Physiotherapy for Hamstring injuries

Watching and enjoying a Gaelic football game at the weekend I witnessed the all too common occurence of the hamstring injury. Unfortunately the player had to stop play and immediately began his rehabilitation with his soon to be close acquantence, the ice pack.It has been a while now since I hung up my boots but I clearly remember the sickening feeling of tightness in the hamstring at  the start of every season. Would this be another injury interupted season spent stretching on the floor, collecting balls behind the goals at training sessions and and lying face down on the physiotherapists table? Or my personal favourite, listening to the coach tell me how in their day there was no such thing as a hamstring injury.

Gaelic Football injuries

So what has changed over the last 20 years in regards to hamstring injuries in Gaelic Games and by obvious extension all field sports including football, rugby and Australian Rules. Hamstring injures still represent the single biggest injury cited for missing games in Gaelic games and Australian rules,

 

The make up  of our muscles hasn’t changed nor has the healing process. What has changed is our knowledge and ability to facilitate recovery, identify and reduce risk factors and the importance we place on pre season conditioning.

We know that the location of the hamstring tear can determine the average time out of sport, with a tear in the upper hamstrings at the musculo-tendo junction requiring more time away from competition than a a tear in the belly of the hamstring. We better understand the relationships between both flexibility and strength of the hamstrings and the risk to injury. We also understand how best to facilitate increases in flexibility and strength of the injured hamstring.

We know that the majority of hamstring inuries occur in the stretch-contract cycle of the game i.e. during kicking or accelerating / decelerating. During this stage the hamstring is working eccentrically.We know therefore that eccentric strengthening of the hamstrings should play an important part in pre season conditioning and rehabilitation post injury. We also know that hamstring injuries occur more in the final quarter of games and training suggesting that strength and flexibility conditioning of the hamstrings should help reduce injury.Gaelic Football, Sprinting with Ball

We also know there are multiple factors hypothesised to contribute to the risk of hamstring injury. These include inadequate warm-up, fatigue, previous injury, knee muscle weakness or strength imbalance, increasing age, poor movement discrimination, poor flexibility, increased lumbar lordosis and poor running technique. We hope that by addressing these and others with each individual we can help reduce the risk of injury.

Recent research suggests that strengthening the hamstrings pre season and especially post injury plays an important part in the reduction of injury. Currently the most efficient form of hamstring strengthening is thought to be eccentric exercises. Eccentric training should be prescribed by a physiotherapist or suitably qualified member of the team’s medical team and is worlds removed from simply sitting in the gym preforming hamstring curls (the only function of which may be to tighten your hamstrings.) One form of eccentric training used is the nordic hamstring raise.

Our understanding of the predisposing factors to hamstring injuries and what constitutes best treatment practice continues to evolve. The challenge as with all injuries is to keep up to date with current research and best practice, hopefully reducing the occurrence of injury and the length of rehabilitation time.

 

 

Sports Massage and Running

Sports Massage.

The benefits of sports massage are applicable to injuries and dysfunction in all sporting fields and in treating the inevitable tension and tightness that result from prolonged work postures. But what specific benefits can it afford certain athletic populations? In this post we’ll investigate the pay-off sports massage therapy can have for runners (elite and recreational alike).

Before we can talk about how sports massage can be effective in treating runners I think it’s essential to briefly explain the kinds of dysfunction, imbalances and subsequent injuries that can result from them.

ILIOTIBIAL BAND SYNDROME

Commonly referred to as ‘Runner’s Knee’ this is lateral knee pain that is usually felt just above the insertion of the dreaded IT band on the lateral femoral condyle (inserts on the lateral condyle of the tibia). Between 0 and 30 degrees knee flexion the ITB flicks over this bony prominence (i.e. during running). The tighter the band the more pressure, friction and the more likely a resultant inflammatory nightmare will follow your 10k. It’s also worth pointing out that the tighter your ITB gets the more active your TFL or tensor fascia lata muscle gets. This is a hip internal rotator and (among other things) can cause inhibition of the gluteus maximus, reduced pelvic stability and increase the ‘dynamic Q angle’ during stance phase which can set you up for a host of other knee problems.

Where does sports massage come in? After the acute inflammatory process has settled down significant sports massage therapy can start. Myofascial release techniques can reduce tension in the ITB and subsequently reduce tone in the TFL enabling the glutes to regain their rightful place. Trigger points (focal spots of hyperirritable skeletal muscle) can cause referred pain when palpated and usually develop from chronic muscle tension left untreated. Due to its indirect fascial attachments with the glutes medius and vastus lateralis muscles, trigger points can manifest in in these areas. Specific trigger point techniques from a sports massage therapist can release these areas of accumulated tension, restoring normal function to the tissues and eliminating referred pain.

GASTRO-SOLEUS COMPLEX TIGHTNESS

Travelling further down the kinetic chain we come to another culprit that can be responsible for pain felt at the knee and again commonly tight in runners. Shortness and/or tightness from high mileage or footwear with excessive heel cushioning can result in some compensatory biomechanical changes that can adversely affect your running. When a tight calf limits dorsiflexion (point your foot upwards) the ankle tends to compensate by over-pronating (inside arch collapsing inwards). This stretches and overtime weakens the medial ligaments of the ankle and puts adverse pressure on the knee joint.

PLANTAR FASCIITIS

Moving ever so slightly further down to the bottom on the calcaneus (heel bone) brings us to yet another injury that can be caused by over-pronation, plantar fasciitis. If you’re experiencing pain on the underside of your heel or on the plantar surface of your foot (especially in the morning) that tends to ease as you walk around more you may well have plantar fasciitis. Overuse, suddenly increasing your training mileage and, as per above, tight calve muscles are again another predisposing factor to developing this condition. Sports massage can help to reduce tightness in the plantar fascia itself using a variety of different techniques either to the fascia as a whole or focusing on specific nodules of tightness.  Specific soft tissue mobilisations (SSTM) can also be used to restore flexibility to the fascia and prepare it for the loads/demands of running.

So in conclusion whether you have a pre-existing injury or not, sports massage therapy can help prevent you from developing these conditions, improve your performance by eliminating the passive drags of reduced flexibility and tissue elasticity and is a great adjunct to physiotherapy interventions.

J.Glover BSc Physiotherapist MCSP

How to solve your Tennis Elbow

To celebrate Andy Murray’s Olympic gold in the tennis, John Glover our Physiotherapist has wrote the following piece on a condition commonly called Tennis Elbow.

It’s ironic that the number of tennis players that suffer from tennis elbow are said to account for 5% of all cases (Peterson and Renström, 2001). In fact those most at risk of developing this condition are people in manual trades (carpenters, builders, electricians, painters etc) that involve repetitive wrist flexion and extension (imagine painting a wall) and also pro and supination (think of turning a screwdriver). I guess ‘Painter’s Elbow’ didn’t catch on but the terms you will commonly here used to describe this injury are: lateral elbow tendinosis, lateral epicondylitis and lateral epicondylalgia. Each of these is an attempt to describe the underlying pathological process, but what is actually going on inside that elbow of yours?

“What causes Tennis Elbow”

Ljung et al (1999) conducted biopsies on patients with tennis elbow and found no evidence of inflammatory markers while Nirschl et al (1989) and Regan et al (1992) discovered degenerative changes in the wrist common extensor tendon, synonymous with other chronic tendiopathies (achilles, and patella etc). There are still several hypotheses as to what the main cause of the pain is: raised glutamate levels (Alfredson et al, 2000); secondary hyperalgesia (Wright et al, 1992) or my favourite ‘angiofibroblastic hyperplasia’ (Brukner and Khan, 2000). This basically suggests that in response to the micro-damage to the tendon, the body deploys cells called fibroblasts that begin to lay down repair tissue (granulation tissue) which contain a lot of painful nerve endings (potentially accounting for the pain).

So what does all this mean and what’s important for you to know? Tennis elbow is essentially an overuse injury where the wrist extensor tendon (mainly extensor carpi radialis brevis) undergoes microscopic tears. The tendon has a poor blood supply leading to a continuous failed healing response as the tissue healing struggles to keep up with the demands placed upon it.

 

How do you know you have Tennis Elbow?

  • Gradual onset of pain (24-72 hours after training or manual work)
  • History of overuse or return to training after a prolonged break
  • Pain over lateral aspect of elbow (+ or – radiating pain down forearm)
  • Pain shaking hands or opening doors (turning door handle)
  • Pain on resisted wrist extension (+ or – passive wrist flexion pain)

What else could Tennis Elbow be?”

Before commencing on any Physiotherapy ot treatment regime, it’s important to confirm that the injury is actually tennis elbow by ruling out other potential conditions first. Other causes of lateral elbow pain are:

  • Referred pain from cervical or upper thoracic spine
  • Radial nerve tension
  • Radiohumeral bursitis
  • Synovitis of the radiohumeral joint
  • Posterior interosseous nerve entrapment
  • Osteochondritis dissecans (flaking of the articular cartilage and subchondral bone) of the captiellum or radius

Brukner and Khan (2000)

 

“How can I avoid Tennis Elbow?”

If you’re a tennis player correcting/adapting technique will definitely play an important preventative role in reducing abnormal stresses placed on the wrist extensor muscles (e.g. adopting a double handed back hand rather than single arm), along with ensuring adequate recovery between training sessions This shuld be done in consultation with your coach and/or Physiotherapist. Other preventative measures include checking the grip width of your racket (should be equal to the distance from the middle of your palm to the top of your middle finger) and replacing tennis balls on a regular basis.

If you’re in a manual trade, factory worker or in any job that involves repetitive stress on the forearm muscles I’d advise taking breaks when able and to regularly alternate arms i.e. not relying purely on dominant side to do all your work.

 

“How do I get rid of Tennis Elbow?”

 

Once a diagnosis of tennis elbow (lateral epicondylitis) has been confirmed your physiotherapist can talk you through a range of treatment options available to you, offer advice and education as to what movements and activities to avoid and inform you when it’s safe to return to activity. Which ones are most appropriate will depend on the severity and stage of the injury. Treatment options include:

 

  • Graduated therapeutic strengthening and stretching programme
  • Mobilisations with movement (MWM)
  • Sports taping / Counterforce bracing
  • DTF (Deep Transverse Frictional Massage)
  • Electrotherapy

*While NSAIDS can be effective in controlling pain some evidence has shown that is can delay/impair the normal cycle of soft tissue healing (Greene, 1992).

**This is not a comprehensive treatment list but just used to give an idea of what’s involved in each stage of the rehabilitation process.

 

NON-CONSERVATIVE TREATMENTS

If your symptoms persist for more than 6-12 months and you’re unable to return to your activity/sport despite rehabilitation from a Physiotherapist then surgery may be indicated. The surgery is an arthroscopic debridement of the extensor carpi radialis brevis tendon that is generally uncomplicated and completed within 30 minutes. 80-85% of patients regain full strength and complete relief of pain although the surgery is always followed by a post-operative rehabilitation programme on week 3. Steroid injections are also another option prior to surgery if conservative measures fail to reduce pain.

 

References/Sources

  • Brukner, P., Khan, K (2000) Clinical Sports Medicine, Australia, McGraw-Hill
  • Greene, J (1992) Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis, Archives of Internal Medicine, 152:1995-2002
  • Peterson, L., Renström, P (2001) Sports Injuries: Their Prevention and Treatment (3rd Ed), United Kingdom, Taylor and Francis.
  • Ljung, BO., Forsgren S., Friden, J., (1999) Substance P and calcitonin gene-related peptide expression at the extensor carpi radialis brevis muscle origin: implications for the etiology of tennis elbow, Journal of Orthopaedic Research, 17: 554-559.
  • Nirschl, R (1989) Patterns of failed healing in tendon injury. In: Leadbetter W., Buckwalter, J, Gordon S (eds) Sports-induced Inflammation, American Academy of Orthopaedic Surgeons, Illinois, pp 577-585.
  • Regan, W., Wold, LE., Coonrad, R., Morrey., BF (1992) Microscopic histopathology of chronic refractory lateral epicondylitis, American Journal of Sports Medicine, 20: 746-749.

 

New Physiotherapy and Pilates Clinic

Please forgive this non clinical blog.

After 3 years in our old clinic and 6 months of telling everybody we were moving, we at JUMP Physiotherapy have finally moved to a bigger space. No new maps are needed, no change of address required and no new telephone number. We are still situated in the same building on the same floor just in the office next door.

Why have we moved? When you see our new bigger clinic it’ll all become obvious. We  now have available a separate Pilates studio, Physiotherapy clinic and Sports Therapy room. The new Pilates studio means we’ve been able to offer more Pilates classes (see our class timetable) as well as add to our Pilates large equipment. We now have a Pilates reformer and tower of power, a Combo chair as well as a Pilates Arc on top of all our small equipment. The Pilates studio also doubles as a Rehabilitation area for our Physiotherapy clients. So we now have an even bigger gym area for post surgery rehabilitation and physiotherapy.

We hope to be able to announce shortly a Sports Therapist and Masseuse joining our team who’ll be available for regular weekly appointments. Kieran O’ Donovan continues as our clinic’s Lead Physiotherapist, Naomi Gill continues as our Womens’ Health Physiotherapist and Andy Bond continues as our Pilates Instructor as normal. To coincide moving to a bigger Physiotherapy clinic we also launched our new website recently (JUMP Physio). Please let us know what you think. You can now follow us on Twitter @jumpphysio and @jumppilates . For those of you who don’t tweet.. we now have a newsletter you can subscribe to. Our monthly newsletter will contain updates on any new classes, special offers (yes they will be special) as well as providing, tips from our  Pilates, Physiotherapy and Sports Therapy teams. We don’t send spam or use existing e-mail addresses to contact you about changes and offers at our clinic so this will be our way of letting you decide how much information you’d like from us.

 

Of course all of these changes are done to enhance the experience of everyone attending JUMP Physio whether it is for Physiotherapy, Pilates or Sports Therapy so please let us know what you think of the space and of your experience here. Suggestions on how to improve are always taken on board.

 

JUMP Physio

 

 

Stress Fracture of the Tibia.

Although stress fractures of the tibia are a pretty rare occurence in the running population, we’ve seen two in our sports injury clinic in the last month. The causative factors in both cases were similar and caused by a combination of tight calves and insufficient recovery periods between runs. Rather than an in depth look at the causative factors and treatment of shin splints this is short post on the questions asked by our two clients in the last few days
1) Can I run with a stress fracture

No, No. No. Absolutely not, if it still hurts stop running. There is no option b.
2) How do I know if I have a stress fracture?

Clients often have pain on walking which intensifies and worsens on running with a local area of tenderness on the front of the shin. Clinically it can be diagnosed with the help of a thorough subjective history and with pain on direct or indirect percusion over the area. Although the first line of investigation is often the x-ray, it tends to be picked up earlier with both an MRI scan or a bone scan and sometimes a combination of two scans will be used to confirm the diagnosis.

3) What causes the stress fracture? -

Stress fractures can can occur in elite runners as easily in novice weekend plodders. They are thought to be the long term consequence of overloading the tissues on the anterior shin. As mentioned in a previous post  one of the the long term effects of training is bone thickening or the osteoblastic formation of new bone. Before this happens however in the short term the tissues fatigue leading to osteoclastic re absorption of bone resulting in a weaker bone. A stress fracture occurs when the weakening phase outstrips the strengthening phase and is the long term result of overloading your tissues when you run. This can be due to direct pressure on the tibia (shin) or indirect pressure through the tissues that attach onto the shin bone. A number of intrinsic and extrinsic factors are thought to contribute to the over load injury including things as varied as  duration, frequency and intensity of exercise, shoe wear,decreased flexibility, changes in muscle strength leg length discrepancies, age and sex.

4) What do I do? Rest the injured area and address any mechanical issues with a health care professional such a Physiotherapist. Assessment and prevention of recurrence may include a gait analysis, biomechaical analysis as well as a re-think of how you train. In consultation with your Physiotherapist or coach try to maintain cardio vascular fitness without directly loading your tibia or surrounding muscles.

What are overuse injuries?

With the London marathon and Manchester 10km now begining to loom on the horizon we have seen the  familiar increase in overuse type injuries  here at JUMP Physio. These have been especially in but not limited to to the running population. The inevitable question always arises. What causes over use injuries? Well, without stating the obvious it is usually a combination of factors such as the training load, the biomechanics of the movement and physiological state of the tissue.   Needless to say here at JUMP Physio we don’t see athletes with excellent biomechanics, normal tissue and subjected to appropriate training load  presenting themselves in the clinic. We do however see a whole bunch of frustrated people of all abilities presenting with one or more of the above  contributory factors. Such as the runner who has gradually being building up their mileage with appropriate recovery periods, developing shin splints, anterior knee pain, achilles tendinopathy or ITB problems due to altered mechanics caused by tight calves or weak glutes.  We also see people with optimal mechanics, present with similar injuries because of inappropriate loading or lack of recovery between runs.

Every time you exercise your tissues are loaded causing physiological change and structural adaptation. In running or with any other  training stimulus this can lead to muscle hypertrophy, thickening of bones, enhancement of neural pathway’s, the strengthening of tendons. These changes take time however and before all these positive adaptations occur the short term effects of training are that tissues fatigue and become less resilient to load. Continuing to apply load to these tissues increases the risks  associated with tissue break down and injury.

Management of these injuries therefore focuses on addressing the relevant biomechanical faults, identifyng the state of the underlying tissue and prescribing a suitable load and recovery plan. Of course it also helps if you understand what has caused the injury so it doesn’t happen again.

The run at Clearwater

If you feel like you may have over done the training or can’t figure out why your body hurts so much after an easy run give us a call at JUMP Physio to see if we can help.

Jemma Oliver Sports Physiotherapist

We are delighted that Jemma Oliver Sports Physiotherapist will shortly be joining our team at JUMP Physio. Having trained in Sports Science in Leeds and graduating as a Physiotherapist from Sheffield in 2007, Jemma has spent the last few years working privately in the sports rehabilitation and sports injury settings. She enjoys all aspects of musculoskeletal Physiotherapy however her specialist interest is in sports injuries and lower limb biomechanics. Jemma is near completion of an MSc in Sport Injury Management.

Jemma’s work in sport makes an impressive CV  to date and includes working with various squads and sports including the Sheffield United Football Academy, Sheffield Hockey Club, the U21 Wales Hockey Squad and more recently work with the GB Bobsleigh and the GB Womens Volleyball team in their run up to the 2012 Olympics.

Jemma describes herself as a friendly and passionate individual with an aim to try and help empower individuals to become more self aware of their own bodies and lifestyle in order to rehabilitate from injury, improve their sport performance or increase their own quality of life through healthy living and exercise.

A full list of the services Jemma will be offering at JUMP Physio will be available shortly on our web site www.jumpphysio.com . In the meantime if you have any questions about sports injuries or rehabilitation you can ask Jemma at info@jumpphysio.com

ITB friction Syndrome

With marathon and triathlon season started we are seeing more and more running related injuries at JUMP Sports Injury Clinic. By far the most common type of running injury/ sports injury we see is an over load injury to the Ilio Tibial Band (ITB) called ITB friction syndrome. Here is a brief discription of the injury and some common causes.

The Ilio Tibial Band  (ITB ) is a thickened band of connective tissue  that runs down the outside of the thigh. As the knee flexes and extends the ITB glides over the lateral femoral condyle, a bony prominence.

If the load across the ITB is increased the point where the ITB runs over the femoral condyle can become inflammed leading to pain and to what is commonly called ITB friction syndrome.

ITB Syndrome commonly presents with the following symptoms.

  • A dull ache on the outside of the knee that increases during a run gradually getting worse for the duration of the run., Pain is often worse the next morning. It can be aggravated further by running downhill, on cambered surfaces or walking downstairs.

ITB friction syndrome is an over use injury with several proposed potential contributory factors.

  • Run technique: Stride length has been proposed to affect both the size of knee bend and thus the load across the ITB. Excessive stride length seems to aggravate the ITB where as pain is often reduced when the length of the stride is reduced.
  • A tight ITB as measured by the Ober’s Test is thought to be a contributory factor to ITB friction syndrome.
  • Training Error: As with all over load injuries doing too much of a particular type of training places excessive loads across the joints. Even if cardiovascularly you feel fine you need to gradually build up your training. What is too many miles unfortunately depends on the individual. In clinic the most common training error we see are runners running the same route 3 times a week at the same pace and gradually increasing the times spent running. If you run the same route night after night at the same pace you are loading your joints muscles in the same way on the same surface night after night. Try varying the length of your runs, the speed of your session and the terrain you run on. 
  • Anything that causes the knee to track medially (towards the mid line of your body loads the ITB. This increases the load over the femoral condyle. Various bio mechanical reasons can cause your knee to drop medially
  1. Weak Hip Abductors. The muscles on the side of your pelvis namely the gluteus medius muscles help control your pelvis when you run.  When you lift your left leg off the ground your right gluteus medius muscle contracts and stabilises the pelvis keeping it level. When your gluteus medius muscles are weak the left side of you pelvis drops and the right knee is pulled across the midline as run. This is repeated endlessly as you run.

Reference : http://www.physio-optima.ca/bibliotheque/bit.pdf

  1. Over pronation of the feet. Feet that over pronate on impact cause the knee to follow the foot and drop medially. By far the most common and correctable cause of over pronation in runners are tight calves.

 

Treatment

  • Have yourself assessed by a chartered Physiotherapist who can diagnose the problem, identify your unique contributory factors and get you back on the road to recovery.
  • Rest from running until the inflammation decreases.
  • Avoid downhill running and running on cambered surfaces.
  • Speak to your pharmacist. Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs.
  • Apply ice to the knee (for 20minutes every evening ) in order to reduce the inflammation
  • Self-massage/ stretching on a foam roller
  • Remember to stretch well before running
  • Address any training errors

 

Recovery: Time to full recovery depends on the extent and cause of the injury. But a general rule is the earlier you address the problem the quicker you’ll recover.

Preventative measures:

  • Regular stretching of the ITB, quadriceps, hamstring, and gluteal muscles.
  • Gradual progression of training program
  • Avoid excessive downhill running, and cambered roads (stay on the flattest part of the road)
  • Working on run efficiency and stride efficiency.
  • Build some regular core strengthening exercises such as Pilates into your routine.
  • Regular sports massage

Running injury Free

Whether you just run to stay fit or you’ve just signed up for one of the big races like the Manchester great run in May or the London Marathon there is nothing more annoying than having your training interrupted by injury  and enforced rest. Knowing a little bit about how to train and what signs to look out for can save you months of discomfort.

The majority of running injuries are caused by overloading to the joints and muscles. Here is a brief list of injury prevention tips to help you run injury free.

1)      The 10% rule. Try not to increase your distance more than 10% per week. Your heart and lungs adjust to stress quicker than the joints so even if you feel ok increase your distances slowly.

2)      Ice aches and pains as soon as you get back. When you do injure yourself the majority of the discomfort is caused by swelling. Minimise the swelling and speed your recovery  by icing immediately for 20 minutes

3)      There is currently lots of debate on the optimal amount of support a runner should have for their feet as they run. We don’t have time to expand the argument for and against but the simple advice is if you are new to running or increasing your distances  it is a good idea to invest in actual running shoes from a specialist running shop and replace them as the support decreases. Running in unsuitable trainers places unnecessary load on your ankles knees and hips if you are not used to running.

4)      Mix-up your training plan. No matter what level of runner you are, running the same route at the same pace every night will not make you any faster or fitter after your initial improvement. Repetition will however give you sore joints and muscles. Your training should include long runs and short runs, slow runs and faster runs.

5)    Perform a good stretching programme before and after exercise.

6)    If your pain is not going away don’t try to run through it consult a sports physiotherapist.

If you have any questions on running injuries feel free to e-mail me for some advice on kieran@jumpphysio.com

Barefoot Running

I’ve noticed in the physiotherapy clinic that barefoot running and its reported benefits is getting a lot of press again recently in main stream media.  The proponents of bare foot running argue that present day running trainers with their inbuilt supports significantly alter the mechanics of how you run thereby increasing the risk of injury. Trainers  which rely heavily on support and comfort as their selling point are argued to facilitate running  with a heal strike while the more natural way to run is on the balls of your foot. Test this out by running in your bare feet the next time you are in the garden, do you land on your heal or stay on the balls of your feet. They make the point that the heal or calcaneus being mostly bone has no capacity for shock absorption and so transmits all the forces of running further up into your knees, hips and lower back. Running on the ball of your foot however takes advantage of the foot’s mechanics designed for shock absorption and the full capacity of the Achilles Tendon to transmit and absorb shock.

All of this argument makes perfect sense to me but a word of caution before you discard the trainers for barefoot running. The intrinsic muscles of the foot work to provide support and shape to the foot, when too much strain is placed through these muscles too quickly we can develop mechanical foot problems such as shin splints and plantar fasciitis. This is a common problem during the summer months when people limp into our physiotherapy clinic after switching from shoes in the office to flip flops at the beach for two weeks. The problem lies in the fact that as a generation we have become used to wearing shoes/ trainers which provide support and our intrinsic muscles have in effect become de-conditioned. As a means of decreasing injuries and increasing the strength of the intrinsic muscles in your feet starting with some barefoot running drills is a great idea but you need to gradually introduce your feet to the concept.

Clients often ask what the best pair of trainers are for their feet. In the absence of any structural problems the answer is the next pair you buy. Wearing the same trainers continuously can result in your feet becoming accustomed to the type of support provided by your trainer and result in a de-conditioning of the intrinsic muscles in your feet. By purchasing different brands or models or having two pairs that you switch between prevents the same load and pressure being placed through your feet repeatedly and challenges the intrinsic muscles by providing different levels of support and preventing de-conditioning.

On a personal note I haven’t yet tested the Nike Frees (which promise to strength train feet by imitating barefoot movement” or the Vibram Fivefingers which have been coined “gloves for your feet” but I am starting to decrease the amount of support and cushioning I now look for in my trainers..