World Cup Football started in Brazil last week and so did the injury worries.
Danny Wellbeck’s thigh injury on the road to recovery, Oxlade-Chamberlane’s knee in final stages of rehab and a minor groin strain scare for Gerrard all add tension to England’s preparation. Brazil also had a scare when star Neymar rolled his ankle in training. Drogba and Yaya Toure also put their Ivory Coast team manager on tender hooks with minor niggles this week. I’m sure these will only be the start of injury disappointments for players in this 2014 Football World Cup.
I seem to recall much media coverage around metatarsal (MT) fractures with Word Cups looming. The most infamous was when Wayne Rooney fractured his 4th MT but recovered in time to play for his country in the 2006 World Cup. Michael Owen also fractured his 5th MT, in 2006, taking 17 weeks to recover, much longer than the 7 weeks it took David Beckham when he fractured his 2nd MT, in 2002.
The increase in fractured metatarsals in football, it seems is put down to a combination of more games being played and therefore an increased risk due to fatigue (stress fractures) or direct blows and lighter, less protective boots. Unfortunately MT fractures are not the only injuries to plight footballers. Low limb injuries predominate and as we are also in the midst of the running season I will focus this blog on foot and ankle injuries.
Ankle sprains are the most common sporting injury, infact the most common injury during outdoor activities. The lateral ankle sprain is the most frequently injured, affecting one or more of the ligaments on the outside below the ankle bone. These can take from 1 -12 weeks to heal depending on the severity or grade of sprain. Ligaments are short fibrous bands of tissue that connect bone to bone and due to their poor blood supply do not heal as well as muscle or even bone. It is therefore essential that the patients strengthens the muscles around that sprained joint to compensate for the reduced efficiency of the danaged ligament.
Balance work is also vital, especially after ankle and knee sprains, as this retrains the sensory receptors and their imput into the central nervous system, about changes in position of that joint. This part of the rehab will help prevent re-occurance.
Tendinopathy not Tendonitis
Research on specimens over the last 5 years or so have shown that most tendon injuries are due to overuse and therefore chronic in nature. An injured tendon leads to pain resulting in reduced strength and function and a low tolerance to exercise. Research has also shown very little or no inflammation of the injured tendon but an increased number of blood vessels and tendon cells. This leads to tightly bundled collagen fibres which are weak and fragile resulting in degenerative changes known as tendinosis.
Most commonly affected are the tendons of the elbow, ie ’tennis or golfers elbow’, the achilles and the supraspinatus tendon in the shoulder. Repetitive overload leading to micro-trauma is more often than not the cause of tendinosis. It can also be due to poor technique, altered gait or poor posture and more recently studies have suggested that genetics have a role to play too (Pribut 2014).
This research has been extremely valuable in the way therapists treat and rehab their patients with a tendinopathy.
Plantar Fasciitis or it it Fasciosis?
Many patients present to my clinic with plantar fascia pain or pain underneath the foot just infront of the heel. This condition is know as plantar fasciitis suggesting an inflammatory condition ‘itis’ meaning inflamation, however more often than not by the time the patient visits the clinic it has moved on the a more chronic condition plantar fasciosis. In this condition according to Lemont (2003) there is no inflammation but a reduction in blood flow and degeneration of the tisue.
This condition is common in runners, in particular marathon and ultra distance runners. There are a number of causes but often their is an abnormal foot motion, over pronation or supination. other reasons may be a sudden increase in running distance or frequency, increase in weight or even old shoes that no longer give the support required.
As an osteopath I would treat this condition by looking at your training schedule, check running gait and wear on shoes. I would then look at your posture and assess any muscular imbalance ie tight hip flexors and calfs v weak hamstrings and glutes and assess joint mobility of the hip, low back, knee, ankle and foot.
Treatment may include soft tissue massage/release, strengthening programme, manipulation, acupuncture and kinesiology taping. Advice may be to avoid bare foot even at home for a short period, icing only in the early stages as it is questionable whether it has any benefit or even may slow down the healing in the chronic stage. Either rest or reduce your training intensity but embark on a stretching and strengthening programme. Possibly buy some over the counter cushioned insoles and or new shoes.
When buying new running shoes go to a specialist running shop that will assess your running gait and choose the best shoe for you. Make sure that the shoe has good stability during this condition but is ‘bendy’ in the mid sole.
Other options if the conservative treatment fails are ultra sound, more rigid taping, shockwave therapy or a boot/cast to keep your foot in dorsi flexion at night .
Shin Splints or Medial Tibial stress Syndrome (MTSS) is one of the most frequently reported causes of pain in the low limb, often affecting runners, jumpers, dancers and in the military. It is defined by the American Academy of Orthopaedic surgeons as a pain along the inner edge of the shin bone.
The cause of shin splints are many but not disimilar to those that cause plantar fascia issues. Biomechanics, sudden increase in training, lack of stretching, running on hard surfaces etc. The sudden increase in frequency or intensity of training is probably the biggest contributor as by overloading the muscles, our bodies biggest shock absorber, they fatigue or tighten and reduce their ability to shock absorb. The calf muscles in particular the lower, deeper soleus, attaches to the tibia via sharkey’s fibres. A tired soleus due to repetitive stress allows bowing of the tibial bone and this leads to MTSS. MTSS will be aggravated by running on uneven surfaces, up and down hill.
Shin splints must be managed carefully as it can lead to stress fractures or even worse, compartment syndrome which is extremely painful due to the build up of pressure and reduction of blood flow within the muscle sheath (Dr Rob Hicks).
If you require any further information on any of these conditions please email me or leave a comment in the box below. Appointment available in Ealing with Lisa 07956 954093 firstname.lastname@example.org