my first half marathon

I have signed up to run in the East London Half Marathon on April the 14th, which gives me pretty much 3 months to train for it. I will be running for cancer research UK. Im 24 years old, 5ft 11in tall and I usually try and go to the gym 3 times a week but I only ever lift weight and this has stopped for 3 weeks over the festive period. I never do cardio so I have entered this race as a challenge. I have never ran more than 5 miles before which took 50 mins a year ago and I want to prove and give myself motivation to improve my cardiovascular fitness and muscular endurance. I plan to practice what I preach and train in the gym specifically to improve my running ability. This will include glute strengthening, pelvic and core stability, lower limb muscular endurance training, plyometrics on the triceps surae, proprioceptive training, flexibility, interval and long distance cardiovascular training (beach weights aswell). Im also going to improve my diet and experiement by using different recovery supplements and also recovery methods (cryotherapy, compression socks etc) to seewhat works best for me. My target is to run the 13.2 miles in under 2 hours.

Day 1 (16th Jan 2013)

Weight: 92kgimage(3)

I went to the gym to start my training for the half marathon today and warmed up with a 5 min cycle with dynamic stretches for the lower limb. I then got on the treadmill and set the pace at 10km which is roughly the pace for a 2 hour half marathon and I wanted to push myself and see how long I could last. This time would then be my baseline figure for me to improve upon each week. The first ten minutes were a real struggle but after that I soon got into a rhythm until 35minutes when my running technique resorted to looking like Quasee Modo, but I lasted 40.46 mins at 10km and covered 6.69km and was impressed with how long I lasted considering I had done very little Cardiovascular training in 12 months.


 
treadmill 1

After I had finished on the treadmill I had good intentions to do so glute strengthening after but after cooling down with a brisk walk on the treadmill for 10 minutes and static stretching of my gastroc, soleus, hamstrings, quads and glutes for 30 seconds I was officially done. During my run I could see that my right hip was falling down during the swing phase (showing a trendelenburg sign) so I need to get my left glutes firing and pelvis more stable.

My food intake for the day was fruit and fibre bran flakes with milk for breakfast, sardines and toast for lunch, half a chicken and coleslaw for dinner with an apple and 3 cups of coffee throughout the day and a protein shake after my workout.

Il be updating my training regime and diet throughout and I will also be experimenting with recovery supplements and methods throughout the weeks.

plantar fasciitis: function, assessment and treatment

Introduction

Plantar fasciitis is a chronic injury which causes pain and inflammation at the origin of the plantar fascia on the plantar surface of the heel. The pain is exacerbated in the mornings after getting up or after long rest periods. Plantar fasciitis is frequently seen in athletic populations, but it is also observed in the sedentary population. Chronic inflammation and may also cause calcification at the origin of the plantar fascia and bony traction spur formation. Ten percent of the population experience plantar heel pain at some point during their lifetime and plantar fasciitis accounts for approximately 1% of all outpatient visits to orthopaedic clinics. (Crawford, 2005; Lee et al., 2007).

Functional Anatomy

The plantar fascia is a broad band of fibrous tissue that normally measures 3mm-3.8 mm in thickness which runs along the bottom surface of the foot, from the heel to the toes. It forms the medial longitudinal arch of the foot. It comprises of three bundles: central, lateral, and medial. It is the principle static and dynamic stabiliser of the longitudinal arches of the foot. It also acts as a shock absorber and helps to protect the underlying soft tissues.

During the toe off portion of gait cycle, the windlass effect on the plantar fascia of the plantar fascia tightening this raises the longitudinal arches to rise. This helps generate a more rigid foot for propulsion. During heel strike the plantar fascia relaxes, flattening the arch. This allows the foot to absorb shock and accommodate irregularities in the walking surface.

(Puttaswamaiah and Chandran, 2007).

Subjective

Pain is most frequently described as sharp rather than dull and is especially prominent first thing in the morning when the patients place their feet on the ground for the first time.

People frequently report that walking helps initially, and they often try to stretch the longitudinal arch to try and break down what they feel are painful adhesions. Although walking helps initially, the pain reoccurs with further exertion.

Objective

Biomechanical analysis of the lower limb, assessing the kinetic chain during functional movements (squat, single leg squat, running technique etc)

Excessive pronation of the foot during gait (pes planus)

Reduced ROM with ankle Dorsiflexion

Tight triceps surae (Gastrocnemius/Soleus)

Pain on passive Dorsiflexion of ankle

Pain on palpation of plantar fascia at calcaneal origin.

Abductor Hallucis tightness.

Navicular drop lower on affected side

Positive windlass test

Differential Diagnosis

Achilles tendinopathy

Complete rupture of the plantar fascia.

Subcalcaneal bursitis.

Medial calcaneal nerve entrapment (tibial nerve).

Tarsal tunnel syndrome.

Rupture fat pad Sever’s disease.

Calcaneal stress fracture.

Treatment

Massage, trigger point therapy to triceps surae, plantar fascia

Specific stretching should be to the gastrocnemius/soleus complex, the hamstrings and the
plantar fascia itself for 3-5 times a week, 2-3 reps for 30 secs hold (De Maio et al., 1993; Pfeffer, 1997)

Strengthening of the triceps surae, tibialis posterior and anterior abductor hallucis (to reduce navicular drop and pronation), intrinsic muscles of the foot and the medial loingitudinal arch of the foot (Guijosa et al., 2006)

Resisted inversion, eversion of the ankle

Modified heel lifts

Short foot exercise

Toe flare out

Eccentric heel drops

Orthotics can help reduce excessive pronation and foot instability however for patients to become less reliant on orthotic inserts using supportive taping and exercise to improve foot biomechanics during functional activities may be more effective and place more emphasis on the patient to strengthen their intrinsic foot muscles, supports and ankle stability.

(Guijosa, 2006;  Bartold, 2004; Jung et al., 2011)

Conclusion

Plantar fasciitis can be a cause of heel pain for recreational athletes

, long distance runners and sportsmen and women in general. It can also affect the sedentary and obese. It its most likely caused by overuse or ineffeicient biomechanics of people during functional movements. Hopefully above I have shown its function, diagnosis and treatment methods to help rehabilitate and improve on the injury.

Any comments on peoples own experience on treating or dealing with this injury would be greatly appreciated

References

Bartold, S.J. (2004). The plantar fascia as a source of pain—biomechanics, presentation and treatment Journal of Bodywork and Movement Therapies, 8 (3), 214-226.

Guijosa, A.L., Muñoz, I.,  de La Fuente, M and Cura-Ituarte. P. (2007) Fascitis plantar: revisión del tratamiento basado en la evidencia. Reumatología Clínica, 3 (4), 159–165.
Puttaswamaiah, R. and Chandran, P. (2007) Degenerative plantar fasciitis: A review of current concepts, The Foot,17(1), 3-9.

Yong Lee, S., McKeon, P. and Hertel, J. (2009)Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis
Physical Therapy in Sport,10 (1)12-18.

can vibration training reduce balance and increase injury risk?

Whole body vibration training (WBVT) is a neuromuscular training method that has become very popular over the last decade, with numerous devices becoming available for use in exercise and physical therapy. It has also become increasing popular within the sporting environment (Cardinale and Wakeling, 2005).

The delivery of vibrations (30–50Hz) to the body stimulates many biological systems. This can lead to physiological changes including stimulation of skin receptors, muscle spindles, joint mechanoreceptors and changes in neurotransmitter, cerebral activity and hormone concentrations (Schuhfried et al., 2005). Vibration strongly affects the afferent discharge from fast adapting Meissner and Pacinian corpuscles, muscle spindles and Ib afferents from GTO are also responsive to muscle vibration (Rittweger, 2010). Pacinian corpuscles respond to high frequencies of vibration (80-450Hz), whereas Meissner corpuscles respond to low frequencies (10-80Hz) (Weerakkody et al., 2007).

WBVT has been shown to improve muscular strength, power and flexibility in athletes (Wyon et al. 2010; Wilcock et al., 2009; Cochrane and Stannard, 2005; Cardinale and Bosco, 2003). However the current literature available on the use of WBVT on proprioception, postural control and balance shows varying results. Most of the research found was conducted using special populations and older adults as their subjects, which showed mixed results (Rees et al., 2009; Trans et al., 2009; Aaboe et al., 2007; Bogaerts et al., 2007; Cheung et al., 2007; Wang and Shiang, 2007; Turbanski et al., 2005; Van Nes et al., 2004). Only two studies were found that used athletic populations (Moezy et al., 2008; Mahieu et al., 2006) and they showed contrasting results. Moezy et al. (2008) studied the effects of WBVT on knee proprioception and postural stability after ACL reconstruction on national and international level athletes. They reported significant improvements in proprioception and balance. Although a trial by Mahieu et al. (2006) on the effects of WBVT versus conventional resistance training on strength and postural control on competitive skiers found that neither, WBVT or conventional resistance training had an effect on postural control.

The fact that little research has been conducted on WBVT using athletic populations,  should it be used so widely in sport and exercise?

A trial conducted last year looked at the effect of a single bout of WBVT on basketball players from the University of Central Lancashire using , The Vibrosphere® (Promedvi: Sweden) which is a unique device that combines balance and WBVT, which the manufacturers state can lead to a rapid improvement in proprioception and balance (Promedvi, 2011). Proprioception was measured using 3D biomechanical analysis of 5 single leg squats (SLS) where the participants were aiming to bend their knee to 30 degrees each time, pre the WBVT intervention and then immediately post and 5, 10 and 15 minutes post the intervention. Their proprioception was measured by how accurate they were to bend there knee to 30 degrees during the 5 SLS. The WBVT intervention had the participants stood on the Vibrosphere in a 30 degree half squat, using 1 minute of vibration : 1 minute rest, protocol for 10 minutes. The accuracy and stability of this movement was recorded using 3D motion analysis cameras and software.

WBVT intervention

Participiant on Vibrosphere

The results of this study suggest that WBVT using the Vibrosphere had a negative effect on proprioception as measured by knee joint position sense and velocity in basketball players. It showed reduced accuracy of the SLS movement post the WBVT when compared to before. It also showed participants to have increased medial movement post the WBVT intervention.

Clinical Implications

The results are clinically relevant due to some of the participants showing greater knee joint position sense (JPS) error in the Sagittal plane and increased medial movement velocity of the knee in the Coronal plane after the WBVT (Vibrosphere®) intervention.

The first figure shows a female participant performing a SLS pre the WBVT intervention. The second figure shows them immediately post the WBVT and you can see the increased medial movement and reduced proprioceptive accuracy (11.2 degree error).

As discussed earlier, the effect of WBVT on mechanoreceptors and joint stability (Rittweger, 2010; Jordan et al., 2005; Riemann and Lephart, 2002b; Thompson and Bellanger, 2002) could have lead to the increased JPS error and medial instability shown in the figure above. The increased medial movement (valgus stress) and reduced proprioceptive sense could lead to an increased risk of injury. Proprioception and balance has been shown to be responsible for a reduced injury rate with Panics et al. (2008) linking an increase in proprioceptive sense to improvements in JPS. They postulate that these measures may be responsible for a reduced incidence of injuries to the lower limbs and therefore reduced JPS could increase the risk of injury. Hewett et al. (2005) looked at female athletes who participated in high injury risk sports which included basketball, and assessed their neuromuscular control during a jump landing task. They found that increased dynamic valgus and high adduction stresses at the knee, increased the risk of ACL injury.

Which poses the question with the lack of research of WBVT using athletic populations and these results showing that it reduces proprioception, which could lead to an increased injury risk. Is it a safe training method to do prior to physical activity or sport?

Reference List

Cardinale, M. and Wakeling, J. (2005) Whole body vibration exercise: are vibrations good for you? Br J Sports Med, 39 (9), 585-589.

Fontana, T.L., Richardson, C.A. and Stanton, W.R. (2005) The effect of weight-bearing exercise with low frequency, whole body vibration on lumbosacral proprioception: a pilot study on normal subjects. The Australian journal of physiotherapy, 51 (4), 259–63.

Schuhfried, O., Mittermaier, C., Jovanovic, T., Pieber K. and Paternostro-Sluga, T. (2005) Effects of whole body vibration training in patient with multiple sclerosis. Clin Rehabil, 19, 834–42.

Benarroch, E.E. (2006) Basic neurosciences with clinical applications. Philadelphia, USA: Butterworth Heinemann. 595.

Cochrane, D.J. and Stannard, S.R. (2005) Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players.  British journal of sports medicine, 39 (11), 860–5.

Wilcock, I.M., Whatman, C., Harris, N. and Keogh, J.W.L. (2009) Vibration Training: Could It Enhance the Strength, Power, or Speed of Athletes? Journal of Strength & Conditioning Research, 23 (2), 593-603.

Wang, L.T. and Shiang, T-Y. (2007) Effects of Random Whole-Body Vibration on Postural Control Muscle Performance and Mobility in Elderly People. Journal of Biomechanics, 40 (2), S355.

Van Nes, I.J.W., MD; Geurts, A.C.H., MD, PhD; Hendricks, H.T. and Duysens, J. (2004) Short-Term Effects of Whole-Body Vibration on Postural Control in Unilateral Chronic Stroke Patients: Preliminary Evidence. American Journal of Physical Medicine & Rehabilitation, 83 (11), 867-873.

Turbanski, S., Haas, C.T.,Schmidtbleicher, D., Friedrich, A. and Duisberg, P. (2005) Effects of random whole-body vibration on postural control in Parkinson’s disease. Res Sports Med. 13 (3), 243-56.

Trans, T., Aaboe, J., Henriksen, M., Christensen, R., Bliddal, H. and Lund, H. (2009) Effect of whole body vibration exercise on muscle strength and proprioception in females with knee osteoarthritis. The Knee, 16, 256–261.

Rees, S.S., Murphy, A.J. and Watsford, M.L. (2009) Effects of whole body vibration on postural steadiness in an older population. Journal of Science and Medicine in Sport, 12, 440–444.

Promedvi, 2011. Vibrosphere-Balance with Vibration. [online] Available at http://www.promedvi.com/vibrosphere.aspx [Accessed 10th February 2011].

Panics, G., Tallay, A., Pavlik, A. and Berkes, I. (2008) Effect of proprioception training on knee joint position sense in female handball players. Br J Sports Med,42 (5), 472-476.

Gilman, S. (2002) Joint position sense and vibration sense: anatomical organisation and assessment. J Neurol Neurosurg Psychiatry, 73, 473–477.