Difference between a Strain & Sprain explained

Simply put – you strain a muscle and you sprain a ligament.

Muscles have a large contractile function and are responsible for creating force and moving your skeleton. When a muscle is strained, most commonly, it means that you have torn a few fibres within the muscle. This means that those fibres are broken and need to heal; that the fibres immediately surrounding the torn ones will contract in an effort to protect the damaged area from further trauma; that the muscle as a whole is unable to work properly.

When you experience a muscle strain that muscle will then be painful to contract and to stretch. You should be able to use all the other muscles around it so you may still be able to move around. Depending on how many fibres you have damaged will determine how bad the strain is, and therefore how long it will take you to recover. It is important to protect a muscle strain in its initial stage of healing to prevent further damage and to allow it to heal at an optimal length. This means avoiding any painful contracting or stretching of th

at muscle for the first few days to weeks, depending on how bad the initial injury is. It is then important to gradually load the muscle back to full strength as it will be weak following the injury. Loading it too much or to soon could lead to further damage. Not loading it enough will leave residual weakness and leave you susceptible to reinjury in the future.

A ligament does not contract. It is responsible for holding a joint in place and runs from one bone to another. Typically, each ligament is designed to be strong in a certain direction to withstand any forces put on the joint in that direction, and to limit excessive movement. This ensures that when a muscle contracts it moves the skeleton in a specific, predictable direction. It also limits the amount of unnecessary compression or shearing forces going through the joint, to minimise wear a tear.

When a ligament is sprained it loses some of its tensile strength and becomes easier to stretch. This hurts, and it makes the joint less stable and the ligament susceptible to further injury. With a ligament sprain it is good to keep doing regular gentle range of movement exercises and static strengthening to help keep the muscles active to compensate for the ligament injury. Dependent on which ligament you injure and how bad it is you may benefit from some strapping or a brace to help support the joint whilst it heels. Once the ligament is more stable it is important to do some rehab exercises to get the joint strong and balanced again.

What is DOMS, am I injured?

DOMS stands for Delayed Onset Muscle Soreness, and it occurs as a result of exerting your muscles. When you do an activity that is new, or you are working harder or for longer than usual, the extra stress on the tissues of your body causes micro trauma. These are microscopic tears in the fibres and occur widespread throughout the muscle groups being used. This usually results in widespread soreness in one or multiple areas of your body 1-3 days after the activity, and the soreness can last quite a few days.

This is totally normal. As these tiny microscopic tears heal they create slightly stronger muscles. It is important that our muscles go through this process in order to allow us to adapt and change, so we get better able to withstand the stresses of a new task in the future. However, it is not possible to predict when DOMS will strike. Not everybody gets it and some people seem to suffer more than others.

As a general rule it is more likely when starting out doing exercise, when doing something new, or when working harder than normal. This means as you keep training it does get better, you won’t always feel like that after exercise. For some this is reassuring to know it is possible to exercise and not feel sore the next day, and for others a lack of DOMS means they are due an upgrade to their program and should be working harder!

Certain types of exercise are more likely to cause DOMS than others. Typically exercises with a high eccentric load are more likely to cause soreness. Eccentric is the lowering phase of a muscle (or the deceleration phase), for example when you bring the weight

back down towards your chest in a chest press.

This means that things like speed work, explosive/plyometric tasks, and repetitive high speed change of direction, all have a higher likelihood of causing soreness the next day. Clear examples of exercises with an eccentric focus would be jumping off of a box, or catching a heavy medicine ball. Generally exercises will always have an element of concentric and eccentric demands, with other muscles working isometrically to control the movement, but you can modify them to increase or decrease the bias accordingly. This knowledge can allow you to control the amount of soreness you are likely to have following exercise. This information is also useful if you do not like DOMS. Doing a graded program that starts with basic isometric and steady concentric exercises and builds up in intensity and speed of movements slowly is more suited to managing DOMS.

There have been lots of studies into what we can do to reduce the soreness that occurs after exercise. The majority of which have shown there is very little we can do to shorten the length of time the soreness lasts. But there are things that we can do to make sure it does not last longer than normal. These include basic things like keeping active and moving around lots despite the soreness, do not repeat a hard activity or workout that targets the same area until the soreness has calmed down, drink plenty of water and eat well, and use things that usually give you a feel good effect (such as a hot bath or some gentle stretches). Some people who are training hard and need to recover as quickly as possible could also look into using the Compex for improved recovery. You are able to hire a Compex unit from The Physio Clinic to try it out.

 

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It is possible to create too much DOMS. Sudden extreme exercise can cause Rhabdomyolysis. This is rare and unlikely but possible. It causes extreme levels of post exercise soreness, rigidity (loss of range of movement due to rigid muscles), lack of urine or urine that is very dark in colour, and this takes longer to recover from that just DOMS. It is due to excessive levels of microtrauma that results in high levels of creatine kinase in the blood and puts excessive stress on your kidneys.

Unlike DOMS, Rhabdomyolysis is a serious condition that requires medical attention. You need all the symptoms for it to be Rhabdomyolysis, if you are just excessively stiff and sore after exercise … you just have bad DOMS, plan better next time.

Do you Run carrying a water Bottle- why is this bad for your technique?

Arm swing is a vital part of running technique. Many running coaches say ‘you may run on your legs, but you run with your arms’. This is because the body is reliant on balanced alternate arm and leg movement across a diagonal to generate forward momentum efficiently. This opposite arm, opposite leg technique allows efficient creation and dissipation of force to and from the ground via the trun

k. How well you swing your arms will therefore have a direct impact on how well you run.

When you carry a water bottle in one hand you create an uneven distribution of weight across your trunk. You al

so create an uneven arm swing and excessive tension in your hand/forearm. The muscles that you use to grip are linked to the control muscles of the shoulder. This means that excessive gripping whilst running will hinder the freedom of swing at your shoulder, which can lead to all sorts of problems over time.

It is advised that you plan long runs to include strategic stops for water or carry a small specialised water backpack for even distribution of weight that will not affect your running gait.

Haile Gebrselassie was a prime example on how much carrying something in one hand can have a prolonged affect on your running style. He used to run 10km to school every day with his books under his arm. This became so engrained into his running pattern that it can still be spotted in his technique during competition videos. Obviously, he had m

any other factors that made him an outstanding distance runner, and these outweighed his slightly unconventional arm technique – it is not the answer to winning world championships! But it does prove that something you learn early on when starting an activity can become deeply engrained in your brains’ movement patterns and that it is very hard to unlearn.

Why do Runners not use their Glutes and what can they do about it

The biggest factor affecting anybody’s hips these days is sitting. We were not designed to sit in a chair and we certainly were not designed to stay there for long periods of time. Keeping your hip at 90 degrees and sitting on your butt holds the glutes in a lengthened position, this will cause them to find it harder to activate and over time can make them harder to recruit. This position also allows your hip flexors, the muscles in the front of your hips, to shorten.

Muscles work in pairs, so if your hip flexors are short and overactive they will also encourage your glutes to turn off. This is just one example of something that we do all the time that will have a direct impact on how well we recruit our glute muscles. If we do not spend enough time warming up prior to exercise and activation our glutes on purpose to overcome these effects then it will directly affect running technique.

See our other article on why the glutes are so important.

In runners the glutes are important in controlling the forces that go through your lower limb as it hits the ground. They play a big part in absorbing the impact from the floor and regenerating it into the next step

Running in particular does not actually do much to improve the glute function. Yet we know they are useful muscles in making you a more efficient runner. Run training typically just involves running, and many runners are guilty of not doing any conditioning outside of this. Running in straight lines will not greatly challenge the glutes or help them improve. To activate and strengthen glute muscles the best exercises revolve around twisting movements and moving sideways – this is because this creates a high demand on the right muscles.

What are the Glutes and why are they so important?

The glutes are a group of muscles around the back and side of your hip that make up your backside. They are responsible for creating some hip movements and for controlling your pelvis on your standing leg. There are 3 different glute muscles – glute maximus, glute medius and glute minimus – their names refer to their size.

The main hip movements they are responsible for are taking the leg out behind you, taking the leg out to the side, and turning the leg so the knee points out. They do also have other functional roles and are required for other more complex movements, and their role can vary slightly depending on what position the body is in to start with – but we’ll keep it simple.

Their role means they play a huge part in controlling the alignment of the lower limb when you land on it, and are a main generator of power in propelling you forwards over that leg. This makes them very useful for tasks such as running, jumping, stepping, lunging, squatting and getting up off the floor.

Glute max is the biggest of the group and is most responsible for generating power. It is responsible for strength and speed.

Glute med and Glute min are smaller and deeper muscles, they are designed to fine tune and control movements around the hip and pelvis.

They need to be able to pre-empt your next move and to have good endurance to ensure you can keep good form throughout periods of exercise.

Due to their complex role and to the affect they have on our efficiency and biomechanics the glutes are very often a key area to rehab to offload lower back and knee pain. When the glutes are not strong enough, or are not working optimally, the load that they are not controlling gets shifted to other areas of the body – such as the lower back and knees. Lower back pain and knee pain are the two most common things seen in a physiotherapy clinic and when both are reliant on a decent set of glutes it becomes a very common area addressed in rehab.

A test to try at home – stand in front of the mirror and relax, take a look at your knee caps in the mirror and see which way they point. Now try tensing your butt muscles – what happens to your knee caps? Then what happens when you totally relax your butt muscles?

This can be applied to things like squatting – if your knees roll in towards each other when you squat, try using your butt muscles to pull the knees out into better alignment. The knees should point in the same direction as your feet throughout the squat.

Also, if you lean forwards excessively through a squat movement, or only get a small way down before you feel like you’re going to topple over backwards – your glutes are not working properly.

Going to run a Marathon- Reasons to start your strength work now

When you’re doing a run training program and have several runs per week, some of which will be long and take hours out of your day, you will have less time to dedicate to strengthening. However, you need to be strong to be able to withstand the increasing demand of upping your mileage. Using your time wisely and getting into a strengthening program before you need to start thinking about how you are going to get the miles in is your safest bet.

The repetitive load of running and the increasing demand on your musculoskeletal system requires you to be nice and strong. It is not enough to think you can rely on gradually getting stronger as your miles rack up. A marathon program will push anyone to their limits and should be respected. It is specifically designed to challenge your stamina and endurance, because that is what most people will need to work on to get round. However it is not designed to build strength or power.

These are different, and require different types of training. Not many peoples’ bodies, or diaries, will be able to tolerate the demand of introducing both at the same time. That would be a prime recipe for injury. As is not doing strength training at all. The stronger the muscles are the better they are able to withstand the forces the body is put under when running. Sub optimal strength of the muscles will lead to excess stress on the joints and other soft tissues. These other tissues do not tolerate new stresses well and can quickly become painful when overloaded. They are also slower to recover and regenerate and can cause a considerable set back to your training if injured.

Getting a decent strength training program underway now will help to ensure you are up to the task of getting through your marathon training program. It gives the body a gradual ramp up of loading and a chance to get used to being under more physical stress. If you are a seasoned marathon runner who knows they have the miles in them then strength training will likely be the thing between you and a new PB for next season.

The key to successful rehab is consistency

A nice analogy that I have found useful when teaching someone to pace their training is to consider training load in terms of alcohol consumption…bear with me.

Imagine that you have been set a weekly target of drinking 14 pints of beer (or your favourite equivalent).

If you were to decide to drink all 14 of those pints on the first evening then you would end up very drunk and likely have a prolonged hangover that meant you didn’t feel like drinking for the rest of the week (or ever again). It would have also meant that after a certain amount of pints that evening you would have already been drunk and the rest of the pints were just pointless excess that are likely damaging.

If you decide to be a little more sensible and drink 7 pints on two evenings that week; the effects will be less dramatic than the first scenario but once again you were likely drinking in excess and would still have a hangover. If you continued to drink like this for too long you would cause your body harm.

The best way to succeed at this challenge, whilst giving your body a good chance to recover, would be to do 2 pints each day or a structured week of 4 days of 3 pints and 1 day of 2 pints with 2 rest days.

Shoulder Rehab

With this analogy the getting drunk from the effects of alcohol would be similar to the acute fatigue effects from exercise, and the hangover would be similar to the soreness and tissue healing that occurs after exercise.

Obviously, exercise is far better for you than beer and you should be doing the exercise version, not the drinking!

Once you have mastered the art of pacing exercise it is important to have a rehab schedule that is varied. This has 2 main benefits – it gives your body a good variety of exercise types to make sure you are covering all the bases, and it keeps it interesting for you.

The other aspect of consistency with rehab is keeping it up over a prolonged period. It takes time for tissues to adapt and muscles to strengthen. It takes 6-8 weeks of consistent exercise to build strength in your muscles, and even longer to get changes in your soft tissues and tendons. If you were to only stick at your rehab program for a few weeks and then find better things to do you would not have given your body a chance to adapt and benefit from the exercises you were doing.

Playing sports and even carrying out new or complex tasks in daily life requires skill. It is widely accepted that skills need to be developed and practised over time. Strength is also a skill, if you want to attain a high level of it, you need to do consistent practise, just like with anything else. We all go through phases where life seems to get in the way – but always remember “Something is always better than nothing”.

Rehab & Loading- The Traffic Light System Explained

Your body adapts to the loads that it is put under on a regular basis. This ensures that your tissues regenerate in response to the stresses exerted on them to enable them to withstand the stress better in the future. This is how we get stronger. When this process goes wrong we end up with a tissue in disrepair – an injury – commonly this is due to sudden unaccustomed increases in load without the appropriate time for recovery and regeneration of tissue.

The Traffic Light System:

This is a system we teach patients in order to help them monitor their return to activity and gauge their progress. It is hard to know how to manage a new injury and how far you should push yourself. Your body is designed to adapt and change in response to stress and sometimes it is OK to feel discomfort when returning to activity. It is your in-built ability to heal and recover that will then decide how quickly you can push things.

Green

  • Monitor your symptoms – pain, swelling and movement – these should be noted DURING exercise, LATER that day, and the next MORNING.
  • It is OK to feel some pain DURING when trying out something new, we normally say working up to 4 out of 10 pain is acceptable.
  • If you do not experience problems during exercise but are struggling LATER that day; this could be a sign you have overdone it a bit.
  • The key time to monitor your progress is the next MORNING. This is where the traffic lights come in…

GREEN LIGHT – no increase in symptoms – you are fine to do the same activity again or try a little bit more.

AMBER LIGHT – Some increase in symptoms but able to move normally within 1 hour AND back to normal within 24 hours – proceed with caution. Try the same activity again after 48 hours and do not progress it until you have achieved a green light.

Red Light– Big increase in pain and/or pain that does not settle within 24 hours – you have done too much, give it 48 hours rest, get moving gently and go easier next time.

Keeping a written training diary can help you to follow your progress and notice any reoccurring patterns to your symptoms.

We usually advised that when introducing new activities or increasing training you have two days of low load to follow to allow recovery time. Hard sessions should be on every 3rd day.

If you are unable to achieve GREEN LIGHTS when doing new activities then it is advisable to contact a physiotherapist.

Acupuncture vs Dry Needling- What’s the difference?

Acupuncture is the use of fine, flexible needles inserted into specific points of the body in order to stimulate the body’s natural healing. In many western circles the terms acupuncture and dry needling are interchangeable and are talking about the same thing, but their methodology and techniques are actually different.

The term acupuncture comes from ancient Chinese medicine and is most commonly referring to the use of needles to stimulate the energy pathways (meridians) of the body to restore balance (Qi). Dry needling is a western medical term for the use of needles, but they tend to be used to directly stimulate nerve endings in a certain area and are most commonly inserted directly into tight muscles. The term dry needling came about to differentiate between it and wet needling – which would be injection therapy.

DOMS

Am I Injured?

What is DOMS, am I injured?

DOMS stands for Delayed Onset Muscle Soreness, and it occurs as a result of exerting your muscles. When you do an activity that is new, or you are working harder or for longer than usual, the extra stress on the tissues of your body causes micro trauma. These are microscopic tears in the fibres and occur widespread throughout the muscle groups being used.

This usually results in widespread soreness in one or multiple areas of your body 1-3 days after the activity, and the soreness can last quite a few days. This is totally normal. As these tiny microscopic tears heal they create slightly stronger muscles. It is important that our muscles go through this process in order to allow us to adapt and change, so we get better able to withstand the stresses of a new task in the future.

However, it is not possible to predict when DOMS will strike. Not everybody gets it and some people seem to suffer more than others. As a general rule it is more likely when starting out doing exercise, when doing something new, or when working harder than normal. This means as you keep training it does get better, you won’t always feel like that after exercise. For some this is reassuring to know it is possible to exercise and not feel sore the next day, and for others a lack of DOMS means they are due an upgrade to their program and should be working harder!

Certain types of exercise are more likely to cause DOMS than others. Typically exercises with a high eccentric load are more likely to cause soreness. Eccentric is the lowering phase of a muscle (or the deceleration phase), for example when you bring the weight back down towards your chest in a chest press.

 

This means that things like speed work, explosive/plyometric tasks, and repetitive high speed change of direction, all have a higher likelihood of causing soreness the next day. Clear examples of exercises with an eccentric focus would be jumping off of a box, or catching a heavy medicine ball.

Generally exercises will always have an element of concentric and eccentric demands, with other muscles working isometrically to control the movement, but you can modify them to increase or decrease the bias accordingly. This knowledge can allow you to control the amount of soreness you are likely to have following exercise. This information is also useful if you do not like DOMS. Doing a graded program that starts with basic isometric and steady concentric exercises and builds up in intensity and speed of movements slowly is more suited to managing DOMS.

 

There have been lots of studies into what we can do to reduce the soreness that occurs after exercise. The majority of which have shown there is very little we can do to shorten the length of time the soreness lasts. But there are things that we can do to make sure it does not last longer than normal. These include basic things like keeping active and moving around lots despite the soreness, do not repeat a hard activity or workout that targets the same area until the soreness has calmed down, drink plenty of water and eat well, and use things that usually give you a feel good effect (such as a hot bath or some gentle stretches). Some people who are training hard and need to recover as quickly as possible could also look into using the Compex for improved recovery. You are able to hire a Compex unit from The Physio Clinic to try it out.

 

When DOMS goes too far:

It is possible to create too much DOMS. Sudden extreme exercise can cause Rhabdomyolysis. This is rare and unlikely but possible. It causes extreme levels of post exercise soreness, rigidity (loss of range of movement due to rigid muscles), lack of urine or urine that is very dark in colour, and this takes longer to recover from that just DOMS.

It is due to excessive levels of microtrauma that results in high levels of creatine kinase in the blood and puts excessive stress on your kidneys. Unlike DOMS, Rhabdomyolysis is a serious condition that requires medical attention.

You need all the symptoms for it to be Rhabdomyolysis, if you are just excessively stiff and sore after exercise … you just have bad DOMS, plan better next time.