Anatomy, Biomechanics, Human, Injury and Rehab, Injury Management

Happy Hamstrings

Do you ever experience hamstring pain during or after exercise? While you might experience hamstring pain or discomfort it may not be the primary source of your problem read on to find out what might be the cause and how to remedy it.

Hamstring Anatomy

The hamstrings are made up of three muscles, the bicep femoris, semitendinosus and semimembranosus. The adductor magnus can sometimes be referred to as a fourth hamstring as it shares one of its origins with the other hamstrings on the ischial tuberosity (seat bones).

Semitendinosus and semimembranosus only have one orgin but the bicep femoris has two heads. The long head originates from the ischial tuberosity and the short head from the lateral lip of the linea aspera of the femur. The two heads merge and insert onto the head of the fibula in the lower leg. The semimembranosus inserts onto the posterior aspect of the medial condyle of the tibia while the semitendinosus merges with gracilis and sartorius to form the pes anserinus tendon. This then inserts into the proximal, medial shaft of the tibia in the lower leg.

All the hamstrings flex the knee and extend the hip. The semimembranosus and semitendinosus medially rotate the knee and hip while the bicep femoris laterally rotates the knee and hip.

Potential Hamstring Issues

Hamstrings can become grumpy due to a number of reasons. Firstly they may actually experience a strain, tear or feel permanently tight. While the hamstring could be the primary cause it is often other soft tissue structures that are the instigator. So the 3 key things to look at if you experience hamstring issues are

  • Quadriceps to hamstring strength
  • Gluteal activation
  • Anterior tilt of the pelvis

Anterior Pelvic Tilt

Anterior pelvic tilt can come about due to tightness in the hip flexors (iliopsoas: psoas and iliacus) as well as tightness in the quadriceps. The pelvic tilt can stretch the hamstrings as a result you ask the hamstrings to take load in this position. The hamstrings feel tight so you try and stretch them further which probably doesn’t do a lot. If the hamstrings are loaded while being stretched then they have less elasticity are are more likely to injure. So by releasing or stretching the hip flexors and quadriceps you can reduce anterior tilt of the pelvis and allow the hamstrings to relax more. This should reduce the chances of straining them.

Gluteal Activation

Another consequence of anterior pelvic tilt can be the gluteal muscles not activating properly. Gluteal activation is not always dependant on anterior pelvic tilt being present. Sports than involve sitting on bending over and not full hip extension can also cause the glutes to not activate. As a result the hamstrings activate before the gluteal muscles do. This again puts extra strain on the hamstrings making them more vulnerable to injury. So to combat this getting the gluteals activating, strong and doing their job will take the load off the hamstrings.

Quadriceps to hamstring strength

Athletes often focus on strengthening the quadriceps and forget about their hamstring. Quadriceps should be stronger because of their job but one of the hamstrings job is to control and stabilise extension of the knee. If this didn’t happen then the strength of the quadriceps would cause the knee to over extend, and cause hamstring injuries. As a result it is really important to do specific hamstring exercises such as Nordic hamstring curls.

Below is a video on how to keep your hamstrings happy and reduce the possibility of sustaining and injury to them

Anatomy, Human, Injury and Rehab, Injury Management

K-taping your knee for patella maltracking

Patella maltracking (or patella femoral pain) is a common occurrence in the sporting knee. It is an overuse injury where the patella is slightly pulled out of its normal position causing irritation and inflammation under the knee cap as it rubs against other structures.

Patella maltracking can be caused by tightness in soft tissue such as the tensor facea latae, rectus femoris, vastus lateralis and potentially bicep femoris. As a result the vastus medialis may also be weak and unable to counter act the tight muscles pulling the patella out or up. As a result the tight muscles need to be released of through soft tissue work and the vastus medialis strengthened. With the primary cause being dealt with taping the knee can help reduce pain and re-educate the movement patterns required.

Below is a video on how to tape your knee to reduce pain and allow you to exercise and strengthen your knee.

Human, Injury and Rehab, Injury Management

Injuries: Overuse

You may wonder sometimes how you sustained an injury when you didn’t have a noticeable traumatic event like a fall. Generally injuries that have no obvious event and build up over time are called overuse injuries. They are really common and can be caused by a number of things. Read on if you want to find out more.

What is an overuse injury

Overuse injuries are a build up of micro trauma to a certain area. The body goes through a process of remodelling to help adapt to stresses placed on it. Through this process we get fitter and stronger. However if this process is disrupted we can’t remodel correctly, as a result we sustain an injury if it continues. Often overuse injuries have inflammation along with the micro trauma.

Examples of overuse injuries

  • Tennis elbow
  • Golfers elbow
  • Runners knee
  • Achilles tendinopathy
  • Shin splints
  • Stress fractures
  • Patella tendon tendinopathy
  • Patella maltracking

Causes of overuse injuries

  • Increased load
  • Frequency of training
  • Not enough rest
  • Poor diet
  • Old or poorly fitting footwear
  • Incorrect equipment

If you want to reduce the risk of sustaining an overuse injury then making sure you increase your training load and frequency gradually with enough rest in between sessions will allow your body to react well to exercise, having regular massages can also help this process. Also making sure you eat a healthy balanced diet to give your body the building blocks to remodel and lastly making sure your equipment is up to the job I.e. fits you and is not worn otherwise this can change your biomechanics and loading of certain tissues.

If you find that you are suffering from an overuse injury then do consult a physio, sport therapist or doctor to help with management and rehabilitation.

Anatomy, Biomechanics, Human, Injury and Rehab

Feet the foundation of movement: Part two Injuries

In the last blog we introduced the anatomy and function of the foot (Part one anatomy and function). With this knowledge it can be seen that the foot is quite a complex structure and with so many components you would think quite a lot can go wrong. If you think how often you walk, run or jump and the forces going through your feet it is quite immense, and yet our feet seem to tolerate this on a daily basis. However there are occasions where trauma occurs or our feet just can’t recover as they should. Below are some common injuries your feet might experience.

Plantar fasciitis

Plantar fasciitis is one of the most common forms of foot pain. It is common in runners and older adults. It is often associated with biomechanical issues due to excessive pronation or supination. It is an overuse injury and what we would term a tendinopathy. You may have experienced tennis elbow or Achilles tendinopathy. Which is a similar condition just affecting a different part of your body. Tendinopathy in short is when the tendon is not healing in the normal manner, it can fray, become thickened and be painful.

Flat feet or high arches can increase the risk of plantar fasciitis. Tightness in the calf muscle, hamstrings and gluteals can also increase the risk. Plantar fasciitis has a gradual onset of pain which is often located on the medial aspect of the heel and experienced after activity. However when it becomes more severe pain can be experienced when weight bearing and on activity. Periods of inactivity during the day can also increase the pain when commencing activity again. Stretching the foot and fascia also can cause pain.

Stress fractures

The common bones in the foot that can suffer stress fractures are the calcanous, navicular and metatarsals. Calcaneal stress fractures are common in runners, military personnel, ballet dancers and sports that involve jumping. Having poor heel cushioning, overstriding and a heavy load can all increase the risk. The onset of pain is insidious in nature and aggravated by weight bearing. There is localised tenderness to the medial or lateral border of the heel.

Navicular stress fractures are the most common stress fracture in the foot. It can occur in sprinters, jumping sports and hurdling. It is an overuse injury and is thought to be due to training errors and impingement of the bone between other tarsal bones. Decreased dorsiflexion in the ankle is thought to perhaps bring about an increase in compensatory dorsiflexion in the foot increasing the stress placed on the navicular. Individuals often experience a midfoot localised ache, radiating along the medial aspect of the medial longitudinal arch. It often gets better with rest.

Metatarsal stress fractures occur with excessive loading of the forefoot and muscle fatigue. Forefoot pain is experienced and aggravated by activity. Pain gradually worsens with activity and tenderness over the metatarsal is present. Stress fractures don’t always present themselves on x-ray straight away so can be harder to diagnose than a complete fracture. However if one is suspected then management strategies can be implemented until diagnosis is confirmed

Metatarsalgia

Metatarsalgia is an inflammatory condition of the metatarsal phalangeal joints. It is caused by excessive pressure over prolonged periods of time. It is associated with high arches, excessive pronation of the foot, clawing/hammer toe, tight extensor tendons of the toes, prominent metatarsal heads and Morton’s foot. Pain is aggravated by forefoot weight bearing and affects the mid stance and propulsive phase of walking. Pain is gradual in onset and local tenderness over joints is present. Passive flexion of the toe causes pain and a v shape between toes can also be an early sign.

Bunion (Hallucis valgus)

This is when the big toe deviates laterally, it is more common in women and older people. There are a number of factors that can lead to the development of a bunion constricting footwear like high heels, excessive pronation of the foot, long first metatarsal (big toe), trauma to the medial and plantar ligaments and trauma to the medial sesamoid bone. As the deformity develops so does the pain over the medial border of the big toe this can be relieved by removing footwear or wearing wider shoes.

Toe Clawing

Toe clawing is not necessarily a painful condition but suggests that the long flexor tendons are tight. During the propulsion phase of gait the long flexors contract to stabilise the toes, if the foot is unstable the long flexor tendons excessively contract causing the toes to claw at the ground to maintain stability. If this continues then it could affect other areas of the foot or body as they compensate.

The above are just a few examples of injuries that can develop with feet. There are many others. The majority of the above injuries can be avoided by performing exercises and taking other everyday precautions. Part three of this series will address these solutions to help you maintain happy feet.

If you have concerns about your feet then either consult your doctor or Pollyanna would be happy to answer any queries you might have where she can

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Anatomy, Biomechanics, Human

Feet the foundation of movement: Part one anatomy and function

Feet are an important part of our lives. They continuously absorb a lot of force to allow us to move and balance in a number of ways. When feet are doing their job life is great but if there is something wrong then daily life can be affected hugely. Do you take care of your feet, understand how they work or want to know more about these incredible structures then continue reading?

Today we are going to discuss the anatomy and function of the foot. Part two will look into problems that may arise with feet and how they can affect the rest of the body. In part three and to conclude the series then ways to keep your feet healthy for pain free movement will be discussed.

Anatomy of the foot

The foot is quite a complex structure compared to the rest of a human body. It is made up of 26 bones, 30 joints and over a 100 muscles, tendons and ligaments all working together to create an apparatus that allows movement, and stability while bearing the weight of the whole body.

The foot is separated into three regions the hindfoot, midfoot and forefoot. The hindfoot is made up of the talus and calcanus. The talus articulates with the fibula and tibia to form the ankle joint (talocrural joint) and the calcanous is your heel. The midfoot has five tarsal bones, which are wedge shaped and help form the arch of your foot. The forefoot contains the metatarsals and phalanges which form your toes.

Function of the foot

As noted earlier the foot bears the weight of our bodies. When walking the pressure on the feet increases twofold and then fourfold when running. This is a huge amount of pressure in such a small structure. As a result the foot needs to be able to absorb and distribute weight. It also needs to be able to help with propelling the body forward in our chosen gait. The foot has three arches the medial longitudinal, lateral longitudinal and transverse arch. These arches allow weight to be distributed throughout the foot as well as allowing the foot to make adjustments to uneven terrain. The medial longitudinal arch is the primary load bearing and shock absorbing structure of the foot. It forms the instep of the foot.

The plantar fascia makes up the primary passive component (along with the bony structures) of the medial longitudinal arch. It covers the sole and side of the foot. Active toe extension stretches the fascia which adds tension to the medial longitudinal arch. It helps stabilise the foot especially in the push of phase of movement. Other structures such as muscles help stop the arch from lowering to much when weight bearing and likely protects against stress related injuries.

The foots ability to repeatedly transform from a flexible and shock absorbing structure to a rigid lever type structure is really important in our ability to move and weight bear. If there is a problem in the foots structure then our ability to weigh bear and move is compromised and our everyday living is profoundly affected. In the next post injuries that can arise with feet will be discussed.

If you have any queries about injuries to your feet then don’t hesitate to get in touch to discuss your concerns or book an appointment

Horse & Rider, Human

Balanced Rider

When we ride our trusty stead, we try and develop balance, straightness and suppleness in our horse so that they can carry us more effectively and efficiently. However, how often as a rider do you develop your own balance, straightness and suppleness? I would hazard a guess, not as frequently or diligently as you do your horse. With the winter almost over and spring on the horizon, now is a really good time to begin focusing and developing yourself for your horse. They will appreciate it!

We often hear the words “balanced rider” being banded around but what does this really mean? A balanced rider can encompass so many things. Here are just a few to consider when talking about a balanced rider

Force Balance

When the word balance is used, most people will automatically think of the ability to balance against gravity, for example, when standing on one leg or on a beam in gymnastics. This is balance and does play a huge part in riding a horse. If you are not balanced then gravity unfortunately takes control and a rider may fall off or come close to it. If this component of balance is something that you find difficult, think how that affects your horse’s balance. If you are carrying a child or small animal that keeps moving and wriggling around, you have to make adjustments so that you don’t drop them and sometimes this ultimately doesn’t work and a fall occurs. The consequences could be injury to both parties and a feeling of letting someone down. This is something that your horse could experience when you are not balanced and fall off. So to help your horse, working on your basic balance would go a long way to helping to make their job of being a ridden horse easier and less stressful for both parties.

Strength Balance

When I talk about balance of strength, I am referring to muscle strength. This can be left and right dominance. The majority of people are right-handed and are therefore stronger in their right hand or arm. Balance of muscle strength can also refer to agonist and antagonist muscle pairs. If there is an imbalance between these then injury can occur. While this is really important, for this blog it is not of focus but something that will be addressed in the future. So going back to left and right dominance, it is a natural occurrence but it is something we can decrease by working and training our non dominant side. This will even our strength out from one side to the other making our aids more consistent side to side when riding. By doing this a rider can further balance their horse out and be more supportive on their horse’s non dominant side.

Tension Balance

Muscle and soft tissue play a huge part in movement biomechanics for horse and rider. If an area is tight this will affect the body globally and also affect how your horse moves. You may not think this is so, however you may be shocked at how much you actually do influence your horse’s movement.

About 5 months ago, I injured my back playing field hockey. I had pain in the right side of my lower back which resulted in a huge decrease in range of motion, strength, force absorption and suppleness in my hips and back. However, I still attempted to ride and it was definitely an attempt. In walk I was not too bad, nor was my horse but going into trot was another story. My horse looked lame on both reins, feeling pretty low at being injured myself, having the prospect of my horse being lame as well, just would have been the last nail in the coffin. I was lucky enough to have my instructor present and being an equine bodyworker myself, we got to work straight away to fix him. Firstly we lunged him still with tack on and were happily surprised to see that he was not at all lame but instead moving rather well. It was therefore put down to rider influence. This surprised me hugely. While I know we influence our horses, I didn’t think by this much. Let me put this into a little bit more perspective. I am a small rider standing at 5ft2″ and 53kg. If my horse was small perhaps this would be understandable but my horse is 16.3hh, maybe a little taller and probably weighs near if not more than 700kg. So you can see that we can influence how our horse moves quite considerably, even minor things that we don’t realise could have an affect.

Soft tissue tension can affect mobility of the body causing decreased movement in various areas. It can also affect how different muscles activate, for instance, when there is a lot of tension in the iliopsoas muscle (hip flexors), this can affect your gluteus medius (one of your many butt muscles). The gluteus medius helps stabilise the lower back so will really kick in when performing rising trot. When the iliopsaos is tight it causes the gluteus medius to become stretched and it doesn’t like it. As a result it doesn’t activate as effectively, thus not stabilising through the lower back. No matter how much you try and strengthen the gluteus medius, it won’t make a difference until the iliopsoas is released and the gluteus medius is no longer stretched. Once this muscle can activate, then strengthening can occur and the body can function as a unit.

Anatomical Balance

Unfortunately, sometimes the way we are built means that we will have some differences from side to side or back to front. We were born like this and this is something we can’t always change, or we may have sustained an injury causing an anatomical difference. However, we can give ourself the best chance possible by being aware and doing something about it.

How do we develop ourselves so that we become the balanced rider that is talked about so much? Well there are many ways and here are some ideas below.

Massage

A massage is not just a luxury or something at a spa, a good sports massage will help with the following

  • Reduce muscle tension
  • Increase flexibility
  • Improve circulation and recovery
  • Help activate muscles
  • Reduce injury risk
  • Improve wellbeing

A good massage therapist will be able to help with improving posture off and on the horse. It is also good practice to be seen around the same time your horse receives bodywork so that one of you doesn’t undo the hard work put in. So when your horse is next scheduled for a session also schedule yourself in.

Pilates

Pilates was developed by Joseph Pilates to help rehabilitate soldiers during the war. It is used now to help people strengthen their core. However it is a bit more than this. Pilates does focus on your deep core muscles but it also develops better movement patterns by encouraging co-activation of deep core muscles and global muscles. I work with athletes and non athletes and while the athletes look strong, they tend to not use their deep core muscles but their global ones. They therefore find the more advanced Pilates exercises often easier but when you take them back to just using their deep core muscles they find this very difficult, unlike non athletes. Due to this, athletes that favour their global muscles will sustain injuries. Pilates teaches people to activate and use their body in a more functional and long lasting way.

Pilates is brilliant for horse riders as it allows a deeper understanding of one’s body. Equipilates™️ was developed specifically for horse riders by Lindsay Wilcox-Reid and is a combination of Pilates and other movement therapies to develop that body awareness and allow a rider to have a deeper connection with their horse. If you have an Equipilates™️ instructor near you, it is worth signing up to regular classes. Over time you will notice a difference. However, if you do not have an Equipilates™️ instructor close by, a normal Pilates class will still make a huge difference.

Things you can do when you ride

There are many things you can do without spending extra money or too much extra time. These include videoing yourself. This will highlight whether you are sitting evenly and what posture you adopt during all gaits and can be quite an eye opener. Often we are unaware of little things like this due to our bodies adapting and normalising them. It feels wrong when we correct them but in time your body will adjust to this being normal. The next step to really highlight any issues would to be to do regular no stirrup work. This will allow you as an individual to lengthen through the leg and hip and work hugely on balance force, especially when transitioning down. As you progress, using Franklin balls would further develop your awareness, balance and connection with your horse. Lastly, and this does cost a bit of money but having lessons with a riding instructor who understands core engagement is worth its weight in gold. Having someone tell you when and how you need to activate and seeing the results transfer to your horse in real time, is a huge learning curve and something you will then use throughout your riding, even when hacking.

So the above are just a few things you can do to become that balanced rider. There are others but the above would be a good first step in the right direction.