As much as we hate to acknowledge it, and although there is still plenty of summer-fun left to be had, back-to-school preparation has begun! One of the best parts about going back-to-school is fall sports! I don’t know about you but my favorite fall sport is cross-country, but I may be a little biased since I ran cross-country and track in high school. Please hold back your “Run Forrest Run!” comments until the conclusion of this blog. Cross-country and long-distance running are very interesting sports because as good as running is for the body, it can also be very stressful on our joints overtime if the training program is progressed too quickly or if we have improper movement patterns. Some of the more common running injuries are as follows:
- Plantar fasciitis
- Stress fractures
- Ankle sprains
- Achilles tendinitis
- Shin splints
- Patellar tendinitis
- Hamstring strains
- Quadriceps strain
- Calf strain
- Patellofemoral pain syndrome
- Iliotibial band syndrome (ITBS)
- Groin pull
- Low back pain
According to Scott Douglas of Runner’s World, out of a group of 933 new runners, 254 met the definition of having a running injury during their first year. Of those injured runners, 15% had shin splints, 10% had patellofemoral pain (runner’s knee), 9% had a meniscus injury, 7% had Achilles tendinitis, and 5% had either plantar fasciitis or a soleus injury. Three-quarters of the injuries occurred during a given runner’s first 125 miles in the sport. To cite a specific example, individuals with a tight gastrocnemius muscle are 3 times more likely to develop metatarsalgia, plantar fasciitis and metatarsal stress fractures. As far as recovery goes, those with calf strains were back to normal running in an average of 30 to 40 days, while those with shin splints needed an average of 72 days to fully recover. Plantar fasciitis was the peskiest of the common injuries, requiring an average of 159 days to get over. Chiropractic care can be very beneficial for managing and preventing these conditions,
especially with the goal of improving the function of the entire body and therefore preventing re-injury. When we refer to function, we mean improving movement patterns, joint stabilization, muscular activation and overall performance of the body throughout everyday activities and especially during physical activity.
What Do We Do?
In addition to spinal and extremity joint manipulation, chiropractors offer various soft tissue and rehabilitative treatments such as myofascial release, dry needling, Graston or FAKTR instrument-assisted work, kinesiology taping, pulse wave ultrasound therapy, electrical stimulation, hydro-massage therapy, mechanical diagnosis and therapy (MDT), reflex locomotion and dynamic neuromuscular stabilization (DNS). Each of these modalities are a great supplement and/or primary treatment on their own. Here is a short explanation of the benefits of each:
- Myofascial release: Myofascial release refers to many different types of soft tissue (muscle) therapies with the use of hands or sometimes a tool. One such technique is called Active Release Technique (ART), which is beneficial for shortened or tight muscles and has become very popular in the sports world as well as for the general population. I myself am certified in ART. The goal of any myofascial release is to break up adhesions in the muscles, increase range of motion and reduce pain.
- Graston/FAKTR: Both Graston technique and FAKTR refer to the use of a metal instrument to break up adhesions in the muscles and increase range of motion, but also to promote blood flow to the area for healing and to re-start the inflammation process. Both are most beneficial when performed on the area during provocative movements. The idea is to provide the therapy in the movement that is most realistic to what is painful and what caused the dysfunction or injury.
- Dry Needling: Dry needling has two main treatment uses: trigger points and blood flow for healing. With treatment of trigger points, we find “tight spots” in muscles that can contribute to pain and dysfunction. We then insert very thin needles into those trigger points and twist them slightly to wrap up the covering of the muscle. The process re-orients the covering of the muscle and results in the muscle relaxing and removal of the trigger point. For the goal of increasing blood flow with dry needling, we simply insert a certain amount of needles into the area that we want to increase blood flow. This process restarts the inflammatory process and brings a bunch of blood to the area for healing. Dry needling can result in slight soreness but nothing that should last more than a day or two. The process overall involves very little pain when done efficiently
- Kinesiology Taping: With taping techniques, we can improve proprioception, swelling and provide support and bracing for functional movements. Proprioception is an awareness of where your body is in space, allowing for coordination of movements.
- Hydromassage and Electrical Stimulation Therapy: Chiropractic massage therapy using the Hydrobed and HydroLounge is an effective way to relax and unwind tight muscles and tense joints before or after a chiropractic adjustment. Pro Chiropractic offers both the HydroBed and Hydro-lounge options for patients at the Bozeman and Belgrade Montana locations. Electrical stimulation therapy is a modality that provides controlled electrical activity to the muscles. The patient may feel some muscle twitching and “buzzing.” In combo with hydro massage therapy, it helps to further relax the muscles before or after treatment.
- Mechanical Diagnosis and Therapy (MDT): The McKenzie method of Mechanical Diagnosis and Therapy is both a diagnostic and treatment technique that utilizes end-range loading of the spine and extremities (shoulder, hip, knee, ankle, foot, etc.). End-range loading means moving the joint into a specific direction repetitively. The diagnostic protocol involves classification of the patient into one of four categories, depending on how the patient responds to the movement. Derangement is the most common classification and is characterized by a mechanical obstruction to movement into a specific direction and that results in centralization of symptoms with repeated end-range loading in that direction (directional preference). Centralization means that the symptoms move towards the spine. For example, from the big toe to the knee, then to the hip and then to the low back. The treatment protocol goes hand-in-hand with the diagnostic protocol because the classification of the patient tells us what they need to do for treatment and for home-exercises: repeated end-range loading in their directional preference. The MDT philosophy stands for empowering the patient and creating self-efficacy through education and guidance from a McKenzie provider. For cross-country runners, these exercises can especially be helpful by providing therapeutic movements for the lower back, shoulders, hips, knees and ankles. These movements also work great for preventing re-injury and flare-ups.
- Dynamic Neuromuscular Stabilization (DNS): The exercises and positions are derived from developmental kinesiology, the way we develop in the first year of life. By using these positions that the body has been in the past, and in fact developed through, we can essentially hit “control-alt-delete” on the brain and re-train movement patterns and joint stabilization. The goal is to put the body back in these developmental positions to optimize joint position and activate all the right muscles around those joints. There is also an emphasis on diaphragmatic respiration (“belly breathing”) and creating intra-abdominal pressure (IAP) for core and pelvic floor stability. Rather, these concepts are actually the building blocks for each of the developmental positions. The goal is to teach the brain how to activate the proper stereotype of movement and stabilization. The combination of joint manipulation and DNS exercises is extremely powerful for the overall function of the nervous, muscular and skeletal systems.
- Reflex Locomotion: Reflex Locomotion was developed by Czech Pediatric Neurologist, Dr. Vaclav Vojta in the early 1950’s. Originally the techniques were designed to enhance motor development of the affected child. By stimulation of the exactly defined zones and specific positioning of the patient, the motor responses are activated. These responses are called global patterns. Muscles throughout the entire body are activated in a coordinated manner. Reflex Locomotion is actually where DNS developed its roots. Where DNS is based on developmental kinesiology and puts the body in positions that we progress through in the first year of life, reflex locomotion takes someone who is developing or has already developed abnormally and returns them to developmental movements through stimulation of specific points in specific positions by evoking motor responses. Those responses include coordinated movements of the trunk and extremities and are activated automatically, without conscious patient cooperation. The priority is to activate the dysfunctional muscles which aren’t entirely under his/her voluntary control but may play a key role in certain dysfunction. The goal is to passively activate muscles and make the brain aware of what movement patterns we are trying to evoke, which is an incredible segue into DNS.
Importance of Foot and Ankle Function
Most running injuries result from overload of certain joints, muscles, tendons and ligaments. Much of this stress, if not purely from too many miles put on too quickly, is due to improper movement patterns as a result of certain joints having restricted movement and other joints having too much motion. Each foot has 28 bones, 55 joints and a deep muscular system that controls stability of the leg. Improper activation of those deep muscles can predispose to injury. Also, each one of the 55 joints needs proper movement for your brain to know where your foot is in time and space. Without that awareness, the knee, hip and spine are being overworked to coordinate movements of the legs. Chiropractic care can help provide proper muscle activation, joint stabilization and mobility. Specifically, a study of a group of chronic ankle instability patients showed improved function after 4 weeks of short foot positioning during balance exercises aimed towards deep foot muscle activation.
Dr. Forrest Allen is a Chiropractor at Pro Chiropractic in
Belgrade and Bozeman, MT. He is also a 2015 MSU graduate
and has an interest in treating athletes. If you or another
family member or friend are in cross-country, track or are a
recreational runner, give the office a call.