Stress Fractures

stress. fractures, tibia, fibula

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

A stress fracture is an overuse injury. Human body creates a new bone to replace a bone that has been broken due to the stress of everyday life. This process is done every day to keep the balance. Unfortunately, this balance can be disrupted because of excessive physical training. There are several factors that can prevent the body from creating enough bone and this make microcracking, called « fracture stress ».

The most common factor of fracture stress is an excessive increase in the intensitiy or frequency of physical activity without adequate rest period. Other factors are nutritional deficiencies, mechanical influences, lack of sleep, systemic factors (hormonal imbalance, etc.) and metabolic bone disorders.

There are case of development of eating disorders and/or amenorrhea (infrequent menstrual periods) for some female athletes who are preparing for a competition. These 2 conditions can create a decrease in estrogen that can decrease bone mineral density. This increase the risk of stress fractures.

Stress fractures are often seen in athletes (especially runners) or military recruiting. For an athlete, 1.6km run is 110 tons of force absorbed by the legs. Bones aren’t made to resist this force (energy) so it’s the muscles that have the function of absorbing shocks.

When the muscles get tired, they stop absorbing the forces and eveything transferred to the bones. Stress fractures occur in almost all bones but are more common in lower bone, expecially the tibia. Depending on the type of sport, there’re distinctive stress fractures such as the elbow in throwing sports, the ribs in golfing and rowing, the spine in gymnastics, the lower extremity in running activities and the foot in gymnastics and bascketball.

Diagnosis

stress, fracture, foot, metatarsal, 5th
stress, fracture, foot, x-rays, metatarsal,2nd

Stress fractures create pain in a limited area directly above the tip of the bone where the fracture occurred. The pain is raw because of physical activity and relived with rest. The sensitivity of the bones is the most obvious conclusion to the physical examination.

With regard to X-rays, this isn’t a tool that actually helps to diagnose an early stress fracture because the bone often looks normal and the microcracking aren’t visible. It’s difficult because after several weeks of rest, the bone begins to repair itself and shows a healing reaction or callus on X-rays.

An early stress fracture is usually confirmed by a bone scan or magnetic resonance imaging (MRI).

Treatment

Stress fractures are generally classified as low-risk (will not become a serious fracture) or high-risk (will become a serious fracture).

Low-risk stress fractures usually require a rest period of 1-6 weeks of limited weight bearing activity progressing to full weight bearing may be necessary. Return to physical activity should be a gratual process.

Low impact activities like swimming or biking are recommended to maintain cardiovascular condition when the pain is gone. When the patient can comfortably perform low impact activities for long, pain-free periods, the patient can begin high-impact activities.

High-risk stress fracture have the danger of becoming a complete fracture. For athletes suffering from chronic pain and having normal x-rays results, it’s recommanded to use a bone scan or MRI. High-risk stress fractures should be treated as traumatic fractures (with cast or surgery) because of complications.

Prevent

food, vitamin,d, carrot, papay, meat, ,egg, chees, broccoli, fish, sweet, potato, mango, pepperoni, apricot, peach, melon, avocado
calcium, food, almond, amarant, grain, aparagus, apricot, artichoke, baked, bean, haricot, blackberry, blackstrap, molasse, blackcurrant, bok, choy, brazil, nut, bread, wholemeal, brocolly, chickpeas, cinnamon, edamame, soya, fennel, kale, kidney, olive, orange, sesame, seed, milk, spring, green, tofu, swede, walnut, watercress

Here are tips developed by AAOS to help to prevent stress fractures :

  • When an athete does a new sport activity, it’s necessary to program progressive goals. For example on the 1st day, don’t run 8km but rather increase the distance gradually per week.
  • Cross-training => Alternate activities to achieve the same fitness goal helps to avoid stress fracture injuries. For example to achieve a cardiovascular goal, alternate cycling and running (cycling one day and riding the other day) is excellent. Adding strength training and doing flexibility exercises help improve performance.
  • Have and maintain a heathy diet with foods rich in calcium and vitamin D.
  • Use good equipment. Don’t use running shoes, gloves, etc, very old and very worn.
  • If during physical activity it start to swell or the pain starts, stop the activity right away. It’s essential to rest for a few days. If the pain continue, you should see an orthopedic surgeon.
  • It’s important to recognize early symptoms and treat them appropriately to return to the sport with a normal level of play.

Stats

  • Stress fractures occur less frequently in those of black African descent than in Caucasians, due to a generally higher BMD (bone mineral densitiy) in the former.
  • Women and highly active individuals are also at a higher risk, The incidence probably also increases with age due to age-related reductions in BMD.
  • Children may also be at risk because their bones have yet to reach full density and strength.
  • The female athlete triad also can put women at risk, as disordered eating and osteoporosis can cause the bones to be severely weakened.

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-Steph

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Shoulder Impingement

shoulder impingement

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Impingement is the fact of having mechanical compression and/or tendon wear of the rotator cuff. Rotator cuff is composed of a serie of 4 muscles connected to the shoulder blade at the humeral head (upper part of the shoulder joint). The function of the rotator cuff is to maintain the humeral head within the glenoid (socket) during normal shoulder function and to participate in shoulder strength during activity. Normally, the rotator cuff glides gently between the inferior surface of the acromion, the bone at the point of the shoulder and the humeral head.

Causes

Any process that can interfere with rotator cuff being able to glide normally can cause impingement. The causes are :

  • Weakening

  • Degeneration of the tendon due to aging

  • Formation of the bone spurs

  • Inflammation of tissues on the space above the rotator cuff

  • Injury due to overuse

Overuse activities that can lead to impingement are most commonly seen in tennis players, pitchers and swimmers.

Diagnosis

shoulder impingement

Diagnosis can be made with the patient’s history and physical examination. Patients suffering impingement often complain of pain in the shoulder. This pain worsens with overhead activity and can be so strong that it causes an awakening during the night. Manipulation of the shoulder in a specific way by a doctor will usually reproduce the symptoms and confirm the diagnosis. X-rays are also useful for the evaluation of the presence of bone spurs and/or the narrowing of the subacromial space.

Treatment

The first thing to do is to eliminate identifiable causes or factor that contribute to the pain. This means temporarily avoiding activities like tennis, pitching or swimming. A non steroidal anti-inflammatory medication may also be recommended by your doctor. The treatment is based on exercises aimed at restoring flexibility and normal strength to the shoulder girdle, especially by strengthening the muscles of the rotator cuff and the muscles responsible for the normal movements of the scapula (shoulder blade). This program may be performed by a doctor, a certified athletic trainer or a qualified physiotherapist. Sometimes a cortisone injection may be helpful in the treatment.

Surgery

Surgery isn’t necessary in most case of shoulder impingement. But if the symptoms persist despite non-surgical treatment, surgical intervention may be beneficial. Surgery involves deriding or surgically removing, tissue that is irritating the rotator cuff. This can be done with open or arthroscopic technique. The result is favorable in about 90% of cases.

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-Steph

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Overuse Injuries

overuse injuries sport injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

There are 2 types of injuries : Acute injuries and overuse injuries. Acute injuries are usually caused by a single traumatic event. Here are some examples :

  • Wrist fractures

  • Ankle sprains

  • Shoulder dislocations

Acute injuries are less common in sport than overuse injuries. Overuse injuries are usually subtle and appear over time, making them difficult to diagnose and treat. Here is some example :

  • Tennis elbows

  • Swimmer’s shoulder

  • Pitcher’s elbow

  • Runner’s knee

  • Achilles tendinitis

  • Shin splints

Why

Human body is extraordinary to adapt to physical stress. We’re used of thinking that « stress » is bad for our emotional well-being, but physical stress is simply doing an exercise or activity. This is beneficial for our muscles, tendons, ligaments and bones. This physical stress causes an internal process called remodeling. Remodeling process involves both the breakdown and the build up of tissue. It’s necessary to have a good balance between 2, if breakdown occurs more rapidly than buildup, an overuse injury occurs.

Causes

overuse injuries sport injury gym fail

Usually, it’s training errors that cause overuse injuries. These errors are too fast acceleration of intensity or duration or activity frequency. These injuries can also happen to people who return to the sport/activity after an injury. They try to make up for lost time as quickly as possible to reach the level they had before the injury. Doing an exercise with a good technique is important to avoid overuse injuries. When the exercise’s technique is bad, it creates overuse injuries. It’s for this reason that coaches, athletic trainers and teachers can play a preventive role so that athletes avoid overuse injures.

There are people who more easily have overuse injuries. An unbalance between strength and flexibility around certain joints predisposes some people to have this type of injury. Body alignment, such as knock-knees, bowlegs, unequal leg lengths and flat or high arched feet, also impact overuse injuries. There are also people who have weak links because of old wounds, incomplete rehabilitation of wounds or others anatomy factors.

Other factors must also be taken into account as equipment such as the type of running shoe or ballet shoe and terrain (hard versus soft surface in aerobic dance or running).

Diagnosis

Generally the diagnosis is based on the athlete’s history and physical examination. It’s recommended to make a diagnosis with a sports medicine specialist with a specific interest and knowledge of your sport. In some situations X-rays, bone scan and MRI may be necessary.

Treatment

overuse injuries sport injury ice

Here are some recommendations for treating an overuse injuries :

  • Cutting back the intensity, duration and frequency of an activity

  • Adopting a hard/easy workout schedule and crosstraining with other activities to maintain fitness levels

  • Learning about proper training and technique from a coach or athletic trainer

  • Performing proper warm-up activities before and cool down after

  • Using ice after an activity for minor aches and pain

  • Using anti-inflammatory medications as necessary

If symptoms persist, a sport medicine specialist may create a more detailed treatment plan for your specific condition. This may involve an exam of your training program and an evaluation of predisposing factors.

Prevention

Majority of overuse injuries can be avoided with a proper training program, common sense and learning to listen your own body. The quote : « No pain, no gain » doesn’t apply here. The 10% rule helps a lot to get things to the next level.

In general, you should increase the training’s intensity to a maximum of 10% per week. This allows your body to have enough time for recovery and response. This rule should be used to increase pace or milestone for walkers or runners. Or for the weights amount to increase for strength training programs. In strength training, add flexibility exercises and core stability exercises help tremendously to minimize overuse injuries.

It’s recommended to seek advice from sports medicine specialist or athletic trainer to prevent chronic or recurring problems. Your training program can also be modified to maintain fitness levels safety while you recover from your injuries. You must return to the sport only if an authorization is granted by a health professional.

Remember, it’s very important to warm-up before training and cool down after training.

Stats

3.5 millions of children are treated for overuse injures every year.

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-Steph

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Mature Athlete

mature athlete

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Physical exercises are for everyone, including the mature population. Exercises allow older people to keep a healthy body and maintain their independence. The main health problems of the mature population are arthritis, high blood pressure, heart disease, lung disease, depression and hearing and sight loss. With the exception of hearing and sight loss, all these health problems can be serious decrease with an adequate workout program.

All mature athletes should have a complete medical and musculoskeletal assessment before starting any workout program. Having a complete medical examination, medical advice and a workout program helps to avoid serious injuries and health accidents. These 3 things should meet the needs of a mature athlete to avoid disease, increase endurance, strength, body image and competitiveness.

Exercises are beneficial

It’s important that a qualified personal trainer create a specific workout program to improve strength, endurance, balance and flexibility. If the workout program includes sports such as golf or tennis, the technical knowledge of the golf/tennis instructors is helpful to avoid injury and improve performance. For results, workout programs must be consistent for at least 30-45 minutes, 3-4 days a week.

If physical conditions require correction, a cardiac or pulmonary rehabilitation program or physical therapy may be helpful before starting a workout program. These rehab programs should be taught to mature athletes at a fitness level where they could continue with their own workout program.

Exercise type for the workout program

physical exercise type

An athlete should use types of exercises based on his/her desire, pre-existing conditions and his/her ability to exercise without pain. For an athlete with lower extremity joint problems such as arthritis or instability, it’s recommended to avoid exercises with repetitive impacts like running. For athletes with an unstable shoulder, it’s recommended to avoid overhead exercises such as military press and pull-ups.

Using several types of exercise to improve strength, can allow better recovery of muscle and tendon tissue. If a mature athlete wants to make a sport that can aggravate a pre-existing problem on a muscle, tendon or bone, that athlete should be in a good condition before doing this sport. It’s recommended to decrease this sport’s frequency to reduce the painful symptoms.

What equipment to use

Having shoes that fit with the exercise and/or the sport is beneficial. If the person has a foot with significant deformity such as flat feet (fallen arches), using orthopedic shoes helps to reduce stress on the entire lower extremity. The symptoms of arthritis in the knee may be decrease by the use of specialized braces.

Prevent injury or discomfort during exercise

If there is discomfort during or after physical exercise, this should be analyzed to prevent it from starting again or getting worse. Over-the-counter painkillers and anti-inflammatory can be used in the short term if there is no interference with other medical conditions. It’s important to know that the use of ice, heat, massage and flexibility programs can decrease several symptoms caused by exercise.

There is more aggressive treatment with narcotic analgesic and/or cortisone injections but this should only be used to treat a specific lesion. This shouldn’t be used to allow an athlete to complete in the short term.

Summary

Creating a customized workout program with a medical professional and/or a qualified personal trainer helps a mature athlete to :

  • Keep independence

  • Increase physical abilities

  • Prevent injuries

  • Improve the quality of life

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food. Click here.

Ankle Sprain

ankle sprain inversion lateral

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

A sprain is a stretch injury of the ligament that supports the ankle. This sprain often happens to the ligament outside the ankle when the foot is twisted inward (inverted). It’s a « lateral » ankle sprain that localized to the ligaments in the outer/lower part of the ankle.

A « high » ankle sprain (or syndesmosis injury) is a ligament stretch injury that holds the tibia and fibula together in the lower leg. This type of sprain happens when the ankle is twisted outward, it’s an eversion injury.

ankle sprain inversion eversion syndesmatic lateral medial high

When there is a sprain, the ankle is tender and swollen on the outside, above and at the front of the ankle bone, but the pain doesn’t come from the ankle bone. A sprain can create moderate or severe pain that can prevent the foot from supporting the body weight.

ankle sprain stretch injury grade

Treatment of sprained ankle

ankle sprain rice rest ice compression elevation

The basic treatment is what we call RICE (rest, ice, compression and elevation). During a severe sprain, it’s advisable to use a walking boot to help support the ankle.

Recovery time for a « lateral » sprain is usually 1-3 weeks and for a « high » sprain is usually 3-6 weeks.

Rehabilitation can begin a few days after the sprain when swelling decreases. The rheabilitation has 3 goals :

  1. Restore movement and flexibility

  2. Restore strength

  3. Restore balance

How to avoid a ankle sprain

It’s possible to use a brace to help prevent sprains. There are several types of neoprene or elastic materials. Here are some models on Amazon, click here .

Statistics

  • Ankle sprains are more common in all sport that involve cutting and pivoting

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Abs Stretching

abs stretching anatomy

What’s up ? This is THE stephane ANDRE ! I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Lying on your stomach on your hands with your arms extended :

  • Straighten up your chest slowly by tilting your head back slightly

  • Maintain this position for few seconds while breathing slowly to feel the stretching of your abs.

Variant

It’s possible to make this movement with your hands on a bench and your feet on the floor, or you’re lying on your back on a big ball (Swissball).

Note

Stretching of abs can be an important element in some sports like throwing sports, especially the javelin. In this type of sports, it’s essential to have good flexibility and a good abdominal amplitude to make the movement perfectly.

Attention

Abs stretching are to be avoided in case of lumbar pathology.

different pelvis position man woman anterior superior iliac spine pubic tubercle anatomy

abs pregnant woman child belly weight antomy

Note

The position tilted forward (anteversion) of women’s pelvis allows a portion of the child’s weight to be transferred to the abs. By analogy, abs muscles can be compared to a « hammock ».

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Adapt Your Training To Your Morphology (Part 1)

morphology

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

In bodybuilding, it’s really important to take into account individual morphological differences. Especially for squat and deadlift.

Squat and deadlift have a different muscular work for a brevilineal person and a rangy person

A brevilineal person has a proportionally long torso and short limbs. An rangy person has a proportionally short torso and long limbs. This has nothing to do with height, muscle development or adiposity. Which means that a person can be a small fat rangy or a tall skinny brevilineal.

A brevilineal person have facility for squat because their short femurs makes that the torso is little inclined. This limits lower back and hamstring tension. As a result, the movement can be done in relative safety and the brevilineal person can almost exclusively focus on quadriceps work. It’s for this reason that almost all squat champions are brevilineal. An impressive example is that usually dwarves monopolize podiums of small categories in powerlifting.

Rangy people have more difficulty to do squat because their long femurs makes that the torso is very inclined forward. This puts hamstrings, adductors and gracilis in a dangerous position. Rangy people must fight constantly to not be out of balance forward.

It’s also important to pay attention to the back’s position to avoid rounding the back. Having the round back causes serious spinal injuries like the famous herniated disc.

Rangy people doing this type of squat leaning forward works much muscles of gluteus maximus which have the function of straightening the pelvis, torso and all erectors spinae muscles that try their best to avoid the rounding of the back.

As a result, the squat for long limbs is excellent for developing powerful glutes and lumbar spine. On the other hand it requires a lot of concentration for the positioning of the body during the movement. It should be noted that more weights are heavy, the more dangerous the movement’s execution.

For rangy people who really want to work quadriceps, it’s advisable to use incline machine like « hack squat ».

Difficulties change side

change side

For brevilineal people who are the kings of squat, there is a reverse medal. They have a lot of trouble to do deadlift.

Brevilineal people with short legs should bend their legs to take the barbell. Sometimes their femurs are almost horizontal and this position requires a lot of energy to start the movement.

On the other hand, rangy people can take the barbell with their legs half bent. With this position, quadriceps can us the maximum energy to start the movement. The morphology of the rangy people allows them to lift heavier weights than brevilineal people despite a tilt of the gluteus and erectors spinae muscles

It’s for this reason that almost all of the deadlift champions are rangy people.

morphology brevilineal rangy

morphology deadlift

Ankles flexibility

ankle morphology

The ankles flexibility has a great influence on the squat’s execution.

Ankles flexibility may be influenced by musculotendinous limitation (such as significant calves retractions) or bone limitation. For example, if the dorsal flexion (the fact of raising forefoot) is limited, the squat technique is completely modified.

The lack of ankles flexibility limits the shifting of the shins forward and the advanced knees. This makes it necessary to squat with the buttocks very back and the back leaning forward, which has the effect of working intensely the gluteus maximus and the spine erectors muscles.

Squat with an excessive inclinaison of the torso put dangerously tension on the back muscles of the thighs, adductors magnus, gracilis and increase the risk of muscle tearing.

It should be added that the positioning of the femurs below the horizontal has the effect of rounding the back, which increases the risk of vertebral damage. This squat requires a lot of concentration for the positioning of the body during the movement because the more the weigh is heavy and more the movement’s execution is dangerous.

Be careful, whether for the squat or the deadlift, having stiff ankles make it difficult to flex our legs even if the femurs are horizontal.

morphology deadlift

Finally, the cantilevered that is more important for deadlift than squat, this is requires quadriceps to provide more strength to extend thighs on the legs.

To read Part 2, click here.

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-Steph