Sunday, April 22, 2012

Cradle and Cuddle: A Perspective on Instinctive Reaction to Pain

Calf Pain - Calf Pain Causes Whether it’s a bump, a strain, a muscle tear or even a broken bone, what’s the first thing you do when you injure yourself? You immediately grab hold of the muscle or area that is in pain.

The management of the injury over the next hours, days and weeks may well differ and be considerably more involved but everyone’s initial reaction to pain is to clutch it, to hold it, to cradle it.

Why is this? Why do we all have this rudimentary, yet universal, reaction?
I got thinking about this the first time I pulled on a pair of Active650 Calf supports. As I got back from one of my weekly long runs (24 miles) I was amazed at how the Active650 Calf supports had made me feel.

Calf Tear - Calf Pain while Running I had been having calf trouble earlier in the season and I had managed to build the mileage back up but I was still lacking confidence. The original minor calf tear, which kept me out of action for 3 weeks, had returned twice without warning and, whilst I had been pain free for several weeks, I had lost a lot of confidence in my calf. I found myself running, almost waiting for the twang of pain and, as a result, I was struggling to push myself during any of my runs.
So what was the difference with wearing the Active650 Calf supports?
My first thoughts as I ran was that someone was running behind me holding my calves with two hands, just cradling the muscles. It felt like someone was actually holding onto my legs looking after me. I have run many times with the Active650 supports on since that first trip out and I have to say that, now I’m used to wearing them, I don’t notice that they are on; much like a watch, you only know it’s there if you think about it. I, however, still think back to that first run with them on and that incredible feeling of support.

So what is the science behind what’s going on?
The Active650 supports are far more elastic than other compression garments or sports supports. This means that they fit perfectly and provide a consistent level of support. In turn, this results in a reduction in the amount of oscillation and vibration of the soft tissues.

Calf Pain Treatment - Calf Strain Compression Treatment To understand what the oscillation and vibration is, and the effect it has on the tissues, we need to look at a bit of basic science; the law of conservation of energy to be precise. This law states that energy can be neither created nor destroyed which, when applied to running, means that energy must be transferred. Consider what happens when a runner’s foot hits the ground: it creates what is known as a ground reaction force. If that sounds a bit technical, imagine lying on your back on a table and getting a friend to hit you on the bottom of one of your feet with a plank of wood.

The reaction force is the energy that is transferred from the moving piece of timber into your body via your poor, throbbing foot. When we run this is what we put our feet through every step, with the ground replacing the plank.

So where does the energy go?
The energy has to dissipate. A bit like the crumple zone of a car takes the energy of a crash and dissipates it in a way that causes the least damage to the occupants, the body takes the energy from the foot crashing into the ground and dissipates it in a way that causes the least damage to the body. The energy is transferred up through the foot, ankle, lower leg, knee, thigh, pelvic structures and into the core; known as the kinetic chain.
The more solid that something is, the worse it is at dissipating energy (remember those swinging click-clack ball bearings, Newton’s cradles). Therefore the bones involved in the kinetic chain tend to pass the energy onwards, up the chain.

The softer and springier something is the better it is at dissipating energy (think back to the crumple zones and the bumpers on Volvos before they became all sleek and streamlined). Therefore the muscles and tendons of the kinetic chain are very good at dissipating energy and do this by oscillating and vibrating.

The more structures that are used in the dissipation of energy the better. Therefore it is better to limit the energy dissipated lower down and direct it upwards towards the core. This is where the bones prove useful, transferring the energy up the kinetic chain as the soft tissues dissipate it. Poor alignment can affect the kinetic chain's ability to transfer energy, resulting in particular areas being stressed as they have to dissipate more energy than they should.
There are not too many soft, springy structures in the foot and ankle so the first big area of muscle and tendon is the calf. This makes it an area that is consistently exposed to the oscillations and vibrations of energy dissipation. If too much energy is dissipated through the calf, as opposed to being dissipated more evenly throughout the whole kinetic chain, it can lead to damage and injury. If there is an existing or previous site of injury in the calf then the process of energy dissipation through oscillation and vibration can aggravate it and cause further damage, re-injury and pain.

Compression Support Treatment of Calf Injury The Active650 range of supports can help prevent damage, re-injury and pain by supporting the muscle and facilitating the transfer of energy through the supported area up the kinetic chain. To relate back to our crumple zones and crashing cars, imagine a crash where the occupants weren’t wearing their seat belts. They would get thrown around inside the car and their movement would contribute to dissipating the energy of the collision. If seat belts were worn the energy would pass through the strapped in occupants to be dissipated more safely where it would be less likely to cause damage. Wearing an Active650 is a similar thing; with the energy passing through the supported tissue to be dissipated more safely where it is less likely to cause damage.

So next time you feel pain, don’t walk around holding it………Active650! Every Muscle, Every Body!
Ben Scott, BSc (hons)
Anatomical Sciences

Monday, April 2, 2012

Runner's Knee - Patellofemoral Pain Syndrome (PFPS)

Runners Knee - Patellofemoral Pain Syndrome Runner's Knee is a generic term used to describe a number of medical conditions that cause pain around the front of the knee (patellofemoral pain). There is no single cause of Runner's Knee. However, there are a number of contributing factors that have been identified. These include intrinsic issues such as poor joint alignment, patella tracking problems and muscle imbalances; and extrinsic factors such as over training and unsuitable sports equipment (eg. running shoes). All of these factors, whether intrinsic or extrinsic, result in additional stresses on the supporting tissue of the knee joint.

The underlying mechanisms of pain may be varied but the symptoms are described as pain (normally, but not always, a dull ache) around the front of the knee, often on the inside of or underneath the kneecap. This pain is worse during or after squatting, running (especially on hills), prolonged sitting with the knees bent, and descending stairs. There may also be increased pain with activity following inactivity.

It is difficult to conduct medical research with this condition due to the nature of the causes. The available research generally focuses on surgical management but there is general agreement on non-surgical management principles1.

Compression Treatment for Knee Pain - Runners Knee Common symptom management strategies include the Rest, Ice, Compression, Elevation (RICE) protocol in the acute phases, non-steroidal anti-inflammatories and stabilisation of the patella. Patellar bracing that supports the kneecap can allow the sufferer to commence rehabilitation exercises sooner and ultimately lead to an earlier return to sport. Studies have shown that supporting the patella can lead to a decrease in symptoms in a large percentage of patellofemoral pain sufferers (50%2 and 92%3 to give 2 examples).

So we know that putting a support on the affected knee can reduce pain and aid stability. Some of these studies are very dated and the results show the effectiveness of knee supports even without the stretch, fit and comfort of the Active650 range of knee supports. The advances in fabric technology that Active650 have brought to the knee support market means that the effective just got super-effective.

Knee Support - Compression treatment of Knee Pain The Active650 range of knee supportsprovide the most efficient way to stabilise the supporting structures of the knee joint. The superior compression prevents the vibration and oscillation of the muscles and tendons, thus minimising the stresses on these tissues without ever pressing the kneecap too firmly. With an Active650 not only do you get the previously demonstrated benefits, you get a support so comfortable the only way you know you’re wearing it is because of the lack of pain. Put an Active650 on it and you’ll be able to push your game harder earlier!

Ben Scott, BSc (hons)
Anatomical Sciences

1) Collado H. and Fredericson M. (2010) Patellofemoral Pain Syndrome. Clinical Sports Medicine 29;379-398
2) Powers C.M., Shellock F.G., Beeriing T.V., Garrido D.E., Goldbach R.M. and Molnar T. (1999) Effect of bracing on patellar kinematics in patients with patellofemoral joint pain. Medicine and Science in Sports and Exercise 31(12) 1714-20
3) Palumbo P.M. (1981) Dynamic patellar brace: Patello-femoral disorders: A preliminary report. American Journal of Sports Medicine 9; 45-49