Running and Chiropractic

For cardiovascular fitness, there’s nothing quite like running.  Unfortunately, that  comes at a price, and that price is the seriously high impact that your feet, knees and hips are all expected to cope with.  Chiropractic can be instrumental in picking up the pieces when this all begins to take its toll, but it is just as important in trying to stop it getting to that stage as well.

I started running when I was 16 or 17.  After years of being forced to take PE lessons, and hating every minute of them, I was suddenly released from that necessity as I started studying for my A-levels.  It took me only a week or two to decide that, while being forced to play tennis or hockey was never going to be my thing, I did miss the rush of exhilaration that came with exercise and that release of endorphins all athletes are familiar with.  So I began to get up early in the mornings, and head down to the athletics track to plod my way around the running track as many times as I could.  I will never be the fastest or furthest distance runner in the world, but I still chug my way around various distances as often as I can.  But this does also mean I have firsthand experience with many of the injuries that runners can suffer from.

The most important thing for any runner is footwear.  Whether you are just starting and are aiming only to get to the end of the road, or whether you have been going for years and are in the middle of training for a marathon, your feet are what are going to get you there and so it only makes sense to take care of them first.  It is a really good idea to go to a dedicated running equipment shop, such as UpandRunning in Shrewsbury to have a full gait analysis and professional shoe fitting performed, but if you can’t do this then the key factors to think about are impact absorption and support.  Decide what type of running you are going to do – are you mostly going to be pounding the streets, or are you hoping to get off the roads and into the cross-country scene?  On the roads, it is going to be really important to reduce the impact of each step you take by making sure the shoe is going to protect you as much as possible.  You might think this means going for one of these air-soled trainers, or some other spongy-looking material, but don’t forget that support is also important so it can’t be too soft.  If cross-country is more your thing, you generally won’t be on hard surfaces for as long, so it is going to be more important to have good grip and ankle support than impact relief.

Arch support is of major significance with running.  While barefoot running looks like a great idea, and indeed it can be, you can’t just kick off your office shoes and go for a jog.  Have a look at my page on foot pain for more information, but essentially supporting the arch is going to help reduce the chance of painful conditions such as plantar fasciitis developing, and will also stop you ending up with problems such as the joints in your foot becoming jammed into immobility.  If you naturally have a good strong arch, then you will be able to use a shoe that has less support and more flexibility, but if the sole of your foot along the inside just sits flat on the floor, you’re going to need all the help you can get from your shoe.

I frequently also get asked about stretching, warming up and cooling down.  Obviously, these are all widely known to be important, but they are less widely done and even less understood is the best time and way to do them.  The answer is…there is no right answer.  Seriously.  I spent quite a lot of time at one point reading all the evidence I could find regarding how and when you should stretch, whether you should warm up by stretching or leave it until you are cooling down and what else you should do before or after you run, and pretty much every piece of research I came across had a different opinion!   So what follows here is what I think seems most logical, based on how your body functions, the muscles you are going to be using and what seems to help in avoiding injury.

First, your warm up.  In my experience, the best warm up for running is walking.  Start off with a fairly slow pace, and gradually pick it up until you are briskly striding along.  The length of time you take to get to this stage depends on various factors, including what you have been doing during the time leading up to your warm up, what the weather is doing and how often you go running.  If you have been rushing madly around the shops, and it is a fairly warm day, you will already have fairly supple muscles with a good supply of blood flowing around them, so you can probably do a bit less than if you have just got out of bed in the middle of winter and are about to set off for your first run in six weeks.

Once your heart rate is raised slightly, and you muscles are nice and warm with a good supply, I tend to recommend a short period of stretching.  This is more to check you haven’t missed any muscles in you warm-up, rather than specifically work on muscle length just yet.  For running, you mostly want to address the quadriceps down the front of your thigh, the hamstrings down the back of your leg, and your calf muscles.   Once you have made sure these are all nice and supple, you are all set to go for your run.

After running, always walk for a short while to gradually reduce the blood supply to your legs.  If you just stop, you risk decreasing the circulation too quickly, which may allow lactic acid to build up in the muscles, causing cramps and that horrible day-after muscle soreness.  Having walked around for this time, it’s time to get in to some serious stretching.  By stretching after you work  out, you are aiming to prevent injury happening the next time you run by keeping the muscles as long and flexible as possible; after exercise they have a tendency to shorten and become tight, and stretching helps to combat this.  So work with the same three muscle groups you addressed in your warm up, but this time spend a bit longer on each area, and challenge them a little more with each stretch.  Generally holding each stretch for three to five sets of 30 seconds is sufficient for most people.  On top of your quads, hamstrings and calf muscles you should also stretch out your inner thigh muscles, iliotibial band and gluteal muscles during your cool down.

By adopting these practices of good supportive footwear and an adequate warm up, stretching and cooling down period you will be doing a reasonable amount to protect yourself from injury.  But however hard you try, running is still a high impact, high intensity form of exercise which can cause problems with your joints.

Simple muscle strains are fairly common, as are repetitive strain injuries such as stress fractures in the feet and hips.  As mentioned previously, plantar fasciitis can also occur in people who haven’t done a lot of running previously, especially if their footwear is providing insufficient support for their arch.

Another repetitive strain injury seen in runners is commonly called shin splints.  More correctly, this is a condition called anterior compartment syndrome in which you experience varying levels of pain down the front of your shin when you start running.  It happens because the muscles down the front of the shin are encased in a strong connective sheath.  When you use these muscles more than they are used to, they can end up with swelling around them.  This swelling has nowhere to go, because the connective tissue sheath is unable to stretch, so it becomes extremely pressured in the area and this causes pain.  In its mildest form, there is no real problem from this besides the discomfort.  However, if it becomes severe then the blood vessels can become compressed and a vicious cycle of increasing swelling can be seen and then urgent surgery is required to relieve the pressure before long-term damage is done.  So while shin splints are a very painful but not particularly severe condition in most cases, it is very important you don’t simply ignore it.  Initial treatment is rest from the activity that caused it in the first place, and then a gradual and careful reintroduction back to that activity with plenty of stretching to make sure the muscles have time to naturally become used to the new movement without becoming swollen.  Chiropractors will often use soft tissue work to help with this recovery process.

There is in fact also a whole condition which is known as “runner’s knee”, because it is so strongly associated with the sport.  It is also called jogger’s knee, patella-femoral pain syndrome, chondromalcia patellae and about a dozen other things, but what is important is it can be extremely painful and it can also be helped by Chiropractic care.  Essentially it is pain located somewhere around the knee joint which is felt usually while running, or while going up and down stairs.  Although the pain is most frequently felt at the front or middle side of the knee, it can be felt elsewhere – or everywhere – in the joint.  Usually it is associated with a tight quadriceps muscle, and pain at the point just below the knee cap to the inner side, where there are a lot of muscles all coming in to attach at one particular point.  Working with these muscles to release tension is usually sufficient to relieve the pain associated with this condition, but sometimes the mechanics of your gait need to be addressed.

One of the reasons this condition can develop is due to a weakness in the gluteus medius muscle, which is responsible for holding the thigh out in a straight line, rather than letting the knees collapse in towards each other in a knock-kneed stance.  If this muscle is unable to perform its function adequately, and the knees are allowed to collapse, then it puts a much greater stress on the knee joints and consequently causes pain and stiffness in the area.  A few simple exercises to strengthen then gluteus medius muscle, and then a bit of training so that the brain learns a new way of moving the joints to use the newly strengthened muscle will soon see a much more healthy movement pattern through the knee.

Finally, I would just like to comment quickly on something that I find rather interesting.  There is, functionally, such a thing as running like a girl – and consequently, running like a boy.  Research has discovered that women generally have comparatively more strength in their hamstrings than in their quadriceps, while men tend to have the reverse.  This produces an observable difference in running style – generally, women will run by pushing off behind them, using their hamstrings most to produce quite a flat, smooth running gait while men will generally run by bringing their leg further in front of them and pulling their body along to catch up, requiring a greater use of the quadriceps muscle and giving a much higher step to their running stride.  Of course, there are women who have stronger quadriceps and men who are better at using their hamstrings, but in general it is the other way around.  So there you are – next time someone says you run like a girl, you can just thank them for complimenting the strength of your hamstrings!

Cycling and Chiropractic

Before I even left college, I was being introduced to the world of international road cycling races as one of my colleagues and patients at college was an international-level competitor.  In helping him with his training, I learned a lot, especially about the problems that can be caused by even the slightest imbalance in the muscles.

Ever since the Olympics there has been a huge increase in the popularity of cycling.  I do a lot of driving between practices, home and my horse, and scarcely a journey goes by without me seeing at least one person clad in their sponsor-laden Lycra, pedalling away with great enthusiasm in the name of fitness and transport.  But with this increase in cycling popularity, there has also been a corresponding increase in the number of health problems related to cycling being seen in my Clinic.

The main problem is position.  It is a really good idea to get your bike professionally fitted to you by a local specialist, as this cuts down on the chances of injuries occurring.  However, it is not uncommon for cyclists to go out for an hour or two at the time, or longer, and throughout that period they are maintaining more or less the same position.  All well and good if that position is a strong one, and they have the muscles to support it, but not so good for John Smith who bought his bike at the weekend off Amazon and is out for his first trip.  The most common area for problems in the early days is in the lower back, and I have put my incredible artistic skill to the test to try and explain why this might be the case.  So here goes.  First we have the posture adopted by people who see Chris Hoy powering around the track and want to be just like him.  So the handle bars are set way down, the saddle almost on a level with them.  And this is what we end up with:

Now, it’s not so much the height of the handlebars compared with the saddle causing the issue here, as the fact our cyclist is using his back to achieve the forward flexion needed to reach the handlebars.  This means that your spine – which isn’t a massive fan of bending at the best of times – spends several hours at a time scrunching forward with no help at all from the fact you are powering up and down hills.  So how can it be corrected? Try this:

Here, the handle bars are still at the same height as the seat, but the forward bend is all coming from this rider’s hips, keeping his back straight and strong in a position it can maintain for the hours required.  An added bonus of this posture is that it allows your gluteal muscles in your buttocks to really get in on the action, and they are the true powerhouses behind straightening your leg from your hip.  More power from the muscles means more power through to the pedals resulting in more speed on the road.

So much for the back, but you are also putting all that force onto the pedals through your legs, and that means your knees are getting involved.  Now, if it is being done properly, cycling is a perfectly good form of exercise in terms of the strain on your knees.  It is low impact, unlike running, and you aren’t likely to be hit from the side as you are in rugby, and you also aren’t expected to do sudden turns with your foot planted as you are in football.  But there are a few areas which, if left unattended, can cause quite significant pain in the knees.

Primarily, the problem comes when the knee joints are allowed to collapse in towards the bike, instead of staying out so that if you were to look straight down they are travelling over your second toe.  This puts a great deal of pressure the outer half of the joint, and also risks straining the ligaments down the inside as they are expected to stretch to accommodate the angle.  This is particularly a problem for women, but is also seen in men.  Strangely, the problem actually has nothing to do with your knees – it’s all about the buttocks.  Well, the muscles that form your buttocks, at least.  The gluteus medius in particular is responsible for taking your leg out to the side, and this translates as being responsible for holding your thigh in a straight line and therefore keeping your knee straight, rather than falling in to the bike.  If this muscle simply doesn’t have the strength to perform this function, then it is highly likely the first symptom you as the cyclist will notice will be pain at the knee.  Besides, cycling in a knock-kneed posture looks a little odd, and we all want to avoid that!

So, as far as road-cycling is concerned, posture and correct muscle strength is key.  Faults with either of these factors can be easily corrected, and injury avoided.

Mountain biking is a whole different kettle of fish.  No nice smooth surfaces to race along for these guys.  Not surprisingly, the most common event which causes a mountain-biker to rock up at the door of my clinic is falling off.   And they do it a lot.  So primarily, my role as a Chiropractor for anyone who enjoys flinging themselves off daft places with only a bit of metal framework, two wheels and a crash helmet is picking up the pieces when it didn’t quite go as planned!

Muscle strains, ligament tears and broken bones are all common sights after a day of extreme biking, but for those who are a little more safety conscious and prefer just going off-track rather than down mountains by the shortest route possible, there are still a number of considerations.

Posture is still important for off-road cycling, and the knees can often take even more of a hammering as when you stand up in your saddle to ease the jarring of a rough track on your back, it is your knees which have to flex and bend to keep your body as still as possible and your feet in contact with the pedals.  A problem which is more often seen in mountain bikers than road cyclists is injury to the nerve which supplies the hand.  If you are using straight handle bars, and imagine where the bar sits across your palm, it quite often ends up sitting right where one of the main nerves into your hand passes through a bony passage.  The constant pressure and occasional shocks it receives as you bounce around on a dirt track can lead to compression and inflammation, resulting in pain and numbness or tingling into your hand which takes longer to ease off the more often it happens.  Unfortunately, the only real way to address this is to change where the handle bars are sitting on your hand, either by using a different style of handle bar, or changing your grip.  If it doesn’t happen very often, it may be sufficient to simply wear padded gloves to minimise the compression.

Finally, we come to the form of cycling where it is more of a mode of transport than anything else.  None of this Lycra obsession, and certainly no rocks and boulders in sight.  Again, posture is important, but the best posture is now focussed on minimising the stress to your back and shoulders, even at the expense of a little of the power and speed.  So rather than having the handlebars low, the saddle high and having to lean forward, you are much better off adopting a high handlebar, low saddle ratio which allows you to sit up straight on the bike.  Imagine your typical cyclist in the Netherlands, or possibly one of those black and white photos of a Victorian person on their bike, and you get the idea.  It may not be as fashionable (although I am pleased to say I seem to be seeing more and more people opting for this posture) but it is by far the best idea for protecting your spine and staying pain-free!

Golf and Chiropractic

Golf is all about your swing.  Get that right, and the battle for the perfect shot and a pain free game is almost won.  Of course, there’s the small matter of aim as well, but that’s more of a skill thing than a physical posture and movement thing!

I used to use Tiger Woods as an example of a really good golf swing to all my patients, but somehow that lost some of its impact when he had to take time off from playing with a back injury.  It really wasn’t helpful, Tiger.  But still, however that injury happened, he still has the sort of swing we should all aspire to.  And the main reason behind that is the way he twists.  If you watch an amateur golfer just knocking around with a few balls, the majority of the rotation which gives their swing power comes from their lower back.  Quite often they leave their feet planted on the ground as well, which just has me cringing in anticipation of their knees giving a loud “pop” and them collapsing to the floor in agony, but we will come to that in a minute!

First, the rotation.  When a good professional golfer swings, you can see that their back hardly moves to twist.  Oh sure, they may lean back a bit, but the actual rotational force comes from their hips twisting around.  If there is one thing guaranteed to cause a painful problem with the muscles and joints of the back, it is twisting; your spine may be able to technically achieve it, but that doesn’t mean it is going to enjoy it.  So the first thing I often work on with my golfing patients is getting them to learn to move their body in a whole block.

At the same time, I will be working on what they are doing with their feet.  Knees don’t enjoy twisting any more than backs do, and one of the ways to get a really good wrenching force through your knee is to leave your foot planted flat on the floor and move the rest of your body in a swinging motion, as you do for your golf swing.  That’s when the various ligaments of your knee scream and run away – or rather more literally, tear or sprain with a pop that leaves you clutching your knee in agony.  So while you are learning to move your body in a block, you are also going to need to learn to do it with your back foot raising up onto the toes so that it can twist on the floor, thereby taking the pressure off your knee.

So much for the body part of your swing, but naturally your arms and shoulders are pretty involved as well.  Once we have you able to pivot in a minimally stressful way, we can start work on making sure you have the necessary strength and flexibility in the shoulder joints to get a really good whack at the ball.  This usually involves repeatedly going through different stages of the movement against varying levels of resistance to make sure the right muscles are being worked, and combining this with different stretches makes sure you also have the freedom of movement to achieve your full range.  This isn’t limited to your upper body either – if you are tight through your lower back, then you will hit a block in your movement before you have had a chance to really get everything going.

Once you have the strength, suppleness and skill of moving as a whole, you are free to go off and wow every single person at your local golf club.  Who knows – maybe  you will even win a place at the next Open!

Horse Riding and Chiropractic

Since a young age, horses have been my passion.  I have ridden for many years, and currently train my ex-racehorse for Dressage, which has given me an extremely useful insight into the way the body works while we work with these beautiful animals…and what can happen when it all goes wrong.

To say I love horses and horse riding is something of an understatement.  I actually became a chiropractor because I wanted to be an equine chiropractor, and found you have to train with people first.  As so often happens, my ideals changed over the years, and I became more and more fascinated with the working of the human body so that I decided to keep horses in my personal life and maintain my work with people professionally.  However, this does give me a very useful knowledge base for helping my horse-riding patients reach their full equitation potential.

It seems to be a near-universal truth that as riders we put the horse first and cater to their every need without any thought to our own.  This can actually be extremely counter-productive.  I know many horse riders who will have the physiotherapist, osteopath or chiropractor out to their horse on a regular basis, yet when it comes to getting their own aches and pains looked to they are strangely reluctant.  But if you are unable to sit correctly on your horse due to pain or muscle tension, then you are going to be constantly stressing your horse’s back which will only cause them to have problems as well.  Besides which, how can you possibly concentrate on getting your horse working well when you are being distracted by that twinge from your lower back.

Of course, when you mention the use of Chiropractic when it comes to horse riding to non-riders, their mind immediately goes to the many tumbles and spills we all expect to take in the name of better riding.  And without a doubt, Chiropractic can be extremely helpful in releasing the muscle and joint tension that so often occurs when you have hit the ground from a height at speed.  But that is by no means the whole story.

Let’s start at the top, and your neck.  Now, in some of my other pages I discuss the fact your neck is a very slender and flexible structure, which is expected to carry around about 9lbs (4.5kg) of your head on it.  Add to this the weight of your riding hat, and the occasional whipping around your head gets when your horse decides that the branch it has gone past without incident one hundred times is suddenly flippin’ terrifying, and you can see how your neck can very easily get injured just in the normal course of riding.  In so many cases like this, we riders don’t bother to get anything done about it.  It’s just a bit sore, it will settle down in a bit.  Well, yes, it might, but in the mean time how are you supposed to follow the riding instructor’s eternal order to “look up and around at where you are going”?  Ninety percent of a good dressage rider’s instructions come not from definite aids, but from having their weight in just the right place at just the right time, and then the leg and reins only come in to support that weight shift.  But you’re neck is the place that weight movement starts, so if you can’t look around at where you want to go, how is your poor horse supposed to understand the instruction?  And the significance doesn’t stop with dressage – it is vital in all forms of jumping as well that you are able to look at where the next fence is, if nothing else so that you can tell your horse which leg he needs to be on to meet the next jump.  Even if you are just a “happy hacker”, then looking for cars and tractors can be just as important.  So you need to have full, free and painless movement of your neck before anything can start to go right.

Coming down then, we hit your shoulders and upper back.  Again, all riding requires a good upright posture, with shoulders back and no slouching through the upper back.  You need to maintain nice soft arms to feed that lovely soft contact we are looking for.  And if you have a mega-load of tension through your shoulders, this is simply not going to happen!  Think of the times you have had a really stressful day at work, and you go home hoping for a really nice ride to make something good out of an otherwise terrible day, and your horse picks that time to really mess you about.  It has nothing to do with horses being vindictive – he doesn’t know that so-and-so at work said such-and-such to the boss and now you’re whole department is in uproar.  He is simply reacting to the fact that instead of giving a springy, light touch on the reins you are set like concrete around him and somehow expect him to be able to bend and flex the same as always.

The lower back is my favourite area for pointing out that men are actually better built for riding than women.  Their lower backs are naturally flatter, whereas a woman will always have slightly more of a curve and their pelvis is set tilting slightly more forward to accommodate child-bearing; so when us girls try and really sit deep in the saddle on our tailbones, it’s a whole load harder than when men try to do it!  But anyway – stiffness and pain in this region is clearly going to cause a massive problem with your riding.  This is the first area of direct contact between you and the horse, through your saddle, and any tension you have in your lower back or hips is going to be transmitted straight to them.  Also, we tend to develop one side that is tighter than the other during the natural course of our lives, and this can cause real problems with balance – and saddle slipping.  If you are tight through one side, your brain will automatically try to keep your upper body straight by tilting your pelvis off to one side meaning you ended up tilted off to one side.

By trying to make sure tension like this isn’t present, we can minimise the effect it has on your horse.  If you are constantly leaning off to one side, then the most obvious occurrence is that your saddle is prone to sliding round to one side.  You will also be placing more strain on one side of your horse’s back, causing an uneven strain in both the topline muscles, shoulders and pelvis of the horse, not to mention on your own spine.

Some riders report that they have difficulty persuading their horse to strike off on the correct leg in canter.  Of course, this might just be something your horse has difficulty with – horses are left and right handed, just the same as their riders, and they can also have physical characteristics which mean they struggle with one lead.  But once these have been ruled out, it is definitely time to start looking at our rider.  The most straight forward reason behind this difficulty could be a tightness of the muscles around the hip joint on one side.  If the muscles are too tight down the front of your leg, you are not going to be able to extend through your hip joint and therefore bring your leg into place behind the girth.  So your horse is only getting half the message – you are clearly telling him to go faster, but in effect you are leaving it entirely up to him as to how he does this.

So while it is extremely important to take care of all aspects of your horse – his muscular and skeletal needs, his saddle fitting, his feet and his teeth – it is every bit as important to take care of your own fitness to ride by making sure you are not being affected by any day-to-day build up of tension or the effect of recent injuries.  Even if you are indifferent to your own pain, you owe it to your horse.  And you’ll be amazed at the difference a little bit of Chiropractic care can make to your overall riding performance!