Injuries by Mike Reeves
“The ankle bone’s connected to the shin bone, the shin bone’s connected to the… ?”
In this article, I set out to explain why your knee pain could, in fact, be due to the stretch you made last week when you were putting in that new light bulb! Did you know that when you are walking and running over three-quarters of your time is spent on one leg and that each leg strikes the ground with force up to seven times your bodyweight? Scary or impressive? Now tell your friends you regularly do 30 mins plus of one-legged twisted squats at speed, with up to seven times your bodyweight, and it will confirm their worst fears about you.
Ankle and foot
So, bang - your heel strikes the ground and that’s it…..not! Like lightning, the force moves up from ankle bone, through the shin bone, the shin bone’s connected to the knee bone, the knee bone’s connected to the thigh bone, the hips, pelvis, spine, shoulder and finally around the skull. Feeling energised?
The course of the force is called the kinetic chain and the heel strike is the spark that fires it. As the heel strikes the floor:
Knee
The knee is a ‘chain-reaction link’ and the primary shock absorber, bearing the weight of the body’s movement and dissipating the upward forces from the ground. Check this for yourself: Stand on the outside edges of your feet and now relax or roll onto the inside. Now do it again, watching what happens to your knees. They will roll in. The inward movement when you walk stretches the big glute muscles which are attached to the back of your pelvis and the top of your legs. But, if you don’t get the inward stretch or the glutes are weak, the ankle has to roll in more to kick-start the process and suddenly you are overpronating. Don’t forget - seven times your bodyweight on a knee, hip or back being rotated too far…ouch!
Hip and pelvis
The hip and pelvis are freely moving joints which work together. They need to be free-moving because of the forces generated up and down the body by our movement .The pelvis rotates backwards on the right side as you step forwards with the right leg, while it rotates forwards on the opposite side to allow the left leg to swing back. Almost all of the muscles in the hip area are in our backside (the glutes), indicating that they are not only very powerful but essential for movement.
So, while walking or running, our glutes stretch in all three dimensions. Once again, if there is any restriction in the chain from ankle-up to hip-down, it will restrict movement and inhibit the glutes’ ability to control the inward rotation of the knee.
Multiply this by every single step taken throughout the day (ie to and from work or the gym plus the exercise you partake in) and it is clear that any fault in the chain will manifest itself slowly but surely as an injury.
However, before you begin to notice the injury, the body does something clever; it uses substitutes - Jose Mourinho style. So when the glutes first become restricted, your body says “Let’s call in the subs”:
Spine
The spinal column is a chain of discs and bones which can bend and rotate. That word rotation again! So, let’s imagine that one side of the pelvis is restricted (muscle tightening after a trip in the woods or muscle weakness in one of the glutes). This means that the lowest vertebra, known as L5, will be permanently rotated. The adjacent vertebra, L4, will be restricted or stressed, meaning that the vertebra above will then need to rotate more to permit ‘normal’ movement, and so on.
Something has to give - and it can be as serious as a slipped disc. The same problem occurs if we are similarly restricted in our upper spine. Many of us sit hunched over our screen and, as the vertebrae close up and become more restricted, the lower back has to become more rotated, leading to instability. What can you do for your spine? Well, there are specialist chiropractors, osteopaths, physiotherapists and sports injury therapists (like me), all trying to work it out. In the meantime, you can help prevent injury by regularly stretching and strengthening your spine.
Shoulder
The shoulder is our most moveable joint but this means it is the one most prone to restriction or injury caused by tight musculature or by our posture. Tight musculature could even be caused by our breathing pattern! We breathe about 15 times a minute or over 21,000 times a day. So, 21,000 times a day the muscles of our upper chest pull our rib cage open. If we become stressed, we breathe quicker and shallower and our ribs do not open as much. We begin to sigh and exhale harder. Our muscles are now working on the inhale and the exhale and will contract over 42,000 times a day, leading to overuse which makes them tight.
This, in turn, will create tension in the neck and, as the muscles shorten, start to pull our head forward. These shortened muscles will pull on the nerves in the neck and tighten the muscles around the skull leading to headaches. As the head comes forward, shoulder muscles will be recruited to pull the head back. These will lock to stop unwanted movement in the shoulder and this leads to shoulder pain.
If one side of the pelvis locks, it produces a corkscrew effect up the spine to the shoulder and down the spine to the ankle, altering opposing leg lengths. The body compensates for this by shifting the weight onto the shorter leg (with the pelvis in posterior rotation). The back muscles on the same side are then activated to keep the body upright. However, this activation pulls the shoulder down, leaving one higher than the other.
As we reach out with the lower shoulder, to swim using the crawl or to unscrew that light bulb, the outstretched arm pulls forward but the shoulder blade remains held firm by the activated back muscles. Soft tissue can then become pinched between the arm and the tip of the shoulder blade. This pinching will restrict the movement in the shoulder and the kinetic chain will falter. So… however many runners it takes to change that light bulb… be very careful.
In this article, I set out to explain why your knee pain could, in fact, be due to the stretch you made last week when you were putting in that new light bulb! Did you know that when you are walking and running over three-quarters of your time is spent on one leg and that each leg strikes the ground with force up to seven times your bodyweight? Scary or impressive? Now tell your friends you regularly do 30 mins plus of one-legged twisted squats at speed, with up to seven times your bodyweight, and it will confirm their worst fears about you.
Ankle and foot
So, bang - your heel strikes the ground and that’s it…..not! Like lightning, the force moves up from ankle bone, through the shin bone, the shin bone’s connected to the knee bone, the knee bone’s connected to the thigh bone, the hips, pelvis, spine, shoulder and finally around the skull. Feeling energised?
The course of the force is called the kinetic chain and the heel strike is the spark that fires it. As the heel strikes the floor:
- the ankle flexes, firing up the calf muscle;
- the heel bone moves out (everts) taking the lower leg, knee and hip towards the mid-line;
- the talus (the bone above the heel) slides forward and unlocks, allowing the foot to mould to the floor and internally rotate the lower leg, knee and hip;
- the hip flexes, stretching and activating the glutes forwards and backwards;
- the hip moves to the mid-line, stretching and activating more of the glutes in a decelerating sideways movement; and
- the hip rotates inwards, stretching the glutes rotationally.
Knee
The knee is a ‘chain-reaction link’ and the primary shock absorber, bearing the weight of the body’s movement and dissipating the upward forces from the ground. Check this for yourself: Stand on the outside edges of your feet and now relax or roll onto the inside. Now do it again, watching what happens to your knees. They will roll in. The inward movement when you walk stretches the big glute muscles which are attached to the back of your pelvis and the top of your legs. But, if you don’t get the inward stretch or the glutes are weak, the ankle has to roll in more to kick-start the process and suddenly you are overpronating. Don’t forget - seven times your bodyweight on a knee, hip or back being rotated too far…ouch!
Hip and pelvis
The hip and pelvis are freely moving joints which work together. They need to be free-moving because of the forces generated up and down the body by our movement .The pelvis rotates backwards on the right side as you step forwards with the right leg, while it rotates forwards on the opposite side to allow the left leg to swing back. Almost all of the muscles in the hip area are in our backside (the glutes), indicating that they are not only very powerful but essential for movement.
So, while walking or running, our glutes stretch in all three dimensions. Once again, if there is any restriction in the chain from ankle-up to hip-down, it will restrict movement and inhibit the glutes’ ability to control the inward rotation of the knee.
Multiply this by every single step taken throughout the day (ie to and from work or the gym plus the exercise you partake in) and it is clear that any fault in the chain will manifest itself slowly but surely as an injury.
However, before you begin to notice the injury, the body does something clever; it uses substitutes - Jose Mourinho style. So when the glutes first become restricted, your body says “Let’s call in the subs”:
- The piriformis now has to control inward movement of the knee, but it’s a small muscle and, as it grows and tightens through overwork, it squeezes the sciatic nerve…arghhh!
- The hamstrings now need to both stabilise and move the hip, making them short and tight, which leads to low back pain or a hamstring strain… arghhh!
- The adductors now have to pull the knee in, rather than subtly adjust it, and this causes lower back pain and groin strain... arghhhh!
- The TFL and the IT band now have to resist the inward roll, leading to tension down the outside of the thigh into the knee, leading to IT band syndrome or runner’s knee…arghhh!
Spine
The spinal column is a chain of discs and bones which can bend and rotate. That word rotation again! So, let’s imagine that one side of the pelvis is restricted (muscle tightening after a trip in the woods or muscle weakness in one of the glutes). This means that the lowest vertebra, known as L5, will be permanently rotated. The adjacent vertebra, L4, will be restricted or stressed, meaning that the vertebra above will then need to rotate more to permit ‘normal’ movement, and so on.
Something has to give - and it can be as serious as a slipped disc. The same problem occurs if we are similarly restricted in our upper spine. Many of us sit hunched over our screen and, as the vertebrae close up and become more restricted, the lower back has to become more rotated, leading to instability. What can you do for your spine? Well, there are specialist chiropractors, osteopaths, physiotherapists and sports injury therapists (like me), all trying to work it out. In the meantime, you can help prevent injury by regularly stretching and strengthening your spine.
Shoulder
The shoulder is our most moveable joint but this means it is the one most prone to restriction or injury caused by tight musculature or by our posture. Tight musculature could even be caused by our breathing pattern! We breathe about 15 times a minute or over 21,000 times a day. So, 21,000 times a day the muscles of our upper chest pull our rib cage open. If we become stressed, we breathe quicker and shallower and our ribs do not open as much. We begin to sigh and exhale harder. Our muscles are now working on the inhale and the exhale and will contract over 42,000 times a day, leading to overuse which makes them tight.
This, in turn, will create tension in the neck and, as the muscles shorten, start to pull our head forward. These shortened muscles will pull on the nerves in the neck and tighten the muscles around the skull leading to headaches. As the head comes forward, shoulder muscles will be recruited to pull the head back. These will lock to stop unwanted movement in the shoulder and this leads to shoulder pain.
If one side of the pelvis locks, it produces a corkscrew effect up the spine to the shoulder and down the spine to the ankle, altering opposing leg lengths. The body compensates for this by shifting the weight onto the shorter leg (with the pelvis in posterior rotation). The back muscles on the same side are then activated to keep the body upright. However, this activation pulls the shoulder down, leaving one higher than the other.
As we reach out with the lower shoulder, to swim using the crawl or to unscrew that light bulb, the outstretched arm pulls forward but the shoulder blade remains held firm by the activated back muscles. Soft tissue can then become pinched between the arm and the tip of the shoulder blade. This pinching will restrict the movement in the shoulder and the kinetic chain will falter. So… however many runners it takes to change that light bulb… be very careful.