What to do when you pull a muscle? January 15, 2013

Muscle pulls can happen to any muscle in the body at just about any time. The most common ones for runners are in the upper and lower leg muscles–calves, quads, adductors, hamstrings, thighs, etc. You get the idea. No matter how hard you try to warm up, cool down, or stretch conscientiously, there’s still overuse and even fatigue that can cause a muscle pull. Accidents can also happen.

A muscle pull means that a sudden force has been applied to the muscle and its fibers were stretched beyond their capacity. A muscle pull is not as severe as a muscle tear–only a few fibers are involved, not all of them.

Muscle pulls are all treated in the same way: ice the injury and rest the muscle until swelling and pain subside. An anti-inflammatory can be helpful to reduce pain and inflammation. Apply the ice for twenty minutes on and twenty minutes off as frequently as you can in the days immediately following the injury. The pain should disappear in a few days. If not, it’s time to see a medical professional.

Try gentle stretching as soon as the muscle will tolerate it. It the muscles are not gradually re-lengthened, you may pull the muscle again because it will heal in a shortened state. Be careful not to overstretch as it might cause the muscle to spasm. When the muscle can be stretched pain free as far as the healthy one on the other side of the body, you can return to normal activity.

Depending on the muscle and the severity of the pull, it can take anywhere from a week to a month for the injury to heal sufficiently to return to your training program.

Long Distance Running Pain Management January 7, 2013

ITBS (Iliotibial Band Syndrome) is one injury that is primary experienced by long-distance runners. It presents itself as sharp or burning pain on the outside of the knee. The pain usually stops when you stop running and resumes when you begin running again.

The iliotibial band is a long, flat band of fibrous tissue that originates on the ilium (upper portion of the lateral pelvis) and extends to the tibia, just below the knee joint. It serves as a tendon for two hip muscles, the tensor fasciae lata at the front of the upper thigh and the gluteus maximus of the buttock. It helps stabilize the knee joint when the foot lands on the ground. During this landing motion, the ITB rubs over the lower portion of the femur. If the rubbing is excessive or too forceful the soft tissues become inflamed. This is known as iliotibial band syndrome.

There can be a number of causes of ITBS: running on a sloped or banked surface, not warming up or cooling down properly, increasing miles too quickly, excessive running downhill, high or low arches of the foot, or overpronation.

This tendon needs no extra strengthening as it is used in every step we take. Stretching the muscular attachments is helpful.

Lie on your back with hands at your sides and your legs out straight. Rotate your right leg outward so that your toes are pointed to the right. Lift your right leg off the floor a few inches, and keeping the knee straight, cross it over the left leg, making sure to keep your toes pointed right. You should feel your groin muscles work to hold your right leg crossed over to the left, and a tightening on the outside of your right thigh. Hold and repeat 8-12 times for each leg. Be careful not to roll over onto your hip as your right leg crosses over the left. Lying on the floor will keep your pelvis stabilized while you use opposing muscles to apply the stretching force.

If you do develop ITBS, get medical advice that goes beyond rest and anti-inflammatory medications. Symptoms will continual to return if the cause is not addressed. If you know that you overpronate, get good motion control running shoes. Try to run on flat roads and do your hill runs during low mileage weeks when your legs are strong.

 

Pronator Syndrome: A Cause of Carpal Tunnel Syndrome November 28, 2012

According to Leahy1 the most common condition caused by entrapment at the pronator teres is the carpal tunnel syndrome and “the most common site of peripheral nerve entrapment is the pronator teres.”

The median nerve can be constricted by a fibrous band within the pronator teres, by hypertrophy of the pronator teres, or can be compressed as it passes deep to both heads of this muscle.2 Leahy1 finds that the pronator teres is much more frequently involved than the actual carpal tunnel as a causative factor; that it is always necessary to evaluate and treat multiple areas of adhesion of the particular nerve which often exist before the actual symptoms appear. Other common areas affecting the median nerve may be at the subscapularis, ligament of Struthers (originating from a spur located on the anteromedial surface of the humerus about 5cm above the medial epicondyle and attaching to the medial epicondyle), or distally past the pronator teres down the forearm.

In a Mayo Clinic series,3 seven of 35 patients were operated on for carpal tunnel who later were found to have a pronator teres syndrome. In this series 50 percent of the patients with definite pronator teres syndrome had a positive Phalen’s test. It was thought that compression of the median nerve at the pronator teres caused the nerve to be more susceptible to compression at the level of the carpal tunnel. A positive Tinel’s sign associated with firmness and tenderness over the pronator teres, compared to the opposite side and associated with carpal tunnel symptoms, points to involvement at the pronator teres level.

Of course an actual pronator syndrome can exist without creating any carpal tunnel symptoms. The median nerve after crossing the elbow must pass beneath the lacertus fibrosus which is a thick fascial band extending from the biceps tendon to the forearm fascia. A thickened lacertus fibrosus could compress the median nerve by indenting the flexor muscle mass2 and visibly depress the contour of the forearm. Besides the pronator teres as described above, the median nerve may be compressed by a tight fibrous arch of the flexor digitorum superficialis.2

The most frequent symptom of pronator symptom may be a mild to moderate aching pain in the proximal forearm described as “tiredness” or “aching,”2 especially with repetitive movements. Pain may radiate to the elbow and shoulder. Dawson et al.,2 states that carpal tunnel syndrome can be differentiated by its frequency of night symptoms and exacerbation by wrist movements which pronator syndrome would not express. Apparently he does not recognize the frequency of the pronator teres as a cause of the carpal tunnel syndrome. In my practice I have found the pronator syndrome to be causative of carpal tunnel syndrome in at least 50 percent of the cases which were effectively treated by Leahy’s method of “active release” as described in articles by Leahy and Mock.4,5 In severe cases of pronator syndrome there may be weakness in the intrinsic muscles of the hand and muscles of the forearm, but usually the weakness is not severe compared to compression at the level of the anterior interosseous nerve.

To determine the level of compression of the median nerve about the elbow, Spinner6 has developed several tests which, although often negative, are significant if found positive.

Pain at the level of the lacertus fibrosus is surmised by resisting pronation of a patient’s arm which is fully supinated and flexed at the elbow. This test contracts the biceps and tightens the lacertus fibrosus.

Compression at the level of the pronator teres is determined by instructing the patient with the elbow extended to place the forearm in full pronation with the wrist in flexion. The patient resists against the examiner attempting to supinate and extend the wrist. Pain in the proximal forearm indicates possible pronator teres involvement.

Evaluation of compression of the flexor digitorum superficialis is determined by having the patient flex the proximal interphalangeal joint of the middle finger against resistance. If this test creates forearm pain there may be compression of the median nerve at the level of the superficialis arch.

The Neck-Wrist Connection November 21, 2012

 

In many cases of Carpal Tunnel Syndrome, a second source of compression occurs in the neck where the median nerve begins! Cervical vertebrae (neck bones) can misalign as a result of poor posture, bad habits like cradling a phone with your neck or sleeping on your stomach; and from previous neck trauma, like for instance, a car accident.

Doctors refer to this condition as a “double lesion neuropathy,” or “double crush syndrome.”

Even if treatment to the wrist successfully removes nerve compression in that location, symptoms will continue to persist if nerve compression in the neck remains!

Many doctors fail to examine the neck when diagnosing and treating CTS, and unfortunately, many CTS sufferers don’t get the treatment that they really need! 

Standard medical treatment for CTS typically consists of prescription pain blockers, anti-inflammatory medication, hand stretches and exercises, wrist splinting, ultrasound treatment, and massage. If these methods fail, cortisone injections to the wrist are usually done to reduce inflammation (does all of this sound familiar?). By this time, the treating doctor may order two diagnostic tests: a needle EMG and a nerve conduction velocity (NCV) test. These are uncomfortable procedures that measure muscle and nerve function. If it is determined that the nerve is not functioning properly, wrist surgery becomes the final option: an incision is made on the wrist, and the transverse carpal ligament‹a band-like ligament directly over the carpal tunnel‹is cut in half in an attempt to relieve internal pressure. This is a risky procedure that oftentimes results in accidental cutting of adjacent nerves in the hand. Surgery has also been known to result in scar tissue formation, which can actually make the condition worse. 

What is Carpal Tunnel? November 16, 2012

Do you often feel a numbness or tingling in your hands, especially at night, or when doing repetitive grasping with your hands? Perhaps you experience clumsiness in handling objects and sometimes you feel a pain that goes up the arm to as high as your shoulder. These may be the symptoms of carpal tunnel syndrome.

The median nerve travels from the forearm into your hand through a “tunnel” in your wrist. The bottom and sides of this tunnel are formed by the wrist bones and the top of the tunnel is covered by a strong band of connective tissue called the carpal ligament. This tunnel also contains nine tendons that connect muscles and bones to bend your fingers and thumb. These tendons may enlarge and swell under some circumstances. When the swelling is sufficient, it may cause the median nerve to be pressed against the strong ligament. This sometimes results in numbness, tingling in the hand, clumsiness or pain, as described above.

An Alternative Permanent Solution

FIRST, DRUGS DO NOT HEAL. The body heals itself. In most cases, drugs only mask the problem. In addition, some drugs have dangerous side effects. Drugs will never treat carpal tunnel syndrome successfully because the problem is not a deficiency of drugs in the body. Second, surgery is not a successful option either. When doctors do surgery, they are merely treating the symptoms of carpal tunnel syndrome. In most cases, carpal tunnel syndrome returns within two to three years after surgical intervention. This is due to the fact that scar tissue takes the place of the cut in the carpal ligament, again putting pressure on the median nerve.

Why is there such a big mystery around carpal tunnel syndrome? Could the problem be as simple as the muscles in the forearm tightening up, thereby cutting off circulation to the median nerve and tendons, causing the tendons to swell?

I am here to say that this is exactly the cause of carpal tunnel syndrome. Therefore, the drugs that doctors give patients will only alleviate the pain temporarily. Surgery will make the muscles tighten up even more.

Is Cracking Your Joints Bad for You? October 31, 2012

Have you ever heard the old wives tale that cracking you knuckles will give you arthritis? At this point it almost seems like common knowledge. So is this true and if so does cracking your back or neck also cause arthritis in your spine?

Numerous studies have shown that cracking knuckles do not lead to arthritis, but there is a relationship between knuckle-cracking and hand swelling, loss of lower grip strength, ligament damage, soft tissue injuries and dislocation. This is really only the result of rapid, repeated stretching of ligaments, like what happens to major league pitchers. Risk is minimal for the rest of us.

Most people crack their back or neck due to the pressure that builds up within the spine. Usually this feels like a deep tightness that is alleviated by a quick movement of the spine which releases the buildup pressure and as the result creates the popping or cracking sound.  

This phenomenon happens when you stretch the bones apart creating space between the articular cartilage and the joint capsule. That vacuum allows more dissolved gas to enter the capsule as a bubble. When the gas bubble bursts, you hear the characteristic popping sound that we all know and some of us love. The reason you can’t re-crack the involved joint immediately is that the joint needs more gas first.

So cracking your back or knuckle is not bad for you by itself, but the underlying condition that creates the need for the cracking is bad for you. If you find that you crack your back or any other joint in the body on a regular basis you should get checked out by a back specialists who can screen for spinal problems. Visit a chiropractor, physical therapist or orthopedist before your problem gets worse.

 

Choosing the Right Running Shoes October 17, 2012

Getting the right running shoes for you may be the most important preparation you do for endurance running. Your feet hit the ground around 800 times in every mile you run.  No matter how much speed work or hill work you do, or how many miles you run each week, or how well you have prepared physically for a marathon–the one thing that can end your day early is a pair of ill-fitting running shoes.

There are several things to consider when you buy running shoes. First of all, skip the department store and their cheaper prices–go to a sports store that specializes in running shoes.  The sales people will know the pros and cons of each of the brands and models of shoes they carry, and they can give you precisely the correct fit.  When you go to the store, take along the socks you normally wear running.  Plan ahead so that the running shoes you are going to use on the day of the marathon have at least 70 miles on them, including a long run.

Know your feet. The kind of running shoe you need is based on the type of foot you have.  If you are unsure, do the wet foot routine.  Wet your bare feet and walk across a surface that will reveal your footprints.  A foot with a significantly high arch will leave the impression of the heel, the ball of the foot, and the toes.  If the impression includes the entire surface of the ball of your foot and looks nearly rectangular, you have a low arch or flat foot. If you leave an outline of the middle part of the foot, it means you strike with the mid-foot and will need extra cushioning there. A foot with a high arch needs arch support and a lot of shock absorption from a shoe. A person with a flat foot overpronates and needs a stiff shoe that offers support throughout.

As always you should consult your doctor if you experience pain or discomfort in the lower extremity and hips region during your training. Having any sort of misalignment in your lower back or hips can increase the pressure on your lower extremity and ultimately can change your running gait.

Running shoes come in these four categories, and within each category are several brands and several models from each company.

Motion control shoes For people with low arches–flat feet that have moderate to severe overpronation. They need a lot of rear foot control and extra arch support. Runners who are heavy also need a good motion control shoe.

Stability For people who have low to normal arches with little to moderate overpronation. Basically, these people need cushioning in the mid-sole area of the shoe and support.

Neutral-Cushioned The so-called shoe for the normal foot if there is such a thing. For people who need a lot of midsole cushioning and not much arch support. These are for people with minimal pronation.

Performance training These are for the racers–a good shoe to stay away from unless you plan on winning the marathon.  They are ultra-light–have some stability– and are designed for people who have “no biomechanical issues,” in other words–the perfect foot. That eliminates most of the people in the universe.