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

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

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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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-Steph

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Knee Instability

knee anatomy

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

When the knee extended, external and internal lateral ligaments stretched and prevent rotation of the joint. Standing on one foot, knee wedged in extension, which means that there is no need for muscle action to stabilize the joint.

knee anatomy extension flexion

When the knee flexed, external and internal lateral ligaments relaxed. In this position, the joint only stabilized by the action of the muscles.

knee anatomy meniscus

In flexion-rotation of knee, meniscus moves forward on the side of rotation If the extension of the articulation which follow is poorly controlled, it may happen that meniscus doesn’t back in its place quickly enough. In this case, meniscus pinched between condyles and there may be a meniscal lesion. If during pinching, a small piece of meniscus has been cut, a surgical operation may be necessary to remove it.

knee anatomy meniscus ligament

During asymmetical exercise such as lunges (lunges and dumbbell lunges), it’s important to preserve the knee joint to control movement in speed and straightness to avoid any injuries.

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-Steph

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Seated Barbell Calf Raises

seated barbell calf raises

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

seated barbell calf raises

Sitting on a bench with a step under your forefeet. The barbell placed on the bottom of your thighs.

  • Do an extension of your feet

This exercise works mainly soleus. This muscle is part of the triceps surae and inserted above the knee’s joint, on tibia and fibula. It attached below to the calcaneus by the Achilles tendon. This muscle has the function of extending the ankles. The difference with the seated calf raises machine is that you can’t work with heavyweights. To have better results, it’s advisable to work with sets of 15 to 20 reps minimum.

Attention

If you have pain on thigh because of the barbell, you can use a towel or barbell pad.

Variant

You can do this exercise with the barbell without weights (the Olympic barbell weighs 20kg/44lbs) on a bench. In this case, it’s necessary to do sets with a lot of reps until the burning sensation,

triceps soleus muscles

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-Steph

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Seated Calf Raises

seated calf raises

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

Sitting on the machine with the bottom of your thighs under the pads. Your forefoot on the step with your ankles in passive flexion :

  • Do an extension of your feet

This exercise mainly works soleus (this muscle named like that because it looks like flat fish, the sole). This muscle inserted above the knee joint, on the tibia and fibula. And it’s also attached to the calcaneus by the Achilles tendon. The soleus has the function of extending the ankles.

muscle triceps surae

The flexed position of the knees relax gastrocnemius who are attached above the knee joints and below the Achilles tendon. In this position, they participate weakly in the extension of the feet.

muscle involve extension foot triceps surae
Although this is not their main function, these muscles are involved in the extension of the foot.

Variant

seated barbell calf raises

It’s possible to do this movement sitting on a bench with a step under your feet and a barbell on the bottom of your thighs. Use a towel or a barbell pad to have less pain on your thighs while performing the exercise.

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-Steph

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Adapt Your Training To Your Morphology (Part 2)

anatomy body squat morphology knee big belly

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

If you didn’t read Part 1, click here.

Legs

Improve your squat position

anatomy body squat morphology knee big belly

To reduce the lower back’s effort and limit the hamstrings tension, it’s possible to do like powerlifters by putting the barbell on posterior deltoids.

This technique decreases the cantilever and increases the power of lifting from the back. This allows you to lift heavier weights.

By using powerlifter of weightlifting shoes (solid raised heel) or a wedge under the heels, this reduces the cantilever by having the buttocks not too back by the advancing knees. This allows for greater amplitudes with the thighs flexion.

With that, we feel better the quadriceps work by limiting the torso’s inclinaison and the work of the gluteus maximus and spinal erectors.

The low barbell and raised heel combination allows you to lift heavier weights. This technique is recommended for rangy people and people with stiff ankles to correct their positioning at squat.

Front squat to target quadriceps

anatomy body squat morphology knee big belly

Front squat limits the torso’s inclinaison. This has the effect of reducing the work of the lower back, decrease the tension of hamstrings muscles and adductor magnus muscle.

On the other hand, front squat increases the cantilever, which forces quadriceps to make more effort to extend the thigh on the leg.

Which means it’s the perfect squat for thighs. But it’s not possible to lift heavyweights like the classic squat and it’s recommended to do it with heels elevated for better stability.

For rangy people, front squat is very hard to do. The torso of rangy people is more inclined, which make it more difficult to hold the barbell which may fall forward during the execution of the movement.

Spread the legs to less incline the torso

anatomy body squat morphology knee big belly

There is a squat’s technique to limit the torso’s inclination. This involves spreading the legs with the feet outward. Some powerlifters do this technique with the legs almost wide apart. With the legs apart, this limits the legs flexion.

To be able to squat with the legs apart, it’s necessary to have an adequate bone conformation of the hip joint and to be flexible of the thighs adductor muscle. Which means, it’s a technique that can’t be used by everyone.

The advantage of the big belly

anatomy body squat morphology knee big belly

Having a big belly for squat and deadlift allow to compress it against the thighs. This helps to limit the inclination of the torso and the back’s rounding. This has the effect of protecting the lower back and limiting the risk of herniated disc.

It’s for this reason that we can see a lot of heavyweight champion of powerlifting or weightlifting with a big belly. They take care to keep their belly fat with an excessively rich diet.

Different forms of knees

anatomy body squat morphology knee big belly

In bodybuilding, it’s important to take into account the different morphologies of the individual and especially for the knees.

Arched legs (genu varum) are not more risky than normal legs. For people with X legs (genu varum) or people who can overly extend the thighs (genu recurvatum), it’s often recommanded to not do leg exercises with very heavy weights.

Cases of genu valgum are often :

  • In people who were overweight during their youth when leg bones weren’t fully developed and still « malleable ». Legs are deformed because of the overload. Now, they have this X shape.

  • In women. The fact that women have wider hips to have children, this influences the femurs direction which are generally more inclined.

For people with genu valgum. If the genu valgum is to excessive, the joint would be overused. The medial collateral ligament would be extremely tense. The lateral meniscus, the articular surfaces coated with cartilage of the external condyle of the femur, and the external lateral tuberosity of the tibia would be subjected to excessive friction, which would cause pathologies of wear.

For people with genu recurvatum. These are people who are essentially very flexible named hyperlaxes or women whose muscular and ligamentous hyperlaxity is related to reproductive function.

Rarely pathological, knees with genu recurvatum can sometimes have some problems like the meniscus pinching. This can happen when the knees are rapidly expanding and the meniscus haven’t had enough time to slip, or during an exercise with a heavy weight that has forced the hyperextension of the thigh.

It’s for this reason that it’s recommended to people suffering from a genu recuvatum pathological never to totally block the knees at the end of extension to the squat or to the leg press.

Note

For 2 people who are the same size, it’s important to consider the torso-leg ratio.

anatomy body squat morphology knee big belly

Type A :

People with proportionally long legs and a short torso will have trouble doing a proper squat without tilting their torso excessively forward.

On the other hand, the short torso (which limits the cantilever) facilitates the execution of the good-morning, classic deadlift and Romanian deadlift.

Type B :

People with proportionally short legs and a long torso will have the facility to squat safety without tilting their torso excessively forward. It’s for this reason that the great champions of powerlifting squat specialist have this type of morphology.

Share this article if you think it can help someone you know. Thank you.

-Steph

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