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Start the right way to reach your full sporting potential; Young sportspeople take note!

Don’t let early injuries continue to affect your sports career

Every ‘experienced’ sportsperson knows that when you are young, recovering from training sessions or injuries tends to be far easier. Parents; think back to your early sports careers and compare your recovery times then and now.

The problem with this is that from an early age many sportspeople assume sports injuries will resolve with a short period of rest, or continue participate in their activity through pain.

There are a number of risks that can be associated with continuing sport whilst ignoring an injury or resting with the hope a problem will resolve itself. Not only will your performance be limited whilst carrying an injury, but an accumulation of scar tissue or chronic inflammation could lead to recurrent injury problems and an even longer spell on the sidelines.

At The Drummond Clinic our Rehabilitation Specialists share the view that early treatment, advice and education on sports injuries will give any young sportsperson the best chance of reaching their full potential and aid in maintaining a successful and injury-free sports career.

For this reason we have created The Youth Clinic, on Mondays and Thursdays 16:00-18:00, for sportspeople under 16 years old to receive injury treatment and advice at discounted rates:

60min Consultations - £50.00 (over 20% discount)

30min Treatment - £30.00 (over 20% discount)

For more information please contact the Drummond Clinic/Sportsfeet UK on 0871 221 9394.

The foot is subjected to forces hundreds of times the bodyweight, thousands of times in a day. The ankle is a complex structure that makes weight bearing possible. It allows the foot to flex and extend and absorb the shock of the compressive forces when walking, running and jumping. The ligaments, tendons, nerves and blood vessels travel over and through the ankle joint to the foot.

The posterior tibial nerve runs down from the leg and behind the medial malleolus, the bump on the inside of the ankle, down into the foot. This nerve is protected by a fibrous sheath, called the flexor retinaculum. The flexor retinaculum, along with the bones of the ankle, forms a tunnel for this nerve (and tendons, arteries, veins) that runs through the foot. This tunnel is the tarsal tunnel. The ligament over the tunnel is meant to protect the components underneath, but if it becomes inflamed or a foreign body obstructs the tunnel, then it can become part of the problem.

What is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome, like Carpel Tunnel Syndrome in the wrist, is a compression of the nerve inside the tunnel. It is less common than its counterpart in the wrist and is sometimes simply wrapped into the foot neuropathy diagnosis. The pressure can come from injuries resulting in deformities, inflammation of the protective sheath, tumors, or other impingements on the nerve. The compression on the nerve interferes with the signals sent through the nerve, causing pain and other neuropathy in the foot.

Anatomy Involved
The ankle is formed by the tibia, fibula and talus. The medial malleolus of the tibia and the flexor retinaculum form the walls of the Tarsal Tunnel. The tibial nerve passes through the tunnel into the foot. The tunnel also houses the tendons, veins and arteries that run down into the foot on the medial (inner) side. The bones, ligaments and tendons in the foot innervated by the tibial nerve are also involved in this condition.

What causes Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome has many possible causes and in some cases doctors cannot pinpoint the exact cause. People with flatfeet may develop this condition due to the strain placed on the structures of the feet and a change in the course of the nerves and tendons running into the feet. This could cause pressure on the tibial nerve. A cyst or tumor in the area may also produce pressure on the nerve. Other abnormalities in the area that may cause this condition include varicose veins, a swollen tendon, or a bone spur.

Systemic disease processes, such as rheumatoid arthritis or diabetes, may also cause, or increase the likelihood of, this condition. The inflammation of the joint caused by arthritis will decrease the space available for the nerve, thereby increasing pressure. The veins and arteries passing through may become enlarged due to higher glucose content in diabetics, also causing more pressure on the nerve. Individuals that are overweight or obese may be prone to this condition due to excessive pressure on the posterior tibial nerve.

Injury to the ankle, due to swelling in and around the joint, may also cause pressure on the tibial nerve. Fractures or dislocations may cause the tunnel to shift slightly, or close up. A bone chip in the area of the medial malleolus may also become lodged in the tarsal tunnel, causing an impingement upon the nerve.

Signs and Symptoms
The most common symptom of this condition is pain, burning, or tingling along the inside of the ankle and down into the foot. The pain can vary from prickly points in the foot to severe burning pain along the entire foot and ankle area. The pain generally gets worse with activity, especially prolonged walking or standing and improves with rest. Pain upon palpation of the nerve may also be noted. Loss of sensation may be experienced if the condition is allowed to progress. A change in gait (a limp and overpronation) may also result if not treated promptly.

The symptoms may occur suddenly, but are often made worse by extended periods of activity. The earliest signs of pain are often ignored and the condition is allowed to progress until the nerve is compromised more severely.

Treatment
Treatment for tarsal tunnel syndrome may include rest, ice (to reduce swelling in the tunnel), NSAIDs (to help with pain and reduce inflammation) and immobilization (this may be necessary to allow the nerve and surrounding tissue to heal.) Physical therapy may be prescribed, as well. An exercise program, ultrasound and other therapies may be used to speed the healing process.

In cases where the pain and inflammation are out of control, injections of a local anesthetic and corticosteroid may be helpful. Bracing may be used in severe cases to reduce the pressure on the foot and on the nerve. Surgical intervention may be required in the most severe cases, or in those cases that do not respond to the non-surgical interventions. This generally involves decompressing the nerve by either; releasing the ligament around it, clearing the obstruction or repairing the structures in the tunnel.

Prevention
Prevention of tarsal tunnel syndrome starts with the knowledge of what causes it and avoiding those circumstances.

• Rest for the foot in between long bouts of standing or walking is important. Trying to sit down, or at least change position, during extended periods of standing or walking will help reduce the stress on the tarsal tunnel and tibial nerve.
• A proper warm up activity before beginning strenuous workouts will also help prevent injuries to the structures in and around the nerve, reducing the likelihood of compression.
• Wearing properly fitted shoes and orthotics if necessary, will reduce the strain placed on the area. Shoes that are tied incorrectly, or too tightly, can cause damage to this area, also.
• Using wraps or bracing while engaging in athletic pursuits, especially on uneven surfaces or involving sudden direction changes in traffic, may reduce the chances of an ankle injury, which could cause tarsal tunnel syndrome.
• A good strengthening program will keep the supporting muscles of the lower leg strong and reduce leg and ankle injuries. These muscles will also reduce the stress and impact on the joint with each step or landing.
• Flexibility in the muscles of the lower leg will help keep the foot in proper alignment and reduce the pull on the tendons during rest. Flexible muscles are also less likely to be injured.

Parkinson’s Disease is a progressive neurological condition which affects everyday movements such as walking, talking and writing. Dr James Parkinson (1755 – 1824) was the physician who first identified it as a specific condition. The disease is caused by a loss of nerve cells in the brain (specifically the substantia nigra) which produce the chemical dopamine, used to transmit messages to the areas of the brain that co-ordinate movement.

Symptoms of Parkinson’s are commonly tremor, which usually begins in one hand, slowness of movement and stiffness or rigidity of muscles. In practical terms, a sufferer will tend to find it difficult to initiate movements, which in turn become slower, while muscle stiffness make basic activities such as standing up or writing very difficult. Speech, swallowing and posture may also be affected. While drugs are usually prescribed to treat the symptoms (there is at present no cure), it is advisable to look at your general lifestyle to help manage the disease on an everyday basis. As movements become more and more difficult, it is easy to understand how many sufferers (not simply of Parkinson’s or any other disease, but even simply those carrying excess weight) become more sedentary – this is where exercise and a good diet are key.

Many Parkinson’s sufferers tend to breathe shallowly, limiting the amount of oxygen that can be taken in. Pilates focusses on breathing thoracically, essentially filling all of the “space” in the ribcage and getting oxygen to the muscles more efficiently. Habitual problems such as tension in the shoulders and back, as well as the “shuffling” associated with Parkinson’s may be alleviated using Pilates exercises which encourage sound movement patterns – essentially moving the limbs well by using the muscles in the correct order. The method employs exercises to improve and challenge co-ordination, balance and strength, using small and controlled movements. As we stretch the muscles and warm them up while exercising, the stiffness and rigidity associated with Parkinson’s may also be relieved. Posture will benefit directly from Pilates, by encouraging use of the strong core muscles and simply standing tall. There are many exercises which also improve dexterity, using tiny movements such as working the fingers and the toes. The beauty of Pilates is that there is no set formula for exercising – each client is an individual, and their experience of Parkinson’s is unique to them, therefore Pilates sessions must take their needs and weak points into account.

For more information on Parkinson’s Disease, visit the Parkinson’s Disease Society <http://www.parkinsons.org.uk/> . Please contact the Drummond Clinic for more information on how Pilates Exercises can help.

Alex Drummond is a director of the Drummond Clinic.  Specialising in Sport and Exercise Performance, Injury Treatment and Rehabilitation, he uses the results from a series of Physical and Functional test to alter the way the body responds to the efforts of skiing.

For the body to function at an optimal level balance (proprioception) is the most important factor in skiing.  Without it skiing is clumsey and awkward often leading to fatigue and even injury.

 Proprioception is the sense of position, posture and movement.  Poor proprioception leads to poor balance, limits skiing performance and can lead to a frustrating lack of improvement in ability, in addition poor proprioception can switch muscles off creating joint misalignments and muscular imbalances.

When one of the joints becomes stiff, injured or out of kilter, the nerves inhibit the messages going  to the surrounding muscles to avoid further injury.  This weakened muscle is disasterous for skiers because a sustained muscle contraction is needed to ski at any level.  To accommodate this the bodies alignment must be addressed to allow for better skiing with less effort.

Put a skiers imperfect balance right and they can ski with agility, strength, carving ability and economy of motion.

The use of orthotic foot beds to return the foot into neutral must be considered as an aid to strive for skiing excellence, as the foot works integrally with the knee, hips and low back. 

 ‘When this integrated system fails, other parts of the body are recruited to aid a carved turn.  The shoulders rotate, the centre of gravity falls backwards and a skid turn is the result.  It might not be due to poor technique but poor alignment, power and balance’  

 This is where a full assessment would be of great benefit.

 What is Involved?

The physical assessment lasts for 60 minutes.  We will look at your body’s symmetry, posture, flexibility, co-ordination and proprioception. Based on the findings of the assessment, recommendations will be made by means of a flexibility and postural stability programme.  Once these recommendations have been achieved, then core stability and proprioceptive training can be advised upon.

…think of it as an M.O.T. for the body.

As a population in general we are exercising more regularly, and staying active for later in life. Therefore the need to look after our bodies must be high up on our list of things to do. Much like we service our cars, a regular check on our body helps us to keep it running smoothly and efficiently.

Most of us will experience joint-related aches and pains at some point in our lives, which often impact on our work or leisure activities. These symptoms are hardly surprising, given many of us spend long hours sat behind a desk or in a car, or maybe performing a job which is quite physically demanding.

These activities place huge demands on our bodies, and as such we need to consider our posture to keep injury free. Muscles in one area may become too tight and other areas get overstretched and weak. These imbalances begin to pull at tendons, ligaments and joints to cause wear and tear and ultimately pain.

Identifying these imbalances as early as possible, helps prevent the pain becoming a chronic issue; and ultimately a limiting factor in our everyday routines.

Common problems related to poor posture include:

• Headaches
• Sore/stiff neck & shoulders
• Back ache
• Stiff joints
• Aching knees & feet

This is just some basic information to think about, but if you should require any further information or help in your quest to resolving your issues you should contact us

Definition

Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause

Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention

The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Orthotics that offer arch support for over-pronation are also important.
Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

With more and more of us exercising here is a guide to get you exercising in safe footwear.

Firstly, we have to take away the look of the footwear – The most important thing to look at is not the sole of the shoe, but the cushioning. When you notice creases in the midsole from it being constantly depressed, it is time to replace your shoes.  Take a running shoe, generally we suggest that a shoe will last for 450-500 miles before the stability of the shoe goes, so for some the life of the shoe can be used up quite quickly.  With a gym shoe/cross trainer a rough guideline to follow is that for every session the shoe is used (approx - 45 mins) this can be equated to 3 miles of use. You do the sums!

If your foot roles in or out excessively the support from the upper will diminish and can sometimes change the function of the shoe.

Body weight is also a factor when looking for the right shoe – Take the Nike Air Pegasus, this is a soft neutral shoe so for a heavier runner say over 80-85 kg (male) 65-70 kg (female) the life of the shoe will be less than something like the Mizuno Wave Creation – which is constructed more for this category.  Be careful when choosing your shoes and watch out for clever marketing as an influence when choosing a new shoe

Take a pair of your old running shoes to your local specialist running retailer. There they will be able to look at the wear pattern in the cushioning and give you specialized help. An often-made mistake is to think you may supinate (roll out) when the outside of the heel is worn down, but don’t worry - this is usually normal. What matters is exactly where the wear is.

The Iliotibial band (IT band) is a thick band of tissue that extends from the thigh, down over the knee and attaches to the tibia. When the knee bends (flexion) and straightens (extension), the IT band slides over the bony parts of the outer knee. The term IT band friction syndrome (ITBFS) refers specifically to a syndrome of lateral (outer side) knee pain related to irritation and inflammation of the bottom portion of the IT band.

As you run, flexion takes place at the hip and at the knee.  The IT band passes over the outside of the knee and friction is produced. During weight bearing activities such as running and walking, compression and friction forces increase and pain occurs. Also during weight bearing, there is a contraction of the surrounding muscles which tightens the knee joint. This leads to more friction over the outside of the knee as the IT band crosses it and pain is increased. If forces are increased the area will become intensely inflamed and IT band friction syndrome is produced.

The average jogger makes 3,000 foot strikes per mile. That is 15,000 foot impacts for every five miles. Each leg impact must bear the entire body weight by itself-because in running you only have one foot on the ground at a time. In walking, 30 percent of the time, both feet are on the ground. The force of landing is about three times your weight. that means that if you weigh 75kg, the force when you land is around 225kg. Shoe mileage should also be considered. After 500 miles most shoes retain less than 60% of their initial shock absorption capacity.

In runners with normal feet, the force of running is dissipated by the foot. However, if you have a minor abnormality in your foot setup, like high or low arches, the force of the foot strike is passed to the knee area. Biomechanical abnormalities associated with the IT band syndrome such as supination in the foot (rolling out when you foot strike) suggest that the stress about the knee will increase and possibly will cause more IT band friction. Common predisposing factors include:

• Footwear -  excessively worn on the lateral heel and outside of the shoe
• The wrong shoe – 9 times out of 10 an individual with runners knee are wearing a support shoe
• Leg length difference
• Runners with overpronation leading to increased internal rotation of the knee and increased tension to the outside of the leg.
• Running on Roads with a camber (side slope)
• Muscle Imbalance
• Foot dysfunction
• Low Back Issues

So What Can You Do?

Firstly, and most importantly the cause of the problem must be addressed.  In this case running posture or footwear is probably the primary cause.  However, it would be worthwhile consulting with a therapist who specialises in gait analysis and injury rehabilitation to ascertain the exact causes.

To get the best advice, a full Running Gait Analysis looking at footstrike, running technique, flexibility and footwear would be of great benefit.  This would identify training faults, poor technique, inflexibility and how functional and supportive your running shoes are.

It maybe a case that the needs between the left and right feet are significantly different, if this is the true then several changes may need to be made:

• To stabilise the foot and running posture it may be advisable to have a custom orthotic made to help to support the feet, legs and pelvis and prevent the stresses of imbalance, weakness and tightness.  Custom orthotic can be of great benefit not just for injury rehabilitation but for prevention and performance as well.
• Assessment of the pelvis and lower back to address any flexibility and strength Issues that may be the cause of this asymmetry.

Secondly comes

The Self-Help Guide.  There are a lot of things that can be done that will help to decrease the amount of muscular tension that would contribute to the problems at the knee.

Flexibility:  It is very important for the body to have the same muscle length and tension on the left and right sides of the body as well as to the front and back.  If there is a flexibility imbalance in any of those combinations then a problem may arise and contribute to further injury.  In this case it is essential that you stretch the tigher areas before you do any strength training.

Stretching is the best thing that you can do immediately (especially of the buttocks, IT band and Quadriceps.)

Self Help Action

• Rest and Ice – icing will decrease the amount of inflammation present.  This will help to settle the problem and decrease the pain
• Stabilise the foot with well-fitted shoes
• Consider Custom Orthotics (Fitted by specialists) buying an off the shelf product may not address the imbalances as these come as the same prescription left and right
• Avoid running on cambered roads
• Run on a variety of soft surfaces
• Avoid running down hill
• Stretching
• Carry out some strength work
• Consider changing discipline for a period of time by cross training with other sports.  If you cycle, reduce the duration and cycle at a higher cadence with a lower resistance. Try swimming, or even deep water running with the aid of an aqua-jogger belt

If you are in doubt about what to do, consult with a specialist in your area or email alex@drummondclinic.co.uk to get more information.

With a high occurrence of low back pain within running sports – Can we attribute this to Lateral Ankle Instability and or the Wrong Footwear?

In previous articles I have suggested that the selection of footwear available for orienteers is quite limited in terms of functional medial support and that choosing a trail shoe from the likes of Mizuno, Asics, Saucony or New Balance from a running shop may lead to raising the heel too much, thus making the heel & ankle potentially more unstable.

Let us look at the mechanisms that occur during an inversion sprain of the ankle, with a view to attempting to link this action to the back and pelvis

In a typical inversion ankle sprain, the foot is suddenly inverted (rolls outward), straining the lateral ligaments and leading to a pulling downward of the fibula. In addition the lateral ligaments are placed under an enormous load and may be strained.

This type of strain may cause a substantial amount of soft tissue trauma and hence a lot of swelling and bruising.  If the ankle has a history of chronic instability then no symptoms (inflammation and bruising may be present apart from pain and weakness.

Where is the link between the Ankle & the Back?

Lets first look at the Anatomy.  As mentioned earlier the lateral ligaments of the ankle attach on to the end of the fibula at the outside of the ankle, whilst the other end of the fibula is located at the outside of the knee, attaching onto this we have one of the hamstrings (biceps femoris) muscles and the illiotibial band (ITB).  Both of these structures attach above the hip joint onto the pelvis. So whilst the structures of the ankle support this area the effects of sprained ankle have far reaching effects into other parts of the body.

What happens next?

Once ankle stability has been altered there is a change in biomechanics to the other joints of the lower limb (knee and hip) and pelvis, these changes alter the way that forces are transmitted through the ankle.

One of the main changes that take place is an inhibition of the lateral hip stabilisers (Abductors) of which results in:

• Weakness to the abductors
• Increased loading to the hip joint
• Decreased stability of the Hip/Pelvic region
• Altered proprioception to the Sacroilliac & illiolumbar regions
• Increased femoral rotation
• Increased Stress to the Inside of the Knee joint
• Tightening of the ITB
• Increased Pronation (rolling in) of the foot

This all seems a little excessive for even a simple ankle sprain, but even though all of these effects happen in small proportion if left then we place an increased loading in areas that should be inherently more functional.

Is there a case for rehabilitating the injured ankle or should we just leave it to get better?

Some may say that rest is a good healer and that over time the ankle pain and swelling will disappear.  I suggest that if left to heal on its own, the chances of recurrent and chronic issues would have a greater chance to prevail.  So what should you do?

Summery of Treatment plan

• Immobilise the joint if necessary
• Reduce pain and swelling
• Maintain or increase range of movement

• Reintroduce loading of the ankle
• Increase flexibility of the calf muscles
• Increase balance at the ankle

• Introduce stability exercises to the knee, hip and pelvis
• Analyse walking/running technique
• Make sure the footwear is giving the correct amount of support
• Analyse the needs of the individual to return to full function and activity levels of that prior to the injury

Rehabilitation in most cases ceases once the individual is pain free and where most of the swelling is gone…… very little regard is placed upon a full functional return to activities for daily living let alone a full and safe return to sport.  If you choose not to carry out any rehabilitation or your treatment programme finishes early (at the end of the blue writing) then questions must be raised namely

ARE YOU INCREASING THE POTENTIAL FOR FURTHER INJURY?

Running injuries are very specific due to the repetitive nature of the sport.  Injuries are caused either by the bodies own intrinsic factors or by external extrinsic factors.

Intrinsic Factors
Extrinsic Factors
Flexibility Issues
Strength Issues
Joint Instability
Excessive Pronation
Excessive Supination
Running Shoes
Environmental Influences
-Running Surface
-Weather
Clothing

Rarely are injuries due to just one of these factors; more commonly it is a combination.  Likewise, injuries are rarely resolved by changing only one thing; usually a comprehensive approach is required.  By taking this open approach to injury rehabilitation/prevention let us look at some of the factors involved and how you can help your clients.

By understanding some of the more common running injuries, a sensible approach to prevention can be initiated early and injury can possibly be avoided altogether.  Here is a list of the most frequently presented injuries:

Runner’s Knee – generic term for pain in or around the patella
Illiotibial Band Syndrome – inflammation of illiotibial band below the knee
Tibial Stress Syndrome – generic term for shin pain
Posterior shin pain
Anterior shin splints
Compartment syndrome
Stress Fractures – generally occur in the lower third medial surface of the tibia
Metatarsal Stress Syndrome – pain in ball or dorsal surface of foot
Achillies Tendonitis – Inflammation of the Achilles tendon
Plantar Faciitis – inflammation of the Plantar Fascia (bottom of the foot)

1. Extrinsic

Footwear
With so many makes and models of running shoe available from either the ‘Specialist Running’ shops or ‘Internet sales’ sites, making the choice of what shoe to buy is made very difficult.  No longer is pulling a shoe off the shelf sufficient to ensure injury free activity.

Fact 1: every make and model of running shoe has a different prescription.  This applies even across the range of neutral cushion i.e. Asics Nimbus is different in function to the Saucony Triumph, even though the marketing suggests that they are similar in function.

Fact 2: On the whole a shoe has a lifecycle of 12 months, so more often than not when you are ready to buy a new shoe, the technical function may have changed.

So as a consumer, how are we to know what shoes are good or bad for us?  No longer is reading an article or listening to someone review a shoe sufficient in the selection process of selecting our shoes.  The process needs to be more informed.

When running the body works on a closed chain system i.e. when the foot is in contact with the ground, the forces and mechanics transmit through the leg to the spine.  This is repeated every step and means if anywhere throughout the chain is out of line then potential injuries can happen.  Add the complexity of the wrong footwear into the equation and all sorts of issues may happen.

By understanding what an individuals needs are, we are able to take out the element of guess when choosing a shoe.  There are several sources from which we can gain the relevant information:

•    Exercise & Injury History
•    Video Analysis – observing:
Initial contact
Loading response
Mid stance
Terminal Stance
Pre swing

Once we have gained this information we can start to make a selection on the prescription of the shoe.  Having made our selection, we must confirm that the shoe is doing what it says on the box (neutral cushion, anti-pronating, motion control).  However, be careful, as explained earlier not all of the same technical shoes produce the same result, it is all dependent on how the body makes the shoe work.

2. Intrinsic

Flexibility
Stretching is probably one of the most neglected and understated components of fitness.  Historically we are taught that if we stretch the right we do the same to the left - with no thought about taking issue with the tighter side. If an individual is assessed correctly, it is more likely the case that we would be presented with a list of muscle groups identifying their tighter sides – this information is very useable and more specific than a notional stretch programme.

However, some say that due to the imbalances that are created as a result of being left or right handed, that it is questionable as to whether we need to change this.  i.e. that we should always have a dominance/imbalance.

In this case the benefits of achieving symmetry are enormous; it allows the bodies natural myofascial tensions to be more balanced enabling our natural movement patterns to be carried out with joints in their optimal position and alignment.  Think about the myofascial sling systems, add an irregular tension pattern to this and the consequences are significant, maybe resulting in accumulative tissue overload, in either the muscular or fascial systems.

Given that stretching is so important, by changing the body’s setup and achieving more of a symmetrical framework – we must be aware of not leaving the body in a vulnerable state e.g. not creating too much flexibility without functional stability:

For example, if flexibility about a joint was increased there may be a period where the proprioceptive qualities of the joint are compromised; here the need to provide ‘Prehabilitation’(specific personalised programme based on injury prevention) exercises would be indicated to limit any injury occurring.

Footbeds / Orthotics – Is it a necessary intervention?
With the custom insert being quite a topical issue where more clinics/websites are purporting to have the solution for back pain and leg pain, we need to have a better understanding of what to expect when going to seek resolution.
Orthotics are custom made inserts that are placed in the shoe to support the structures of the foot.  In some cases, the foot can over-pronate, leading to excessive rolling in of the heel and collapse of the arch. The result of this could lead to abnormal and repetitive stresses to the ligaments, tendons and other connective tissue in the foot. Excessive torsional forces can be produced through the leg, resulting in an overloading response to the ligaments and tendons supporting the knee (esp. medial knee and the soft tissue in the hip, sacro-iliac and spine.  If there is an asymmetric loading pattern present, i.e. one foot pronating excessively, this will further influence biomechanical issues into the knees, hips, pelvis and spine
Making the decision to support the foot should not be taken lightly and should be an outcome of an informed physical assessment.  This should include as a minimum -
•    Exercise & Injury History
•    Video & Pressure Plate Analysis – observing:
Initial contact
Loading response
Mid stance
Terminal Stance
Pre-Swing
•    Postural & Flexibility Testing
The information gained from this process allows for a comprehensive understanding on how functional the feet are, but more importantly how the feet impact on lower limb mechanics (from the low back and pelvis downwards) and vice versa.  Unless this relationship is quantified, making an orthotic is only addressing part of the problem rather than the whole.
i.e. Once the orthotic has been made this must fit into the process for change.  When looking at running shoes, it must be noted that a large percentage of people in need of an orthotic are already in an anti-pronating shoe (Asics 2120/Kayano, Saucony Guide/Stabil, New Balance 766/1221).  If an orthotic is added to this shoe prescription, further evaluation of this unit must be made otherwise we are in danger of overstabilising the foot and loading the lateral structures of the leg and thigh, which may lead to injury and further imbalance.