Achilles Pain Related To Your Glute Strength

I've just had 3 patients in a row today all come and see me with pain in their Achilles. Strangely enough, all 3 had weakness in their gluteus medius muscle despite that side being their dominant (and should be stronger) leg. That was also the leg that had Achilles pain. Hence this write up.

It has been published and I've written before on how your gluteus medius (or buttock muscles) can cause knee pain especially in females. Well guess what, I just found a published paper from Australian researchers that found a link between gluteus medius and maximus weakness and Achilles pain (in male runners). Yet more confirmation on how important your gluteus medius and maximus really are.

The Australian researchers in the published paper compared 2 groups of male runners where one group had Achilles pain while the control group did not. Both groups of  runners did short runs at about 6:40 min per mile pace and the group of runners with Achilles pain were found to activate their gluteus muscles later than the group with no Achilles pain.

And not only that, their gluteal activation was also shorter in duration compared to the pain free group. This is of significance as poorer gluteal muscle activation can cause increased hip internal rotation and adduction (movement towards the midline of the body) leading to Achilles problems.

The authors are suggest retraining and strengthening gluteal muscles be included for runners with Achilles injuries.

The causes of your Achilles pain can be multifactorial, one of which can be due to your weakness in your gluteus medius and maximus as described above. Come see us at Physio and Sports Solutions to treat the cause of your Achilles pain.

Worth a look?

Reference

Smith MM, Honeywill C et al (2013). Neuromotor Control in Runners with Achilles Tendinopathy. Med Sci in Sports Ex. doi: 10.1249/MSS .0000000000000133.

*Pictures from Flickr.com

Triathletes Feel Less Pain Than Others

Me at the 2005 SEA Games on the left

We know triathletes can handle a lot of pain, especially since they need to push through pain barriers to complete their races. A new study published recently shed some light on how good triathletes are at handling pain.

Researchers at Tel Aviv University in Israel studied a group of Ironman triathlon (swim 3.8km, bike 180km and run 42.195km--yes they go through a lot of pain) triathletes and another group (who swam, ran and did other sports but do not compete in races).

Both groups of participants went through a battery of tests including one that involved applying a heating device to one arm while the other arm was submerged in cold water. In addition the participants also had to answer a questionnaire on pain perception, stress perception and fear of pain.

Compared to the other group, the triathletes displayed greater pain tolerance during the tests. They rated lower pain intensity on the pain scale and tolerated pain longer allowing the researchers concluding that triathletes can perform at high levels because they feel less pain compared to casual exercisers. What the researchers cannot decide is whether triathletes compete in triathlons because they feel less pain or they feel less pain because they train for and compete in triathlons.

My personal experience suggests the latter. Cumulative effects of hard workouts does blunt the body and mind to pain. It makes you more willing to put up with pain and tough it out until you cross the finish line.

Reference
Geva N and Defrin R (2013). Enhanced Pain Modulation Among Triathletes: A Possible Explanation For Their Exceptional Capabilities. J Int Assoc for study of Pain. doi : 10.1016/j.pain.2013.06.031

Beards Keep You Young, Healthy And Handsome

2002 Sprint World Champion Sean Eadie

Have you thrown away your razor yet? Here's why you may wanna consider tossing your razor in the trash can and how beards can be useful other than in the looks department (as some women like men with beards).

Researchers have found that men with beards and moustaches actually enjoy numerous benefits. In a study from Queensland Australia, researchers found that beards block 90-95 per cent of UV rays, thereby slowing the ageing process and reducing your risk of skin cancer. Better still if you have asthma. Pollen and dust will get caught in that bunch of facial hair of yours, lessening your chance of an attack.

Moisture is also retained by the hair keeping you young and fresh faced (probably less in Singapore since it's already so humid, but definitely in Australia).

Down side of course is that beards can spread infection if you don't look after it and it can make eating some meals real messy.

Sean Eadie with his gold medal

Reference

Paris AV, Turnbull DJ and Smith D. (2012). Dosimetric Investigation of the Solar Erythemal UV radiation Protection Provided By Berads and Moustaches. Radia Prot Dosimetry. 150 (3): p 278-282. doi: 10.1093/rpd/ncr418

*Picture from cyclingnews.com by Rochelle Gilmore

New Marathon World Record 2:03:23 Hours

Once again, the Berlin marathon has lived up to its name as the fastest marathon in the world. This is the 9th world record ran in Berlin so far, with eight coming in the last 15 years.

The man who beat the world record this year is Wilson Kipsang, from Kenya of course. Kipsang won the bronze medal at the London Olympics last year after winning the 2012 London marathon. His previous claim to fame was missing the world record by 4 seconds when he won Frankfurt marathon in 2:03:42 hours. This was less than a month after Patrick Makau set Berlin's seventh world record after running 2:03:38 hours in 2011.

Kipsang ran Berlin in 2:03:23 hours to best Makau's time by 15 seconds. He is 31 years old, in only his fourth year of racing marathons. Berlin was his 7th race.

It was a well controlled race overall. The pace makers did a good job running the first 30 km well. Kipsang's 10 km splits were 29:16, 29:03, 29:42 and 29:11. He ran an amazing 2:49 min / km for the final 2 km.

Will we see a sub 2 hour marathon soon? Exercise physiologists say it's not possible yet. We await and see what the Kenyans can do.

*Picture from Iaaf.com

Laughter Is The Best Medicine?

Have a look at pages 10-11 in today's Mind Your Body section of the Straits Times and you will see our staff being quoted as being a skeptic when asked if laughter yoga can help with improving your aerobic fitness.

Can laughing yoga really improve your aerobic fitness? Please read on to find out. It's posted in our other blog.

What Do You Do When Your Child Tears His ACL

I was at the supermarket yesterday when I met a patient of mine and his wife. After we exchanged greetings they informed me that their teenage child had just tore his anterior cruciate ligament (ACL) during football training at the Singapore Sports School recently. 

A MRI scan taken confirmed that the ACL was torn. In addition, to complicate matters,the MCL and meniscus was also damaged and there was some bone bruising as well. They then asked for my opinion on what he should do. 

I thought writing about our chance encounter would be really helpful for other parents too and so this is how today's post came about.

My immediate suggestions were to settle the inflammation, regain pain-free full range followed by strengthening the muscles around the knee joint before deciding whether he needs to reconstruct his ligament. All of which are covered in this post in our other blog.

Concurrently, they probably needed to consult a surgeon or two as to whether he needed surgery. In an earlier post, we discussed a published study in which active adults who opted for specialized rehabilitation  after tearing their ACL may not need the operation as their knees were found to be clinically stable and had no real loss in function even five years later. 

However, their teenage son is definitely different from the active adults studied. Evidence suggests that athletes definitely perform better with a reconstructed knee. They definitely needed to discuss at length with their surgeon and their son as well whether he wants to resume competitive sports. I suggested that their son be present at these discussions as he may need to explain his own medical history to his future coaches and subsequently when he reports for national service in the army as well.

One important consideration would be the graft the surgeon chooses to use. Some studies suggest that using the hamstring graft means the hamstring muscle remains weakened even up to five years after the operation despite rehabilitation. There are also cadaver ligaments although a number of studies show that these frozen and sterilized tissues may not be as strong as the bone patella tendon or hamstring option.

One final suggestion was for their child to remain in close touch with his team. He should attend training sessions and games still and help with the coaching staff if necessary. this ensures he feels he's still part of the team and keep his spirits up.

* Picture from richseow - Raffles vs ACJC  'A' Division semi finals match, 2013.

Want To Run As Fast As The Kenyans?

Want to run as fast as the Kenyans? You may need to lose some more weight. A new study suggests that Kenyan runners are fast because of their extreme thinness (and not just due to living / training from young at altitude).

For a long time it was thought that the success of Kenyan runners were due to their walking/ running long distances on their way to school while growing up. In comparison, our kids now get a ride in fancy cars from their parents or the school bus to school and play computer games after. And, of course struggle to keep up in major marathons and get their behinds kicked.

Renown scientists Yiannis Pitsiladis and Daniel Lieberman were among the group of researchers who tested the early training theory and to their (and mine) surprise found that there was not sufficient evidence supporting that. These mostly thirteen year old Kenyan kids were really active and they covered around 7.5km to and fro in their daily trips to school and back. They also did not eat any junk food. The kids who ran and walked the most to school did not actually have the highest Vo2 max scores.

Rather, what actually stood out in their research was that the kids had a really low BMI (body mass index), i.e. they were really thin. Being fit and skinny means you'll have a high Vo2 max. These "untrained" kids were found to have the potential to run a 2:18 marathon for the boys and 2:39 hrs for the girls! And these are just the groups' averages.

So bad news for the rest of the world as Kenyan runners will probably continue to dominate distance running for a while yet.

Reference

Gibson AR, Ojiambo R, Konstabel K, Lieberman DE et al (2013). Aerobic Capacity, Activity Levels and Daily Energy Expenditure in Male and Female Adolescents of the Kenyan Nandi Sub-Group. PLoS One. 8(6) : e66552. doi: 10.1371/journal.pone.0066552.

*Picture from Flick.com