies to aim to rectify any biomechanical flaws.

In conclusion, ITBFS is a complex over-use injury that can be easily treated symptomatically but has numerous predisposing factors that if not addressed will lead to persistence and/or recurrence of symptoms.

Case study

A 35-year-old male triathlete (Olympic Distance) presented to the clinic with moderate right Æ lateral knee pain with a two week history of gradually increasing symptoms. He had never had any lower limb over-use injuries before but had sprained his right ankle many times. His training history showed a steady increase in cycling and running mileage and over the last month he had begun intensive hill work in both disciplines. He commented that his running shoes were reasonably good and that he did not wear orthotics.

His physical assessment highlighted the following factors:

  • Short stocky build with lordotic lumbar posture
  • Increased pronation (Æ > (L)) with walking and running
  • Poor proprioception and control on right side with single leg squat test
  • Weak Æ Posterior Gluteus Medius on modified Ober’s test
  • Tight Iliopsoas & ITB Æ > (L)
  • Tight and tender Æ TFL
  • Tender on palpation of the distal 2-3 cm insertional portion of the ITB over the lateral

Diagnosis

The diagnosis was ITBFS caused by an increase in training intensity over last month. An hypothesis as to the potential predisposing factors leading to the injury could be: the past Æ ankle sprains; poor propriception; poor gluteal stability; overactive TFL; tight ITB; microtrauma; inflammation/injury. One cannot exclude the triathlete’s lordotic posture with tight iliopsoas and ITB as a component of injury predisposition.

Symptomatic treatment consisted of:

  • deep tissue massage to the distal half of the ITB;
  • once daily oral anti-inflammatory medication prescribed by GP;
  • topical application of anti-inflammatory gel to tender injured area;
  • application of ice for 20 minutes daily and after cycling.

Essential rectification of his predisposing factors included:

podiatry review and orthotic prescription (Æ > (L) arch support); trigger point releases of TFL and Iliopsoas; stretching of ITB/TFL, Quadriceps, Iliopsoas; proprioceptive training of right lower limb (wobble board/single leg stance); stability training with single leg squats (shoes on with inserted orthotics).

Training modification consisted of:

  • no running for two weeks;
  • maintain cycling mileage with reduced intensity (no hills or speed training).

At two weeks, fitness tests showed symptoms were elicited after 3 km jog so the athlete started graduated programme of running every third day, increasing each run 500m from 2km starting point ensuring that he remained symptom-free.

After six weeks he was back to full intensity training (cycling and running) with no symptoms.

He still had poor balance and stability on the right leg as compared to the left but the deficit had significantly reduced. He was encouraged to continue his rehabilitation programme to rectify all predisposing factors in order to prevent a likely recurrence of injury.

Mark Alexander

Article published by the Sports Injury Bulletin