Common soft tissue injuries and how Pilates can prevent them

- by Pippa Flanagan (APA Sports Physiotherapist)

Runners usually exhibit a large amount of strength in their lower limb muscles however often at the cost of flexibility, lumbo-pelvic/hip stability and core strength.  If not detected early, an increase in running training load can potentially reinforce bad movement patterns and muscle imbalances, which can lead to an increased risk of soft tissue injuries and time away from the sport.

 

Core stability is a term commonly used to describe correct posture, stabilising muscle strength and motor control around the trunk and pelvis. Runners need to exhibit effective amounts of core and pelvic/hip stability in order to repetitively load through a single leg. Weakness through the gluteal muscles, along with tightness through anterior and lateral hip muscles can lead to poor alignment of the pelvis and hip when weight bearing through the stance leg during a cyclical running motion. This can lead to unnecessary strain through the lumbar spine, hips, knees and feet leading to common soft tissue disorders such as iliotibial band friction syndrome (lateral knee pain), patello-femoral pain syndrome  (anterior knee pain) and medial tibial stress syndrome (shin splints).

 

Iliotibial band friction syndrome (ITBFS) is commonly felt as pain or pressure on the outside of the knee that is made worse with running (or immediately after a run). Often the ITB (a muscle on the outside of the knee and hip) is extremely tight in runners and can cause excessive pressure over the outside of the knee and therefore pain.

 

 

Figure 1: www.running4women.com

 

Patellofemoral pain syndrome (PFPS) is pain felt in the anterior part of the knee that can be experienced during running or with day-to-day activities such as walking up and down stairs. The pain is reproduced with quadriceps loading, which occurs repetitively during running and therefore can make the knee pain worse.

 

Figure 2: www.kitsportschiro.com

 

Medial tibial stress syndrome (MTSS) is commonly referred to as shin splints. It is pain felt on the inside of the shin due to increased tension on the muscles that attach onto the bone. It is an extremely painful condition that if not corrected can lead to stress reactions on the bone and stress fractures which require non-weight bearing rest for up to 6 weeks.

 

Figure 3: stronglikeagirl.blogsport.com

 

Even though the above conditions are felt at different points along the lower limb, often they have a common cause that can be corrected with pilates. Weak gluteal muscles can cause a malalignment of the hips and pelvis known as a trendelenburg sign (see figure 4), whereby the opposite hip to the stance leg drops and can cause subsequent tightening of hip muscles such as the iliotibial band. This in turn causes an inward rotation at the hip and further malaligns the hip and shin leading to overpronation (or dropping of the arch of the foot), or vice versa.

Figure 4: www.tjwnscacpt.blogspot.com

 

A physiotherapist will be able to detect these problematic muscle imbalances and either treat them manually or develop an exercise program aimed at increasing the strength of the gluteal muscles, the stability and alignment of the lumbo-pelvic-hip area and therefore the overall lower limb alignment and also flexibility. Physiotherapy or clinical pilates utilises specific equipment that is able to replicate closely the movement patterns required for any sport, such as running. Because of this your rehabilitation can be very “sport-specfic” which allows optimal muscle recruitment and function for the nature of the sport. For running specifically the program should be aimed to increase gluteal and lower limb strength, control and flexibility in upright positions with fast repetitive cyclical motions and added trunk rotations.

 

So whether you’re an elite marathon runner or simply a recreational jogging enthusiast, it is advisable to seek a thorough postural and muscle length/strength assessment from a physiotherapist prior to a sudden increase in training load, for example when training for events such as the “City to Surf”. For optimal results any pilates program undertaken should be highly supervised by a physiotherapist or other qualified health professional.

 

Happy Running!

LIVe Physiotherapy offers comprehensive sport-specific assessments and exercise programs at its Applecross studio. Classes are highly supervised and individualised and health fund rebateable. Please call 9364 9599 for more information.

 

Key Words Running Injuries, Running Pilates, Soft Tissue, Exercise Programs,