Training the Weakest Links

Training the Weakest Links
Cures for lower extremity dysfunction in Triathletes.
Written by: Dr David Ness, CCSP, ART, CGFI

As triathletes most people spend the most time training to swim, bike, and run. You train usually 2-3 days or more on each aspect of the triathlon race. As training and in season racing begins nagging injuries old and new can pop up. Shin splints, ITB syndrome, patella femoral dysfunction, hamstring strains, quad strains, calf strains, and plantar fascitis are some of the typical complaints we see in our office in addition to lower back pain and hip pain. What I have found being a sports chiropractor and Active Release Techniques provider for the past 5 years, working at countless HVTC, NYTC, SOS, and Iron man races is that all of the above injuries are symptoms of dysfunction going on somewhere else in the kinetic chain. When it is not due to the above reason it is likely that the injury was due to errors in training, or overtraining, and or a combination of both. So what is the most likely cause of lower extremity injuries when they not due to running on a canted road, or direct injury from overtraining like excessive mile hill repeats, or sudden increase in mileage. The answer is altered biomechanics and weakness resulting in an altered running gait, which over time causes the injury. Usually there is weakness in the Gluteus Medius muscle, which controls abduction of the hip, the Gluteus Maximus muscle, which extends the hip, or the Psoas muscle, which flexes the hip, and stabilizes the lower back. Additionally there can be weakness in the Hamstrings resulting in an inability to fully extend the hip, and flex the knee. Tightness alone in any of these muscles will alter your range of motion to some degree. This when combined with the volume of training triathletes go through is a recipe for overuse, and repetitive strain injuries.

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Iliotibial Band Syndrome (ITBS): Causes and Treatment

Written by: Dr David Ness, CCSP, ART, CGFI

Iliotibial band syndrome (ITBS) is a condition that affects runners and other athletes that causes pain in the lateral (outside) part of the knee. It is an inflammation of the lower part of the band that inserts on the outside of the knee caused by the IT Band rubbing over the bony part of the lower femoral condyle. The IT Band is a thick band of ligament that at its upper portion has the Gluteus Maximus, Gluteus Medius, and Tensor Fascia Lata muscles connecting to it, and it then runs down the outside of the leg to insert in the lateral side of the Tibia. The IT Band works to control the outside of the knee, and to flex the knee. ITBS can be caused by many factors such as overuse, weakness of the hip abductors (Gluteus Medias, Tensor Fascia Lata), improperly made shoes, bad feet (pronators), running on a canted or crowned surfaces, circular track running, and a high Q angle (the angle that is formed from the hip to the knee that causes a knock knee, or bow leg deformity).

Symptoms may present at the end of a run in the beginning of this problem, but more severe and untreated cases may prevent you from running even short distances. Often there is associated stress on other muscles in the kinetic chain. This can be weakness and tightness in the Quadriceps, Tensor Fascia Lata, Psoas, and hip abductors. Training may also contribute to the development of ITB syndrome. It is always important to look at your training routine and see what changes have recently occurred. A rapid increase in running distances, speed work, hill work, and time spent running often precedes the development of this injury.

Treatment of ITBS should include all of the following:

Ice, rest, decrease in training and or changes in training regimen, stretching of the IT Band and associated muscles, massage or foam rolling of the lateral quadriceps and IT Band, and strengthening of the hip abductors all. If none of the above treatments resolve the problem a sports medicine professional should be consulted. This could be an orthopedist or other medical doctor who could refer for physical therapy, a chiropractor, or a massage therapist. Deep tissue massage, and Active Release Techniques to the ITB, Quadriceps, TFL, Psoas, and hip adductors are highly effective in treating ITBS. Last resort treatments include cortisone shots, or a surgical procedure called a lateral release. These last resort treatments are used for cases that do not respond to any form of treatment and rest.

 

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Dr. David Ness is a certified sports chiropractor, practicing in New Paltz. He has worked the last 4 years at the Lake Placid Iron man event as part of the ART treatment team. As well, Dr. Ness has been the ART provider for the HVTC for the past three years providing free ART care after club races. Dr. Ness also provides treatment at NYTC races around the NY metro area, and continues to work as part of the SOS Triathlon post-race care team. Dr. Ness can be reached at (845) 255-1200.

Stress Fractures

Stress Fractures
April 3, 2011
Written by: Dr David Ness, CCSP, ART, CGFI

Stress fractures, also known as fatigue or hairline fractures, are caused by repeated stress or heavy, continuous weight. They are much more likely to occur in the lower extremities, which bear the body’s weight, than in the upper. A sudden increase in physical activity, such as rapidly ramping up training for a big event, is often the underlying cause. Bones attempt to remodel and repair themselves, but can be overwhelmed if the amount of stress increases suddenly and is maintained at that higher level of intensity. The osteoblasts, the cells which are responsible for bone growth and repair, simply can’t keep up with the extra work, and a stress fracture forms.

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Swimmer’s Shoulder

Swimmer’s Shoulder
Written by: Dr David Ness, CCSP, ART, CGFI

Swimmer’s shoulder (SS) is a term used by swim coaches to describe pain in one or both shoulders. The pain associated with SS is in the front of the shoulder. Under these muscles passes the supraspinatus muscle and tendon, which is a rotator cuff muscle. This muscle along with the Biceps tendon, are affected when you have SS causing tendonitis and inflammation of both tendons. As well, the ligaments that attach from the scapula (shoulder blade) and the clavicle (collar bone) become irritated and inflammation occurs. When this happens the space that the Supraspinatus tendon has to pass through to connect to the Humerus becomes smaller, pinching and further irritating the tendon. Due to age, hereditary factors, and arthritis the space for this tendon to pass through gets even smaller leading to more inflammation, scar tissue formation, pain, and shoulder weakness. Eventually, overuse of the shoulder that is common from triathlon training could cause a partial or full tear of the Supraspinatus tendon that could require a trip to the orthopedic to repair.

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