Do I need orthotics for running?

Orthtoics for Runners KneeWhy would I need orthotics?

Although running shoe design and technology has progressed leaps and bounds over recent years, there are certain foot types that will require more support, explains James Masterson, physio here at Sundial, Brighton.  However not everyone will benefit from orthotics and it’s important to gain professional advice before deciding on whether an orthotic is right for you.  A full biomechanical assessment from a physiotherapist or chiropractor can help determine whether the underlying root of the problem stems from your feet and whether or not an orthotic is appropriate for your foot type.

Orthotics can help running and are designed to optimize the alignment of the lower limb, which can improve shock absorption in the lower extremity and realign joints from the foot all the way through the kinetic chain to the spine, preventing problems foot, knee or hip.  The main role of an orthotic is to restore a neutral alignment which will in turn reduce the stress carried throughout the body during weight bearing activities.  This is particularly important during running as (hopefully!) the feet are the only part of your body in constant contact with the ground.

An orthotic can either be an off the peg prefabricated orthotic, with a selection made to fit most general foot types, or a custom made orthotic, normally constructed by a podiatrist which is made specifically for the individual. The off the peg orthotics work well for most people and are considerably cheaper. We sell Superfeet orthotics at Sundial.

Another important factor worth considering with orthotics is that most people change their shoes several times throughout the day.  Although your running shoe will provide you with support whilst you’re wearing them, it’s likely that you will spend more time out of these shoes than in them.  This can potentially lead to overuse injuries during regular every day activities, especially if your profession requires you to spend large amounts of time on your feet.  This is another way in which an orthotic can be useful as it can often be taken from one shoe and placed in another.  However orthotics aren’t your only option and if possible should only be used as a short term solution, please see my future posts on physiotherapy exercises to improve overpronation.

The three basic foot types:

Firstly, it should be noted that pronation is a natural movement of the foot’s mechanics.  It occurs at the joint below the ankle called the subtalar joint and this movement allows the foot to roll in slightly during the stance phase of gait and helps the lower limb deal with shock.  Although this process is not necessarily detrimental to your body it can affect your running style and possibly lead to injury.

 Neutral foot:Over pronation, Brighton physio

This means that you’re a neutral pronator, meaning your foot rolls in slightly and you push off evenly through the front of the foot.  Sometimes you can tell if someone is a neutral runner by looking at the sole of their shoe, running from the heel to the big toe along the outer surface there will often be signs of S-shaped wear and tear.

Underpronator:

Underpronation, or supination as it is often referred to, is when the outer surface of your foot hits the ground at an increased angle causing minimal or no natural pronation.  Again this leads to access shock throughout the lower limb and can be potentially damaging to your body when running.

Overpronator:

There is significantly more inward rolling of the foot meaning more weight is transferred to the inner surface of the foot late in the stance phase.  This causes instability and leads to compensatory movement patterns throughout the kinetic chain, potentially leading to injury throughout the lower limb and within the spine.

If you have any queries or want more help then book in for a free Runner’s MOT

 

Happy running.

Running shoes – top tips for the marathon season from Brighton physio

Choosing running shoe, Brighton physioIf like me you’re considering starting your preparation for the up and coming marathon season then take a look at my top tips for staying injury free and completing the 26.2 miles with a smile on your face says James Masterson,  a physiotherapist here at Sundial, Brighton.

Which running shoe shall I buy?

Inappropriate footwear is the root of all evil when it comes to running.  Before embarking on the long and tedious road to the finish line every runner should start with their feet.  Visiting your local running shop for a gait analysis is a good place to begin. As well as being advised on the most appropriate running shoe for your foot type it’s also an opportunity to view yourself in action.  Video analysis taken during these consultations will allow you to look at your lower limb alignment whilst you’re walking and running, giving you a good idea of movement patterns which could potentially lead to overuse injury.

 Top 5 running injuries caused by over use and inappropriate footwear:

1. Plantar fasciitis

2. Achilles tendinitis

3. Medial tibial stress syndrome (aka shin splints)

4. Patellofemoral pain syndrome (aka Runners knee)

5. Iliotibial band syndrome

When it comes to purchasing your shoe it’s likely that you will come across the below terms. Remember it’s not all about what foot type you are!  Take the time to get a feel for the shoe, being able to stand, jump, walk and run before handing over your cash is a great way to find out if the shoe works for you and reduce the risk of injury later in your training.

Useful tips for purchasing your running shoe:

  • Try having a foot analysis in the late afternoon/evening as your feet swell as the day goes on and may give you a false feel when purchasing your running shoes in the morning.
  • Pick a shoe that matches the contour of your arch, you won’t be able to feel this by just standing in them so always make sure you take them for a spin before handing over your cash.
  • Try and have your feet measured before trying on your shoe, this will give the running shoe assistant an idea of the size and width of your foot.  Different brands suit different foot types and not all shoes will equal in size, for example, Nike shoes tend to be good for wider feet and Adidas tend to be better for a narrow foot type.
  • Don’t buy your shoes too small, the fabric will loosen as time goes on but generally if a shoe has hot spots that aggravate your feet whilst trying them out in the shop then it’s likely this will occur during your training.  Remember! Tight shoes equal blisters and potential toenail damage, this will limit the amount you’ll be able to train and will also look horrendous in a pair of flip flops.
  • Lace your shoe up from the bottom up, not just at the top two eyelets!  This allows you to support the shoe around your foot equally and avoids excess movement.  Your heel should fit snug within the shoe and your toes need to have some wriggle room at the front.  A good test for this is to see if you can still scrunch up your toes whilst the shoe is fully laced up.
  • Change your shoes according to your individual usage, most manufactures will recommend that you change your shoe roughly every 300 – 500 miles but this is dependent on so many factors, for example a person’s weight, gait mechanics and running terrain will all play a massive factor in your choice to change your shoes.  Let’s be honest running shoes are expensive, so my advice is look for signs of wear and tear and as soon as the natural cushioning of the shoe starts to depreciate this is probably a good time to start looking for your new runners.

If you have any queries or want more help then book in for a free Runner’s MOT.

Happy running.

Next: Do I need orthotics?

 

 

Knee pain in runners: the 2 most common causes

Knee pain running is common. With the marathons in London and Brighton we’ve seen an increase in people coming into our clinics with knee pain associated with running. The 2 most common causes of knee pain in runners are “Runners knee” and ITB syndrome. In this posting we’ll talk about runners knee pain, what it is and how to treat it. Next we’ll do the same for ITB syndrome.

Runners knee

“Runners knee pain” is more correctly termed patella femoral syndrome and can affect as many as 1 in 4 runners. The symptoms are typically pain under the knee cap and around the front of the knee and used to be called chondromalacia patella.

Anything where the leg is bending and straightening can become painful, particularly when weight bearing, and there may be creaking or cracking under the knee cap, a symptom termed crepitus. Of course running, particularly once milage when training for a longer distance event is increased is a common cause. Aggravating factors also include going up and down stairs, running, in particular up or down hill, leg extensions/quad strengthening in the gym, often sitting for a prolonged times at work or in the car for instance.

Cause of Runners Knee Pain

The causes of runners knee are related to the anatomy of the area. The underside of the patella (kneecap) has a ridge which slides along a narrow groove in the femur (thigh bone). Every time you bend and straighten your knee the patella slides up and down the groove. Trouble can start when your kneecap moves out of its track or groove and rubs up against its sides causing friction. This is called patella misalignment or maltracking. That it becomes painful when you run is not surprising when you realise that there are on average nearly 1000 steps per mile.

Common things that can cause misalignment and how to fix them are:

  • Quadriceps imbalance: This is perhaps the most common cause of runner’s knee. The quadriceps muscle on the front of the thigh is made up of four parts and running strengthens the outer part more than the middle part, thus the patella is pulled out of alignment. This usually resolved with some specific rebalancing exercises for the muscle group.
  • Foot instability: Often your feet imbalanced every time they hit the ground, and you’re feeling the constant pounding and repetition of this mistake in your knee. Over pronating, which means your foot is rolling in too much when you run, is the most common type of this, something that is often associated with fallen foot arches. A combination of orthotics (these are special insoles; at Sundial we use Superfeet orthotics) for your running shoe and exercises is usually enough to rebalance and stabilise the foot. You should also have your running analysed to make sure your shoe is the suitable for you. For more on orthotics and running go here.
  • Tight muscles at the back of the calf or thigh: If the calf muscles are tight the foot will have to pronate further when running or walking causing an increase in rotation at the lower leg bones, if the hamstrings are tight when running or walking the knee is not fully straightened, this also means the foot has to roll more into pronation. Both of these can cause patella misalignment and are treated with specific stretches and rebalancing exercises.
  • Gluteus medius weakness: One of the muscles that make up the buttock, it often relatively weak in runners. If the gluteus medius is not strong enough the upper leg rotates inwards and causes an unequal pull of the patella over its groove. Again, some specific strengthening and stretching exercises usually resolve this.

In addition to the specific treatments for each cause there are a few other things which also help resolve runners knee.

  • Ice: Wrap a cold packs around each knee, with the pack at the front for about ten minutes, a few times a day to bring down the swelling. Make sure the cold pack is wrapped in a thin cover to avoid cold burns!
  • Rest: Not what a runner wants to hear close to an event, but where possible, stopping or decreasing your running will help then problem settle whilst treatment takes effect.
  • Laser treatment: This is useful in reducing the inflammation around the patella and encouraging faster healing
  • Taping: Specific taping techniques, particularly kinesio or Rock taping, something our physio Quentin specialises in, can help straighten the pull of the patella
  • Running/gait analysis: Many running shoe shops offer this and it’s a good way of screening your running for problems and also seeing if your shoes are suitable for you

If you would like a check to see if you have runners knee then call us for our free Runners MOT with our physios or chiropractors.

7 Tips to Prevent Back Pain in Golfers

Preventing back pain in golfers is easy with these tips. Brighton chiropractor, Matthew Bennett, shares the 7 essential tips. By following these simple rules your back will be pain free and your game can even improve.

Back pain in golfers is quite common. Four out of five will experience some back pain at some point and up to one in five will have pain now. Here’s how to make sure you are not one them:-

1 Don’t stretch beforehand

2 Get fit to play golf, don’t play golf to get fit

3 Strengthen trunk and shoulders muscles

4 Do flexibility exercises

5 Use brains not brawn

6 Wear orthotics if needed

7 Wear a hat

Golf is an un-natural activity. Evolution has not caught up with our leisure activities yet, otherwise golfers would have rubber spines and knees that bent in all directions. The twisting action whilst bending forwards can put large strains on the muscles and joints of the back and knees.

Tips to Prevent Back Pain in Golfers

1. Don’t stretch beforehand

Believe or not stretching before sport can actually decrease a golfers performance. Scientists think stretching may decrease the resting tone of a muscle making it less able to respond to sudden bursts of activity. In one study a group of sprinters who stretched before the timed run ran more slowly. Other studies have not conclusively shown that pre-sport stretching helps to prevent injuries. The benefits remain uncertain.

2. Get fit to play golf, don’t play golf to get fit

Whilst many of us play golf to improve our fitness we need to exercise in between trips to the golf club. Walking is obviously helpful but swimming  can also be good as it works the shoulders as well.  Other sports like tennis and badminton are great too.

3. Strengthen trunk and shoulders muscles to take the strain off the back

The core stability muscles have been getting a lot of good press recently. These deep trunk muscles in the abdomen and back provide support in the same way that a weight-lifters belt does but in a more flexible and dynamic way. You don’t need to go to Pilates classes in your best lycra though, simple abs exercise are good enough. If you want to get the best abs and back exercises get a gym ball and do sit-ups and back extension exercises on the ball instead. It works more quickly and tunes the muscles up more effectively. It’s fun too!

Shoulders and upper back muscle are often overlooked when it come to golf specific exercises. This may be because few of us relish the idea of lifting weights which can get boring very quickly. Instead try a flexi bar. These simple exercises will work on the strength, flexibility and control in the shoulders and back very quickly. Just a few minutes a day really does make a difference.

4. Do flexibility exercises to prevent back pain

Strength is nothing without flexibility in golf. The lower back joints are not designed to twist very much. If you have a stiff mid-back or hips this will place more strain on your lower back joints and discs increasing the chance of injury. If your shoulders are stiff you run the risk of Impingement Syndrome or other shoulder damage.

Yoga and Tai Chi are excellent at improving flexibility. If you don’t fancy classes try one-to-one sessions to be shown a few moves or try these.

5. Use brains not brawn

This tip will make the golf club pros happy. The cause of many strains whilst playing golf is incorrect technique. A few lessons and driving range sessions can lessen the load on your joints and muscles and relieve back pain in golfers. Over-hitting the ball for those last few yards can force a muscle or ligament that may be under strain already to finally give out and tear leading to the pain and inflammation which causes back pain.

6. Wear orthotics if needed

Orthotics can improve swing speed and improve distance research has shown, if you have even slight flattening of your feet arches (over-pronation). Interestingly many people are unaware of over-pronation as it can even happen in people with seemingly good arches whilst standing still. On the move, however, especially trying to swing a golf club at 100mph any minor defects can get emphasised.

7. Wear a hat

Of all the tips for golfers here, this is the most unusual. On a cold day you may get cold. If that happens your body decreases blood flow to your arms and legs to preserve what little heat you have in your blood for the essential internal organs. Muscles which you carefully warmed up (not stretched!) don’t get the oxygen and nutrients that they need and are more likely to pull. Wearing a hat keeps your core temperature up by slowing the heat loss out of your exposed head.

If you have any aches and pains that are causing problems with your golf or just want a preventative check-up then give us a call so we can make you an appointment to see one of our chiropractors or physio’s.

Foot, Knee or Hip pain – A Simple Solution

If you ever get foot knee or hip pain on standing or walking for a while, then you’ll know the misery that this can cause.

Fortunately, there is a simple solution.

Here at Sundial we use Superfeet orthotics to help ease the discomfort. In this short video Brighton chiropractor Matthew Bennett talks about the causes of foot knee and hip pain associated with over-pronation. If you want to know more about this click here:–

If you would like to know if you would benefit from wearing Superfeet orthotics then pop in for a free check with one of our physios or chiropractors here in Brighton.

Do orthotic insoles help with knee pain in runners? Leading Brighton Chiropractor answers

Knee pain is common in runners and a common cause is the patella or knee cap. Pain caused by the patella is often called patello-femoral syndrome or PFS for short. The pain can be severe enough to stop runners going out but also occurs in other sports people and non-sports people alike.

Chiropractor and physio treatment in Brighton

The research on PFS treatment is poor. The studies that have been done are often of poor quality and come up with conflicting results for all sorts of treatment and this can be confusing not only if you are a runner looking for something to help but also if you are a physio or a chiropractor treating these common knee problems.

One of the recent reviews (1) looking at all the evidence for orthotics in the treatment of PFS, sometimes called Runners Knee, found little difference between the groups given orthotics and those given flat insoles which were supposed to do nothing. The other trial which met the criteria compared physio exercises and orthotics. Again not much difference was found between the 2 groups. Delving deeper into the 2 trials reveals why the orthotics groups did not do so well as groups in other trials – but more of that below.

Another study (2) into patello-femoral pain found that orthotics may indeed help. In fact more than three quarters of the runners involved improved. The authors concluded that orthotic or orthoses as they called them may have had a significant effect. This study was excluded from the larger review because it did not meet all the inclusion and exclusion criteria. For example some of the patients were only 12 years old and the study was not a randomised controlled trial.

The difference with this small study and the previous review is that the runners were analysed much more carefully. Their feet, ankles and knees were measured and an orthotic prescribed if they had the right sort of problem.

Chiropractic treatment may help

There are many different causes of PFS. One cause is thought to be over-pronation or excessive flattening of the arch after the heel strikes the ground. If you have over-pronation and it is contributing to PFS then you may respond well to the correct orthotic. If you have PFS from another cause, a weak thigh muscle for instance an orthotic will be a waste of time. In this case a pelvic joint manipulation by a chiropractor may help as in this study (3).

A correct diagnosis of the knee pain is essential for the correct treatment to be applied. A thorough examination should reveal the cause of the problem so that the right treatment can be applied. Too often clinicians use a one size fits all approach that is doomed to fail. This may well also explain why some studies don’t show an improvement whereas others do.

Orthotic buying advice

You can spend a fortune on a custom made orthotic and except in rare cases it is completely un-necessary. Other trials comparing custom made orthotics, often costing several hundred pounds, with much cheaper off-the-peg versions fail to show a difference in the outcome of symptoms.

We have found Superfeet insoles an effective and cost-effective option. They cost between £25-32 and are available on an unconditional money back guarantee from the manufacturer. So even if you don’t have faith that they might work for you it is worth giving them a try but only if you over-pronate. Many running and hiking shops as well as clinics sell them.

For more information you might like to look at a presentation given in June 2011 to the European Chiropractors Conference in Zurich here

Matthew Bennett DC

Sundial chiropractor working with Brighton and Hove Albion and previously with the British Alpine Ski Team.

References

1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008402. DOI: 10.1002/14651858.CD008402.pub2.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008402.pub2/full

2.The Lower Extremity 5(2): 95-102, 1998. Copyright © 1998. Reprinted with permission from Elsevier and the American College of Foot and Ankle Orthopedics and Medicine. Journal of the American Podiatric Medical Association http://www.japmaonline.org/content/93/4/264.abstract

3. Journal of Manipulative and Physiological Therapeutics Volume 22, Issue 3, March-April 1999, Pages 149-153

http://www.jmptonline.org/article/S0161-4754(99)70128-4/abstract

4. A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices. Davis IS; Zifchock RA; DeLeo AT. Journal – American Podiatric Ass, Sep 1, 2008; 98(5): 394-403